Document Detail

The risk of rebleeding after external lumbar drainage in patients with untreated ruptured cerebral aneurysms.
MedLine Citation:
PMID:  16041467     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Does continuous external lumbar CSF drainage before aneurysm repair in patients with aneurysmal subarachnoid hemorrhage increase the risk of rebleeding? METHOD: The study population, consisting of 18 patients treated by External Lumbar Drainage (ELD) after SAH before aneurysm repair, was compared with an independent control group of 324 SAH patients treated in another clinic. Control patients were selected for not being treated for the ruptured aneurysm yet and not having undergone any form of CSF drainage during the exposure time in the case patients. We calculated hazard ratios with the Cox regression model, adjusted for age and clinical condition on admission and hydrocephalus. FINDINGS: The cox regression analysis shows a non-adjusted hazard ratio of 2.1 (95% CI 0.8 to 5.3) in the model with 5 rebleedings in 18 patients. Adjustment for age, clinical condition on admission and hydrocephalus did not alter the hazard ratio estimate importantly in either analyses. CONCLUSIONS: An increased risk of rebleeding by external lumbar drainage in the acute phase after aneurysmal SAH could not be confirmed, but the data are too imprecise to rule out an increased risk. The potential benefits of early drainage should be weighed against the risks if the aneurysm is not occluded before or early after the start of drainage.
A C J Ruijs; C M F Dirven; A Algra; I Beijer; W P Vandertop; G Rinkel
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Publication Detail:
Type:  Journal Article     Date:  2005-07-25
Journal Detail:
Title:  Acta neurochirurgica     Volume:  147     ISSN:  0001-6268     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-10-17     Completed Date:  2006-10-04     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  1157-61; discussion 1161-2     Citation Subset:  IM    
Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Age Factors
Cerebrospinal Fluid Shunts / adverse effects
Disease Progression
Early Diagnosis
Hydrocephalus / etiology*,  physiopathology,  surgery*
Intracranial Aneurysm / complications*,  physiopathology
Intracranial Hypertension / physiopathology,  prevention & control,  therapy
Middle Aged
Recurrence / prevention & control
Regression Analysis
Risk Factors
Rupture, Spontaneous
Spinal Puncture / adverse effects*
Subarachnoid Hemorrhage / complications*,  physiopathology
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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