Lee, Keng Siang;
Chari, Aswin;
Motiwala, Mustafa;
Khan, Nickalus R;
Arthur, Adam S;
Lawton, Michael T;
(2024)
Effectiveness of Cerebrospinal Fluid Lumbar Drainage Among Patients with Aneurysmal Subarachnoid Hemorrhage: An Updated Systematic Review and Meta-Analysis.
World Neurosurgery
10.1016/j.wneu.2024.01.062.
(In press).
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Abstract
INTRODUCTION: Cerebral vasospasm in patients after aneurysmal subarachnoid hemorrhage (aSAH) continues to be a major source of morbidity despite significant clinical and basic science research. The removal of blood and its degradation products from the subarachnoid space of blood through prophylactic lumbar drainage (LD) is a favorable option. However, several studies have delivered conflicting conclusions on its efficacy post-aSAH. METHODS: Systematic searches of Medline, Embase and Cochrane Central were performed. The primary outcome was good functional outcome (modified Rankin Scale [mRS] with scores 0-2). Secondary outcomes included symptomatic vasospasm, secondary cerebral infarction and mortality. RESULTS: 14 studies reporting 2473 patients with aSAH were included in the meta-analysis. Compared with the non-LD group, there were no significant difference in rates of good functional outcomes in the LD group at discharge - 1 month (RR=1.28, 95%CI: 0.64;2.58) and 6 months (RR=1.12, 95%CI:0.97;1.41). These findings were consistent in subgroup analyses of only randomized controlled trials (RCTs) or observational studies. LD was associated with lower rates of symptomatic vasospasm (RR=0.61, 95%CI: 0.48;0.77), secondary cerebral infarction (RR=0.59, 95%CI:0.45;0.79) and mortality at discharge - 1 month (RR=0.58, 95%CI:0.41;0.82). The effect on mortality diminishes at 6 months (RR=0.70, 95%CI: 0.34;1.45). However, when analysing only RCTs, the benefit of LD on lower rates of mortality continued even at 6 months (RR=0.75, 95%CI:0.58;0.99). CONCLUSIONS: In aSAH patients, the use of LD is associated with benefits in of rates of vasospasm, secondary cerebral infarctions, and mortality without an increased risk of adverse events.
| Type: | Article |
|---|---|
| Title: | Effectiveness of Cerebrospinal Fluid Lumbar Drainage Among Patients with Aneurysmal Subarachnoid Hemorrhage: An Updated Systematic Review and Meta-Analysis |
| Location: | United States |
| DOI: | 10.1016/j.wneu.2024.01.062 |
| Publisher version: | https://doi.org/10.1016/j.wneu.2024.01.062 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | aneurysm, cerebrospinal fluid drainage, ischemia, lumbar drain, meta-analysis, subarachnoid hemorrhage, vasospasm |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10186721 |
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