Spinal Cerebrospinal Fluid Drainage for Prevention of Vasospasm in Aneurysmal Subarachnoid Hemorrhage: A Prospective Randomized Controlled Study

Introduction: Cerebral vasospasm following aneurysmal subarachnoid hemorrhage is a major cause of mortality and morbidity. Among various treatment options, lumbar cerebrospinal fluid drainage is an effective alternative to prevent cerebral vasospasm and its sequelae.

Material and Methods: Patients with aneurysmal SAH who met the inclusion criteria were randomized into two groups as follows: Group I (30 patients) underwent lumbar CSF drainage, and group II (30 patients) did not. Aneurysmal clipping was done in all patients. Both groups received standard neurosurgical treatment except for lumbar CSF drainage. The outcome was measured in terms of (1) clinically evident vasospasm, (2) vasospasm-related cerebral infarction, (3) condition of the patient at the time of discharge, and (4) GOS at 1 and 3 months follow-up.

Results: Lumbar CSF drainage conferred a statistically significant benefit, reducing the incidence of clinical vasospasm from 63% to 30% (P value = 0.01), and incidence of vasospasm-related cerebral infarction from 53% to 20% (P value = 0.007). Incidence of vasospasm was quantitatively lower in lumbar the CSF drainage group across all Hunt and Hess grades; however, it was statistically significant in SAH grade III (P value = 0.008). Mean duration of hospital stay was lower in group I; however, it did not reach statistical significance. Higher GOS was observed in group I at 1 and 3 months follow-up compared with group II.

Conclusion: Lumbar CSF drainage following aneurysmal SAH reduces the incidence of clinical and radiological vasospasm and its sequelae. It shortens overall duration of hospital stay and improves outcome.