Efficacy and Safety of Lumbar Drainage before Endovascular Treatment for Ruptured Intracranial Aneurysms

Toshitsugu Terakado; Yoshiro Ito; Koji Hirata; Masayuki Sato; Tomoji Takigawa; Aiki Marushima; Mikito Hayakawa; Wataro Tsuruta; Noriyuki Kato; Yasunobu Nakai; Kensuke Suzuki; Yuji Matsumaru; Eiichi Ishikawa

doi:10.5797/jnet.oa.2023-0069

Efficacy and Safety of Lumbar Drainage before Endovascular Treatment for Ruptured Intracranial Aneurysms

J Neuroendovasc Ther. 2024;18(2):29-36. doi: 10.5797/jnet.oa.2023-0069. Epub 2024 Jan 13.

Authors

Toshitsugu Terakado^{1

2}, Yoshiro Ito³, Koji Hirata⁴, Masayuki Sato³, Tomoji Takigawa⁵, Aiki Marushima³, Mikito Hayakawa⁴, Wataro Tsuruta⁶, Noriyuki Kato⁷, Yasunobu Nakai¹, Kensuke Suzuki⁵, Yuji Matsumaru^{3

4}, Eiichi Ishikawa³

Affiliations

¹ Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.
² Department of Neurosurgery, Koyama Memorial Hospital, Kashima, Ibaraki, Japan.
³ Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
⁴ Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
⁵ Department of Neurosurgery, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan.
⁶ Department of Neuro-Endovascular Therapy, Toranomon Hospital, Tokyo, Japan.
⁷ Department of Neurosurgery, National Hospital Organization Mito Medical Center, Higashi-Ibaraki, Ibaraki, Japan.

Abstract

Objective: Intraoperative rebleeding during endovascular treatment for ruptured intracranial aneurysms is associated with poor prognosis. Lumbar drainage is performed preoperatively to control intracranial pressure; however, it is associated with a risk of brain herniation or rebleeding because intracranial pressure may change rapidly. Therefore, this study aimed to examine the efficacy and safety of preoperative lumbar drainage.

Methods: This retrospective study enrolled 375 patients who underwent endovascular treatment of ruptured intracranial aneurysms at our institution between April 2013 and March 2018. The incidence of rebleeding and clinical outcomes were compared between patients who did and did not undergo preoperative lumbar drainage.

Results: Among the 375 patients with ruptured intracranial aneurysms, 324 (86.0%) and 51 (14.0%) patients did and did not undergo lumbar drainage, respectively. The incidence of rebleeding was 11/324 (3.4%) and 2/51 (3.9%) in lumbar drainage and nonlumbar drainage groups, respectively, with no statistical differences (p = 0.98). Of the rebleeding cases, 9/11 (81%) and 2/2 (100%) in lumbar drainage and nonlumbar drainage groups, respectively, were due to intraoperative bleeding, and 2/11 (19%) in the lumbar drainage group, the causes of the rebleeding were undetermined. The incidence of symptomatic vasospasm did not differ significantly between the groups (13.2% vs. 11.8%, P = 0.776), while the incidence of hydrocephalus (24.6% vs. 11.8%, P = 0.043) and meningitis (15.2% vs. 5.9%, P = 0.075) were slightly higher in the lumbar drainage group. Favorable clinical outcomes (modified Rankin Scale score <2) at discharge were less frequent in the lumbar drainage group (55.3% vs. 70.0%, P = 0.051). No significant differences were observed in the propensity score-matched analysis.

Conclusion: Lumbar drainage before endovascular treatment for ruptured intracranial aneurysms is a safe procedure that does not increase the incidence of rebleeding.

Keywords: cerebrospinal fluid; drainage; endovascular procedures; subarachnoid hemorrhage.