Controlled drainage of lumbar cerebrospinal fluid for the management of increased intracranial pressure in patients with subarachnoid hemorrhage

• Published in: International Congress series 2002-12, Vol.1247, p.605-610
• Main Authors: Schmiedek, Peter, Bauhuf, Christian, Horn, Peter, Vajkoczy, Peter, Munch, Elke
• Format: Article
• Language: English
• Subjects: Intracranial pressure; Lumbar CSF drainage; Subarachnoid hemorrhage
• ISSN: 0531-5131; 1873-6157
• DOI: 10.1016/S0531-5131(02)01109-3

Intercranial hypertension represents a significant complication in patients with severe subarachnoid hemorrhage (SAH) from aneurysm rupture. In the acute state of SAH, increased intracranial pressure (ICP) is usually due to the direct effect of the initial hemorrhage. Over the following days, ICP may rise as a result of cerebral ischemia from developing vasospasm. Management protocols for intercranial hypertension include hyperventilation, use of mannitol ventricular cerebrospinal fluid (CSF) drainage, sedation, hypertonic saline, barbiturate coma, and decompressive surgery. In addition to these measures, we have introduced lumbar CSF drainage for the control of malignant hypertension over the last 3 years. A total of 21 patients included. All had SAH from ruptured aneurysm and underwent early surgery. Postoperative increase of ICP was treated according to a standard protocol. When all other measures had failed, lumbar CSF drainage was initiated under continuous ICP monitoring. In all patients, this resulted in an immediate decrease of ICP and an increase of cerebral perfusion pressure (CPP). Lumbar drainage was continued for a mean of 4.8 days, and without exception, resulted in lasting control of elevated ICP. In two patients with absent basal cisterns before treatment, transient herniation of the brain resulted from lumbar drainage. We conclude that controlled lumbar CSF drainage represents an effective method to control refractory intercranial hypertension in carefully selected patients.