Continuous Lumbar Drainage for Subarachnoid Hemorrhage: A Systematic Review_West China Medical Journal

Authors：

 XIONGJing , RAOChun-guang , WANGQian , XUEXiu-yun ,  TIANYe

Department of Neurology, Xi'an Central Hospital Affiliated to Xi'an Jiantong University, Xi'an, Shaanxi 710061, P. R. China;

Corresponding?author：

TIANYe, Email: chhty@sina.com

Keywords：

Subarachnoid hemorrhage; Continuous lumbar drainage; Systematic review

DOI：

10.7507/1002-0179.20150127

Video：

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Objective To assess the effectiveness and safety of continuous lumbar drainage of cerebrospinal fluid for subarachnoid hemorrhage (SAH). Methods The Cochrane Library (January 1992 to May 2013), Medline (January 1950 to May 2013), SinoMed (January 1979 to May 2013), CNKI (January 1979 to May 2013), and Wanfang Database (January 1979 to May 2013) were searched for randomized controlled trials (RCTs) on continuous lumbar drainage for SAH. The method of Cochrane systematic review was used to evaluate all the included RCTs. Results Twelve RCTs (857 patients) met the inclusion criteria, but the general methodological quality of trials was poor. Only two studies addressed the outcomes about SAH patients' death, vegetative state or disability and other adverse events at the end of the follow-up period (at least 3 months). Meta-analysis of fatality showed a better effect of lumbar continuous drainage of the cerebrospinal fluid for SAH than the control group with statistical significance [RR=0.27, 95%CI (0.12, 0.59), P=0.001]. Meta-analysis of complications also showed a better effect of lumbar continuous drainage of the cerebrospinal fluid for SAH than the control group with statistical significance (except re-bleeding) [cerebral vasospasm: RR=0.20, 95%CI (0.14, 0.30), P<0.000 01; hydrocephalus: RR=0.24, 95%CI (0.13, 0.41), P<0.000 01; cerebral infarction: RR=0.27, 95%CI (0.16, 0.45), P<0.000 01]. Only one trial reported the adverse events of lumbar continuous drainage of the cerebrospinal fluid including intracranial infection and intracranial hypotension reaction, while the others did not report the adverse events. Conclusion With poor quality of the most included trials, insufficient evidence is obtained to support the conclusion that lumbar continuous drainage of the cerebrospinal fluid is safe and effective in the treatment of SAH. Further high-quality RCTs should be carried out to provide more reliable evidences.

Citation： XIONGJing, RAOChun-guang, WANGQian, XUEXiu-yun, TIANYe. Continuous Lumbar Drainage for Subarachnoid Hemorrhage: A Systematic Review. West China Medical Journal, 2015, 30(3): 438-446. doi: 10.7507/1002-0179.20150127 Copy

1.	Anderson C, Anderson N, Bonita R, et al. Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand:incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS)[J]. Stroke, 2000, 31(8):1843-1850.
2.	Linn F, Rinkel G, Algra A, et al. Incidence of subarachnoid hemorrhage:role of region, year, and rate of computed tomography:a meta-analysis[J]. Stroke, 1996(27):625-629.
3.	Van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage[J]. Lancet, 2007, 369(9558):306-318.
4.	Hop JW, Rinkel GJ, Algra A, et al. Case-fatality rates and functional outcome after subarachnoid hemorrhage:a systematic review[J]. Stroke, 1997, 28(3):660-664.
5.	Stegmayr B, Eriksson M, Asplund K. Declining mortality from subarachnoid hemorrhage:changes in incidence and case fatality from 1985 through 2000[J]. Stroke, 2004, 35(9):2059-2063.
6.	Huang J, Van Gelder JM. The probability of sudden death from rupture of intracranial aneurysms:a meta-analysis[J]. Neurosurgery, 2002, 51(5):1101-1107.
7.	Munch EC, Bauhuf C, Horn P, et al. Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage[J]. Crit Care Med, 2001, 29(5):976-981.
8.	黃琦, 蔣曉星, 王偉民. 腰大池穿刺持續引流的臨床應用及現狀[J]. 中國微侵襲神經外科雜志, 2003, 8(12):571-573.
9.	劉文君, 彭林, 黃傳平, 等. 外傷性蛛網膜下腔出血行腰大池持續外引流的療效分析[J]. 中國微侵襲神經外科雜志, 2004, 9(1):41-42.
10.	李揚, 馬曉東, 任賀成, 等. 腰大池引流治療術后顱內感染及腦脊液漏[J]. 中國臨床神經外科雜志, 2008, 13(5):282-284.
11.	中華醫學會, 中華神經外科學會. 各類腦血管疾病的診斷要點[J]. 中華神經外科雜志, 1997, 13(1):3-5.
12.	萬里姝, 劉宏奇, 徐輝, 等. 持續腰池腦脊液引流治療蛛網膜下腔出血的臨床觀察[J]. 中國現代醫學雜志, 2004, 14(1):94-96.
13.	劉政委, 孔文龍, 石小峰, 等. 腰大池持續外引流合并鞘內注射尿激酶治療腦血管痙攣的臨床效果[J]. 熱帶醫學雜志, 2012, 12(1):45-46, 59.
14.	孫文才. 腦脊液腰大池引流治療創傷性蛛網膜下腔出血的臨床分析[J]. 齊齊哈爾醫學院學報, 2008, 29(22):2691-2693.
15.	孟波, 李自然, 岳炫燁. 腰大池腦脊液持續引流治療對蛛網膜下腔出血的預后分析[J]. 中國實用神經疾病雜志, 2007, 10(1):40-42.
16.	張寧. 控制性腰大池引流用于治療蛛網膜下腔出血臨床觀察[J]. 包頭醫學院學報, 2008, 24(2):186-187.
17.	張建嶺, 杜林娜, 任衛東. 持續腰池引流加亞冬眠療法治療蛛網膜下腔出血的臨床療效觀察[J]. 河北北方學院學報:醫學版, 2006, 23(5):42-43.
18.	張旭, 張可帥. 腰大池引流在外傷性蛛網膜下腔出血治療中的臨床應用[J]. 中國醫學工程, 2012, 20(10):111.
19.	李惠珍, 崔兆文, 單睿君, 等. 腰終池持續引流治療蛛網膜下腔出血臨床研究[J]. 張家口醫學院學報, 2003, 20(4):23-24.
20.	李艷春, 張國利, 胡繼實, 等. 腰大池持續引流腦脊液治療自發性蛛網膜下腔出血36例臨床體會[J]. 醫學臨床研究, 2005, 22(4):548-549.
21.	楊金福, 廖達光, 張天一, 等. 創傷性蛛網膜下腔出血患者血漿NPY水平變化及腰大池持續引流干預研究[J]. 中國現代醫學雜志, 2007, 17(11):1361-1364.
22.	盛漢松, 張弩, 王懷甌, 等. 持續腰大池引流治療外傷性蛛網膜下腔出血[J]. 浙江創傷外科, 2009, 14(6):569.
23.	覃遠生, 馮麗華. 腰大池微創持續腦脊液引流治療蛛網膜下腔出血[J]. 廣西醫科大學學報, 2005, 22(4):541-542.
24.	Profeta G, de Falco R, Profeta L, et al. Reasons against lumbarpuncture diagnosis with cerebrospinal fluid drainage insubarachnoid hemorrhage[J]. Minerva Anestesiol, 1998, 64(4):137-139.
25.	Staykov D, Schwab S. Clearing bloody cerebrospinal fluid:clot lysis, neuroendoscopy and lumbar drainage[J]. Curr Opin Crit Care, 2013, 19(2):92-100.
26.	Maeda Y, Shirao S, Yoneda H, et al. Comparison of lumbar drainage and external ventricular drainage for clearance of subarachnoid clots after Guglielmi detachable coil embolization for aneurysmal subarachnoid hemorrhage[J]. Clin Neurol Neurosurg, 2013, 115(7):965-970.
27.	Fül?p B, Deak G, Mencser Z, et al. Factors affecting the development of chronic hydrocephalus following subarachnoid hemorrhage, with special emphasis on the role of ventricular and lumbar drainage[J]. Ideggyógyászati Szemle, 2009, 62(7/8):255-261.
28.	Tuettenberg J, Czabanka M, Horn P, et al. Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure[J]. J Neurosurg, 2009, 110(6):1200-1208.

1. Anderson C, Anderson N, Bonita R, et al. Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand:incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS)[J]. Stroke, 2000, 31(8):1843-1850.
2. Linn F, Rinkel G, Algra A, et al. Incidence of subarachnoid hemorrhage:role of region, year, and rate of computed tomography:a meta-analysis[J]. Stroke, 1996(27):625-629.
3. Van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage[J]. Lancet, 2007, 369(9558):306-318.
4. Hop JW, Rinkel GJ, Algra A, et al. Case-fatality rates and functional outcome after subarachnoid hemorrhage:a systematic review[J]. Stroke, 1997, 28(3):660-664.
5. Stegmayr B, Eriksson M, Asplund K. Declining mortality from subarachnoid hemorrhage:changes in incidence and case fatality from 1985 through 2000[J]. Stroke, 2004, 35(9):2059-2063.
6. Huang J, Van Gelder JM. The probability of sudden death from rupture of intracranial aneurysms:a meta-analysis[J]. Neurosurgery, 2002, 51(5):1101-1107.
7. Munch EC, Bauhuf C, Horn P, et al. Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage[J]. Crit Care Med, 2001, 29(5):976-981.
8. 黃琦, 蔣曉星, 王偉民. 腰大池穿刺持續引流的臨床應用及現狀[J]. 中國微侵襲神經外科雜志, 2003, 8(12):571-573.
9. 劉文君, 彭林, 黃傳平, 等. 外傷性蛛網膜下腔出血行腰大池持續外引流的療效分析[J]. 中國微侵襲神經外科雜志, 2004, 9(1):41-42.
10. 李揚, 馬曉東, 任賀成, 等. 腰大池引流治療術后顱內感染及腦脊液漏[J]. 中國臨床神經外科雜志, 2008, 13(5):282-284.
11. 中華醫學會, 中華神經外科學會. 各類腦血管疾病的診斷要點[J]. 中華神經外科雜志, 1997, 13(1):3-5.
12. 萬里姝, 劉宏奇, 徐輝, 等. 持續腰池腦脊液引流治療蛛網膜下腔出血的臨床觀察[J]. 中國現代醫學雜志, 2004, 14(1):94-96.
13. 劉政委, 孔文龍, 石小峰, 等. 腰大池持續外引流合并鞘內注射尿激酶治療腦血管痙攣的臨床效果[J]. 熱帶醫學雜志, 2012, 12(1):45-46, 59.
14. 孫文才. 腦脊液腰大池引流治療創傷性蛛網膜下腔出血的臨床分析[J]. 齊齊哈爾醫學院學報, 2008, 29(22):2691-2693.
15. 孟波, 李自然, 岳炫燁. 腰大池腦脊液持續引流治療對蛛網膜下腔出血的預后分析[J]. 中國實用神經疾病雜志, 2007, 10(1):40-42.
16. 張寧. 控制性腰大池引流用于治療蛛網膜下腔出血臨床觀察[J]. 包頭醫學院學報, 2008, 24(2):186-187.
17. 張建嶺, 杜林娜, 任衛東. 持續腰池引流加亞冬眠療法治療蛛網膜下腔出血的臨床療效觀察[J]. 河北北方學院學報:醫學版, 2006, 23(5):42-43.
18. 張旭, 張可帥. 腰大池引流在外傷性蛛網膜下腔出血治療中的臨床應用[J]. 中國醫學工程, 2012, 20(10):111.
19. 李惠珍, 崔兆文, 單睿君, 等. 腰終池持續引流治療蛛網膜下腔出血臨床研究[J]. 張家口醫學院學報, 2003, 20(4):23-24.
20. 李艷春, 張國利, 胡繼實, 等. 腰大池持續引流腦脊液治療自發性蛛網膜下腔出血36例臨床體會[J]. 醫學臨床研究, 2005, 22(4):548-549.
21. 楊金福, 廖達光, 張天一, 等. 創傷性蛛網膜下腔出血患者血漿NPY水平變化及腰大池持續引流干預研究[J]. 中國現代醫學雜志, 2007, 17(11):1361-1364.
22. 盛漢松, 張弩, 王懷甌, 等. 持續腰大池引流治療外傷性蛛網膜下腔出血[J]. 浙江創傷外科, 2009, 14(6):569.
23. 覃遠生, 馮麗華. 腰大池微創持續腦脊液引流治療蛛網膜下腔出血[J]. 廣西醫科大學學報, 2005, 22(4):541-542.
24. Profeta G, de Falco R, Profeta L, et al. Reasons against lumbarpuncture diagnosis with cerebrospinal fluid drainage insubarachnoid hemorrhage[J]. Minerva Anestesiol, 1998, 64(4):137-139.
25. Staykov D, Schwab S. Clearing bloody cerebrospinal fluid:clot lysis, neuroendoscopy and lumbar drainage[J]. Curr Opin Crit Care, 2013, 19(2):92-100.
26. Maeda Y, Shirao S, Yoneda H, et al. Comparison of lumbar drainage and external ventricular drainage for clearance of subarachnoid clots after Guglielmi detachable coil embolization for aneurysmal subarachnoid hemorrhage[J]. Clin Neurol Neurosurg, 2013, 115(7):965-970.
27. Fül?p B, Deak G, Mencser Z, et al. Factors affecting the development of chronic hydrocephalus following subarachnoid hemorrhage, with special emphasis on the role of ventricular and lumbar drainage[J]. Ideggyógyászati Szemle, 2009, 62(7/8):255-261.
28. Tuettenberg J, Czabanka M, Horn P, et al. Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure[J]. J Neurosurg, 2009, 110(6):1200-1208.

West China Medical Journal

Continuous Lumbar Drainage for Subarachnoid Hemorrhage: A Systematic Review

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