A Randomized Clinical Study to Assess the Effectiveness of Lumbar Cerebrospinal Fluid Drainage (LCSFD) for Prevention of Cerebral Vasospasm and its Sequelae

Description

Abstract (English)

Aim: The aim of the present study was to evaluate the effectiveness of lumbar cerebrospinal fluid drainage
(LCSFD) for prevention of cerebral vasospasm and its sequelae.
Methods: This was a prospective, randomized control trial conducted at Department of Neurosurgery for 12
months . Patients of aneurysmal SAH (Hunt and Hess Grade II–IV) and 50 patients met the inclusion criteria
and were randomly allocated to one of the two groups – thirty patients in Group I and thirty patients in Group II.
Results: There were 25 patients in each group. Both groups were matched with respect to age, sex, GCS on
admission, and SAH grade at admission. Clinical evidence of vasospasm and rising TCD velocities suggestive
of vasospasm developed in 28% (7/25) patients in LCSFD group compared to 64% (16/25) patients in nonLCSFD group and this difference was found statistically significant (P = 0.01). Although more number of
patients in Group II developed hemiparesis was more due to vasospasm compared to Group I, this difference
was not found to be statistically significant. The patient outcome as quantified by GOS at the time of discharge
was better in LCSFD group (median GOS = 4) as compared to non-LCSFD group (median GOS = 3) and this
difference was found to be statistically significant (P = 0.01). Median GOS at 1- and 3-month follow-up was 5
in Group I compared to 4 in Group II and this difference was statistically significant (P = 0.04).
Conclusion: This study has demonstrated the efficacy of LCSFD to significantly reduce clinical vasospasm and
vasospasm‑related cerebral infarction in patients with aneurysmal SAH, thereby contributing to a better
outcome. Lumbar CSF drainage is believed to decrease cerebral vasospasm by promoting circulation of CSF
and clearance of blood from the subarachnoid spaces.