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.	黄琦, 蒋晓星, 王伟民. 腰大池穿刺持续引流的临床应用及现状[J]. 中国微侵袭神经外科杂志, 2003, 8(12):571-573.
9.	刘文君, 彭林, 黄传平, 等. 外伤性蛛网膜下腔出血行腰大池持续外引流的疗效分析[J]. 中国微侵袭神经外科杂志, 2004, 9(1):41-42.
10.	李扬, 马晓东, 任贺成, 等. 腰大池引流治疗术后颅内感染及脑脊液漏[J]. 中国临床神经外科杂志, 2008, 13(5):282-284.
11.	中华医学会, 中华神经外科学会. 各类脑血管疾病的诊断要点[J]. 中华神经外科杂志, 1997, 13(1):3-5.
12.	万里姝, 刘宏奇, 徐辉, 等. 持续腰池脑脊液引流治疗蛛网膜下腔出血的临床观察[J]. 中国现代医学杂志, 2004, 14(1):94-96.
13.	刘政委, 孔文龙, 石小峰, 等. 腰大池持续外引流合并鞘内注射尿激酶治疗脑血管痉挛的临床效果[J]. 热带医学杂志, 2012, 12(1):45-46, 59.
14.	孙文才. 脑脊液腰大池引流治疗创伤性蛛网膜下腔出血的临床分析[J]. 齐齐哈尔医学院学报, 2008, 29(22):2691-2693.
15.	孟波, 李自然, 岳炫烨. 腰大池脑脊液持续引流治疗对蛛网膜下腔出血的预后分析[J]. 中国实用神经疾病杂志, 2007, 10(1):40-42.
16.	张宁. 控制性腰大池引流用于治疗蛛网膜下腔出血临床观察[J]. 包头医学院学报, 2008, 24(2):186-187.
17.	张建岭, 杜林娜, 任卫东. 持续腰池引流加亚冬眠疗法治疗蛛网膜下腔出血的临床疗效观察[J]. 河北北方学院学报:医学版, 2006, 23(5):42-43.
18.	张旭, 张可帅. 腰大池引流在外伤性蛛网膜下腔出血治疗中的临床应用[J]. 中国医学工程, 2012, 20(10):111.
19.	李惠珍, 崔兆文, 单睿君, 等. 腰终池持续引流治疗蛛网膜下腔出血临床研究[J]. 张家口医学院学报, 2003, 20(4):23-24.
20.	李艳春, 张国利, 胡继实, 等. 腰大池持续引流脑脊液治疗自发性蛛网膜下腔出血36例临床体会[J]. 医学临床研究, 2005, 22(4):548-549.
21.	杨金福, 廖达光, 张天一, 等. 创伤性蛛网膜下腔出血患者血浆NPY水平变化及腰大池持续引流干预研究[J]. 中国现代医学杂志, 2007, 17(11):1361-1364.
22.	盛汉松, 张弩, 王怀瓯, 等. 持续腰大池引流治疗外伤性蛛网膜下腔出血[J]. 浙江创伤外科, 2009, 14(6):569.
23.	覃远生, 冯丽华. 腰大池微创持续脑脊液引流治疗蛛网膜下腔出血[J]. 广西医科大学学报, 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.	Fülöp 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. 黄琦, 蒋晓星, 王伟民. 腰大池穿刺持续引流的临床应用及现状[J]. 中国微侵袭神经外科杂志, 2003, 8(12):571-573.
9. 刘文君, 彭林, 黄传平, 等. 外伤性蛛网膜下腔出血行腰大池持续外引流的疗效分析[J]. 中国微侵袭神经外科杂志, 2004, 9(1):41-42.
10. 李扬, 马晓东, 任贺成, 等. 腰大池引流治疗术后颅内感染及脑脊液漏[J]. 中国临床神经外科杂志, 2008, 13(5):282-284.
11. 中华医学会, 中华神经外科学会. 各类脑血管疾病的诊断要点[J]. 中华神经外科杂志, 1997, 13(1):3-5.
12. 万里姝, 刘宏奇, 徐辉, 等. 持续腰池脑脊液引流治疗蛛网膜下腔出血的临床观察[J]. 中国现代医学杂志, 2004, 14(1):94-96.
13. 刘政委, 孔文龙, 石小峰, 等. 腰大池持续外引流合并鞘内注射尿激酶治疗脑血管痉挛的临床效果[J]. 热带医学杂志, 2012, 12(1):45-46, 59.
14. 孙文才. 脑脊液腰大池引流治疗创伤性蛛网膜下腔出血的临床分析[J]. 齐齐哈尔医学院学报, 2008, 29(22):2691-2693.
15. 孟波, 李自然, 岳炫烨. 腰大池脑脊液持续引流治疗对蛛网膜下腔出血的预后分析[J]. 中国实用神经疾病杂志, 2007, 10(1):40-42.
16. 张宁. 控制性腰大池引流用于治疗蛛网膜下腔出血临床观察[J]. 包头医学院学报, 2008, 24(2):186-187.
17. 张建岭, 杜林娜, 任卫东. 持续腰池引流加亚冬眠疗法治疗蛛网膜下腔出血的临床疗效观察[J]. 河北北方学院学报:医学版, 2006, 23(5):42-43.
18. 张旭, 张可帅. 腰大池引流在外伤性蛛网膜下腔出血治疗中的临床应用[J]. 中国医学工程, 2012, 20(10):111.
19. 李惠珍, 崔兆文, 单睿君, 等. 腰终池持续引流治疗蛛网膜下腔出血临床研究[J]. 张家口医学院学报, 2003, 20(4):23-24.
20. 李艳春, 张国利, 胡继实, 等. 腰大池持续引流脑脊液治疗自发性蛛网膜下腔出血36例临床体会[J]. 医学临床研究, 2005, 22(4):548-549.
21. 杨金福, 廖达光, 张天一, 等. 创伤性蛛网膜下腔出血患者血浆NPY水平变化及腰大池持续引流干预研究[J]. 中国现代医学杂志, 2007, 17(11):1361-1364.
22. 盛汉松, 张弩, 王怀瓯, 等. 持续腰大池引流治疗外伤性蛛网膜下腔出血[J]. 浙江创伤外科, 2009, 14(6):569.
23. 覃远生, 冯丽华. 腰大池微创持续脑脊液引流治疗蛛网膜下腔出血[J]. 广西医科大学学报, 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. Fülöp 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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