Effect of continuous cisternal drainage on cerebral vasospasm.

Abstract

The effect of continuous cisternal drainage on cerebral vasospasm was studied under strict criteria in 140 patients with ruptured intracranial aneurysms. The degree of subarachnoid haemorrhage (SAH) on the computed tomography scan was graded from I to IV. The patients were classified according to the total amount of cisternal drainage into three groups, regardless of the duration of the drainage and whether or not it was accompanied by irrigation; i.e., those with less than 500 mL (group 1: 57 cases), those with 500-3000 mL (group 2: 44 cases), and those with 3000-9500 mL (group 3: 39 cases). While correlations could be found between both clinical and SAH grades with the severity of vasospasm, closer correlation could be found in the SAH grades. In analyzing the cases with subarachnoid haemorrhage grades III-IV (severe clots), the angiographic vasospasm was less severe in groups 2 and 3 than in group 1, and the incidences of permanent symptomatic vasospasm and low-density area on computed tomography were lower in groups 2 and 3 than in group 1. Regarding the surgical outcome in cases with SAH grades III-IV, the mortality rate was lower in groups 2 and 3 (22% and 19%) than in group 1 (33%). Further, the rate of good recovery was higher in groups 2 and 3 (61% and 57%) than in group 1 (28%). However, there were no differences between groups 2 and 3 in cerebral vasospasm or in surgical outcome. As a shortcoming of continuous cisternal drainage, the need for shunt operation was higher in groups 2 and 3 than in group 1.