External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage: effect on preoperative grading and prognosis.
BACKGROUND
The importance of preoperative response to external ventricular drainage (EVD) for treatment of acute hydrocephalus (HCP) following poor grade (Hunt & Hess grade IV or V) aneurysmal subarachnoid hemorrhage (aSAH) has not been clearly defined. The effect of EVD response on preoperative grade and prognosis is described.


METHODS
Fifty-nine poor grade patients had an EVD placed preoperatively and underwent definitive aneurysm treatment between September 1996 and March 2002. Patients improving > or = one Hunt and Hess grade were considered responders. Case-control comparisons were completed for each responder, based on clinical grade; the pre-EVD grade and the post-EVD (response) grade were used to generate two independent control cohorts. Logistic regression was used to evaluate the relationship of 12-month modified Rankin disability score (mRS) to clinical grade.


RESULTS
Nineteen (32%) responders were identified, and were less likely Grade V (p < 0.05), and more often had smaller (<13 mm, p < 0.01) and posterior circulation (p < 0.03) aneurysms. The frequency of favorable outcome (mRS < or= 3) was greater in responders than non-responders (68% vs. 28%, p < 0.001). Responders had a similar incidence of favorable outcome as response-grade controls (74%), and a higher incidence of favorable outcome than pre-EVD controls (47%). Regression analysis identified the post-EVD grade, but not the pre-EVD grade, as significantly predictive of long-term outcome (p < 0.04).


CONCLUSIONS
Long-term outcomes in poor grade patients who improve after EVD placement are similar to patients with lower grade hemorrhages. When an EVD is placed preoperatively in a poor grade aSAH patient, the neurological status after EVD determines the clinical grade.
Ransom
Evan R
ER
Department of Neurological Surgery, Columbia University, College of Physicians & Surgeons, Neurological Institute of New York, 710 W 168th Street, Room 431, New York, NY 10032, USA.
Mocco
J
J
Komotar
Ricardo J
RJ
Sahni
Deshdeepak
D
Chang
Jennifer
J
Hahn
David K
DK
Kim
Grace H
GH
Schmidt
J Michael
JM
Sciacca
Robert R
RR
Mayer
Stephan A
SA
Connolly
E Sander
ES
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002552:Cerebral Ventricles / Q000601:surgery*; D015331:Cohort Studies; D004185:Disability Evaluation; D004322:Drainage; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012008:Recurrence; D012044:Regression Analysis; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors