Role of controlled lumbar CSF drainage for ICP control in aneurysmal SAH.
BACKGROUND
a prospective study of lumbar CSF drainage in the setting of raised intra-cranial pressure refractory to medical management and ventriculostomy placement is presented. There has been increasing data that this may be a effective and safe intervention for reduction of ICP.


METHODS
an IRB approved prospective study was conducted. Six patients with increased intracranial pressure secondary to aneurysm rupture were initially managed with sedation, ventriculostomy placement, mild hyperventilation (pCO(2) = 30-35), and hyperosmolar therapy (Na = 150-155). A lumbar drain was placed if ICP continued to be above 20 mmHg despite optimization of medical therapy.


RESULTS
after lumbar drain placement, ICP was reduced from 30.2 mmHg ± 6.7 to 9.7 mmHg ± 7.4, an average decrease of 20.5 mm H(2)O (P < 0.001). There was no significant change in CPP. Requirements for hypertonic saline and/or mannitol boluses and sedation to control ICP were decreased. There was no incidence of CSF infection or cerebral herniation.


CONCLUSIONS
we have shown that controlled lumbar drainage is a safe, efficacious and minimally invasive method for treatment of elevated ICP which refractory to medical management. Ventriculostomies are always placed before utilizing lumbar drains to minimize the risk of cerebral herniation. We would advocate making controlled lumbar drainage a standard part of ICP control protocols.
Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Rm. 2562-B, Loma Linda, CA 92354, USA. amurad@llu.edu
Ali
A
Murad
Samer
S
Ghostine
Austin R T
AR
Colohan
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000628:therapy*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome; D014696:Ventriculostomy