The influence of cisternal and ventricular lavage on cerebral vasospasm in patients suffering from subarachnoid hemorrhage: analysis of effectiveness.
OBJECTIVE
within the last decades several clinical trials were performed to analyze the effectiveness of cisternal and ventricular lavage on cerebral vasospasm in patients suffering from subarachnoid hemorrhage. Aim of the present analysis was to review and summarize all documented clinical studies using cisternal or ventricular lavage to prevent vasospasm.


METHODS
the MEDLINE Web site ( www.pub.med.com ) was searched using the clinical query function optimized for clinical therapy. Search terms were subarachnoid hemorrhage, vasospasm, cisternal and ventricular lavage. Results were divided into cisternal and ventricular lavage therapies alone and its combination with additional treatment modalities.


RESULTS
so far the literature search revealed a total of nine clinical trials using cisternal or ventricular lavage alone in patients suffering from subarachnoid hemorrhage. The patients were treated using urokinase or recombinant tissue plasminogen activator. A metaanalysis, investigating a total of 652 included patients revealed a significant reduction of delayed neurological deficits, a significant increase of outcome and a significant decrease of mortality in the treatment group. Additional there was no difference of effectiveness or side effects using urokinase or recombinant tissue plasminogen activator. Hence, only one of these studies was based on a prospective, randomized study design. A combination of cisternal or ventricular lavage with some sort of kinetic treatment was documented in a total of three studies. All of them were designed prospectively. The combined application demonstrated reduced delayed neurological deficits, reduced vasospasm and better outcome in two studies for the treatment group. One study was stopped early due to unexpected complication.


CONCLUSIONS
In conclusion, there is strong evidence that cisternal or ventricular lavage alone and in combination with kinetic therapy lead to a reduction of cerebral vasospasm and better outcome in patients suffering from subarachnoid hemorrhage. As a consequence a prospective randomized study would be of great interest.
Department of Neurosurgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany. Daniel.Haenggi@uni-duesseldorf.de
Daniel
D
Hänggi
Hans-Jakob
HJ
Steiger
D002552:Cerebral Ventricles / Q000502:physiology*; D002946:Cisterna Magna / Q000502:physiology*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D016239:MEDLINE / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D013345:Subarachnoid Hemorrhage / Q000150:complications; D007507:Therapeutic Irrigation / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000628:therapy*
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator