title: Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage: a prospective, randomized, controlled trial (LUMAS).
abstract: OBJECTIVE
  A single-center prospective randomized controlled trial has been conducted to determine if lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage reduces the prevalence of delayed ischemic neurological deficit and improves clinical outcome.
  
  
  METHODS
  Patients with World Federation of Neurological Surgeons Grade 1 to 3 aneurysmal subarachnoid hemorrhage and modified Fisher Grades 2, 3, 4, and 3+4 were randomized to either the study group of standard therapy plus insertion of a lumbar drain or the control group of standard therapy alone. The primary outcome measure was the prevalence of delayed ischemic neurological deficit.
  
  
  RESULTS
  Two hundred ten patients with aneurysmal subarachnoid hemorrhage (166 female, 44 male; median age, 54 years; interquartile range, 45-62 years) were recruited into the control (n=105) and study (n=105) groups of the trial. World Federation of Neurological Surgeons grade was: 1 (n=139), 2 (n=60), and 3 (n=11); Fisher grade was: 2 (n=87), 3 (n=85), and 4 (n=38). The prevalence of delayed ischemic neurological deficit was 35.2% and 21.0% in the control and study groups, respectively (P=0.021). The prevalence of a modified Rankin Scale score of 4, 5, or 6 at Day 10 and 6 months, respectively, was 62.5% and 18.6% in the control group and 44.8% and 19.8% in the study group (P=0.009 and 0.83, respectively).
  
  
  CONCLUSIONS
  Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage has been shown to reduce the prevalence of delayed ischemic neurological deficit and improve early clinical outcome but failed to improve outcome at 6 months after aneurysmal subarachnoid hemorrhage.
  
  
  BACKGROUND
  URL: www.clinicaltrials.gov. Unique identifier: NCT00842049.
authors.affiliation: Department of Neurosurgery, Level G Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire, UK LS1 3EX. yahia27@hotmail.com
authors.forename: Yahia Z
authors.initials: YZ
authors.lastname: Al-Tamimi
authors.forename: Deepti
authors.initials: D
authors.lastname: Bhargava
authors.forename: Richard G
authors.initials: RG
authors.lastname: Feltbower
authors.forename: Gregory
authors.initials: G
authors.lastname: Hall
authors.forename: Anthony J P
authors.initials: AJ
authors.lastname: Goddard
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Quinn
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004311:Double-Blind Method; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid* / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome