title: Comparison of lumbar drainage and external ventricular drainage for clearance of subarachnoid clots after Guglielmi detachable coil embolization for aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Subarachnoid clots play an important role in development of delayed vasospasm after subarachnoid hemorrhage (SAH). The purpose of this study was to compare clearance of subarachnoid clots using external ventricular drainage (EVD) or lumbar drainage (LD) after Guglielmi detachable coil (GDC) embolization for aneurysmal SAH.
  
  
  METHODS
  The subjects were 51 treated with GDC coil embolization for aneurysmal Fisher group 3 SAH within 72 h of ictus. Software-based volumetric quantification of the subarachnoid clots was performed on CT scans and the hemoglobin (Hb) level was measured in CSF drained from each catheter.
  
  
  RESULTS
  Clearance of subarachnoid clots was more rapid in patients treated with LD (n=34) compared to those treated with EVD (n=17). The Hb level in CSF was significantly higher in the LD group on Days 4-5 after onset of SAH (P<0.05), but was higher in the EVD group on Days 8-9. The incidence of symptomatic vasospasm did not differ between the two groups. The rate of occurrence of a new low density area on CT scans was higher in patients treated with EVD, but not significantly higher than the rate in the LD group.
  
  
  CONCLUSIONS
  GDC embolization followed by lumbar drainage accelerates the reduction of subarachnoid clots, but EVD may contribute to stasis of hemorrhage within subarachnoid spaces.
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shirao
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoneda
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ishihara
authors.forename: Mizuya
authors.initials: M
authors.lastname: Shinoyama
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Oka
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sadahiro
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Ueda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sano
authors.forename: Shohei
authors.initials: S
authors.lastname: Kudomi
authors.forename: Yukari
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Shigeeda
authors.forename: Kaori
authors.initials: K
authors.lastname: Nakano
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Koizumi
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Nomura
authors.forename: Masami
authors.initials: M
authors.lastname: Fujii
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Nomura
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002552:Cerebral Ventricles; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004322:Drainage / Q000379:methods*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000134:cerebrospinal fluid; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010243:Paralysis / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000601:surgery*; D013346:Subarachnoid Space / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000209:etiology
chemical_list: D006454:Hemoglobins