Croci, Davide Marco and Dalolio, Martina and Aghlmandi, Soheila and Taub, Ethan and Rychen, Jonathan and Chiappini, Alessio and Zumofen, Daniel and Guzman, Raphael and Mariani, Luigi and Roethlisberger, Michel (2021) Early permanent cerebrospinal fluid diversion in aneurysmal subarachnoid hemorrhage: does a lower rate of nosocomial meningitis outweigh the risk of delayed cerebral vasospasm related morbidity? Neurological Research, 43 (1). pp. 40-53. ISSN 0161-6412, DOI https://doi.org/10.1080/01616412.2020.1819091.
Full text not available from this repository.Abstract
Objective Early permanent cerebrospinal fluid (CSF) diversion for hydrocephalus during the first 2 weeks after aneurysmal subarachnoid hemorrhage (aSAH) shortens the duration of external ventricular drainage (EVD) and reduces EVD-associated infections (EVDAI). The objective of this study was to detect any association with symptomatic delayed cerebral vasospasm (DCVS), or delayed cerebral ischemia (DCI) by the time of hospital discharge. Methods We used a single-center dataset of aSAH patients who had received a permanent CSF diversion. We compared an `early group' in which the procedure was performed up to 14 days after the ictus, to a `late group' in which it was performed from the 15(th) day onward. Results Among 274 consecutive aSAH patients, 39 (14%) had a permanent CSF diversion procedure with a silver-coated EVD. While the blood clot burden was similarly distributed, patients with early permanent CSF diversion (20 out of 39; 51%) had higher levels of consciousness on admission. Early permanent CSF diversion was associated with less colonized catheter, a shorter duration of extracorporeal CSF diversion (OR 0.73, 95%CI 0.58-0.92 per EVD day), and a lower rate of EVDAI (OR 0.08, 95%CI 0.01-0.80). The occurrence of CSF diversion device obstruction, the rate of symptomatic DCVS or detected DCI on computed tomography and the likelihood of a poor outcome at discharge did not differ between the two groups. Discussion Early permanent CSF diversion lowers the occurrence of catheter colonization and infectious complication without affecting DCVS-related morbidity in good-grade aSAH patients. These findings need confirmation in larger prospective multicenter cohorts.
| Item Type: | Article |
|---|---|
| Funders: | Martin Allgower Foundation, Departments of Surgery and Neurosurgery of the University Hospital Basel (Basel, Switzerland), Gottfried and Julia Bangerter-Rhyner Foundation (Bern, Switzerland), University Hospital of Basel (Basel, Switzerland), University of Malaya Specialist Centre (Kuala Lumpur, Malaysia) |
| Uncontrolled Keywords: | External ventricular drain; Infection; Ventriculo-peritoneal shunting; Cerebral vasospasm; Delayed cortical infarction; Aneurysmal subarachnoid hemorrhage |
| Subjects: | R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry |
| Divisions: | Faculty of Medicine |
| Depositing User: | Ms Zaharah Ramly |
| Date Deposited: | 09 Jun 2022 07:08 |
| Last Modified: | 09 Jun 2022 07:08 |
| URI: | http://eprints.um.edu.my/id/eprint/34338 |
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