PMID- 28799877
OWN - NLM
STAT- MEDLINE
DCOM- 20190913
LR  - 20190913
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 128
IP  - 6
DP  - 2018 Jun
TI  - Volume of cerebrospinal fluid drainage as a predictor for pretreatment aneurysmal 
      rebleeding.
PG  - 1778-1784
LID - 2017.2.JNS162748 [pii]
LID - 10.3171/2017.2.JNS162748 [doi]
AB  - OBJECTIVE Initiation of external CSF drainage has been associated with a 
      significant increase in rebleeding probability after aneurysmal subarachnoid 
      hemorrhage (aSAH). However, the implications for acute management are uncertain. 
      The purpose of this study was to evaluate the role of the amount of drained CSF 
      on aneurysmal rebleeding. METHODS Consecutive patients with aSAH were analyzed 
      retrospectively. Radiologically confirmed cases of aneurysmal in-hospital 
      rebleeding were identified and predictor variables for rebleeding were retrieved 
      from hospital records. Clinical predictors were identified through multivariate 
      analysis, and logistic regression analysis was performed to ascertain the cutoff 
      value for the rebleeding probability. RESULTS The study included 194 patients. 
      Eighteen cases (9.3%) of in-hospital rebleeding could be identified. Using 
      multivariate analysis, in-hospital rebleeding was significantly associated with 
      initiation of CSF drainage (p = 0.001) and CSF drainage volume (63 ml 
      [interquartile range (IQR) 55-69 ml] vs 25 ml [IQR 10-35 ml], p < 0.001). 
      Logistic regression showed that 58 ml of CSF drainage within 6 hours results in a 
      50% rebleeding probability. The relative risk (RR) for rebleeding after drainage 
      of more than 60 ml in 6 hours was 5.4 times greater compared with patients with 
      less CSF drainage (RR 5.403, 95% CI 2.481-11.767; p < 0.001, number needed to 
      harm = 1.687). CONCLUSIONS Volume of CSF drainage was highly correlated with the 
      probability of in-hospital aneurysmal rebleeding. These findings suggest that the 
      rebleeding probability can be affected in acute management should the placement 
      of an external ventricular catheter be necessary. This finding necessitates 
      meticulous control of the amount of drained CSF and the development of a 
      definitive treatment protocol for this group of patients.
FAU - van Lieshout, Jasper H
AU  - van Lieshout JH
AD  - 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University 
      Dusseldorf, Germany; and.
FAU - Pumplun, Ina
AU  - Pumplun I
AD  - 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University 
      Dusseldorf, Germany; and.
FAU - Fischer, Igor
AU  - Fischer I
AD  - 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University 
      Dusseldorf, Germany; and.
FAU - Kamp, Marcel A
AU  - Kamp MA
AD  - 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University 
      Dusseldorf, Germany; and.
FAU - Cornelius, Jan F
AU  - Cornelius JF
AD  - 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University 
      Dusseldorf, Germany; and.
FAU - Steiger, Hans J
AU  - Steiger HJ
AD  - 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University 
      Dusseldorf, Germany; and.
FAU - Boogaarts, Hieronymus D
AU  - Boogaarts HD
AD  - 2Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The 
      Netherlands.
FAU - Petridis, Athanasios K
AU  - Petridis AK
AD  - 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University 
      Dusseldorf, Germany; and.
FAU - Beseoglu, Kerim
AU  - Beseoglu K
AD  - 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine University 
      Dusseldorf, Germany; and.
LA  - eng
PT  - Journal Article
DEP - 20170811
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
MH  - Adult
MH  - Aged
MH  - Catheters
MH  - Cerebral Ventricles
MH  - Cerebrospinal Fluid Leak/*cerebrospinal fluid/*therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Probability
MH  - Recurrence
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Subarachnoid Hemorrhage/*cerebrospinal fluid/*therapy
OTO - NOTNLM
OT  - CI = confidence interval
OT  - EVD = external ventricular drain
OT  - ICP = intracranial pressure
OT  - IQR = interquartile range
OT  - NNH = number needed to harm
OT  - RR = relative risk
OT  - SBP = systolic blood pressure
OT  - WFNS = World Federation of Neurosurgical Societies
OT  - aSAH = aneurysmal subarachnoid hemorrhage
OT  - cerebrospinal fluid
OT  - external ventricular drainage
OT  - intracranial aneurysm
OT  - recurrence
OT  - risk factor
OT  - subarachnoid hemorrhage
OT  - vascular disorders
EDAT- 2017/08/12 06:00
MHDA- 2019/09/14 06:00
CRDT- 2017/08/12 06:00
PHST- 2017/08/12 06:00 [pubmed]
PHST- 2019/09/14 06:00 [medline]
PHST- 2017/08/12 06:00 [entrez]
AID - 2017.2.JNS162748 [pii]
AID - 10.3171/2017.2.JNS162748 [doi]
PST - ppublish
SO  - J Neurosurg. 2018 Jun;128(6):1778-1784. doi: 10.3171/2017.2.JNS162748. Epub 2017 
      Aug 11.