Effectiveness of Cerebrospinal Fluid Lumbar Drainage Among Patients with Aneurysmal Subarachnoid Hemorrhage : An Updated Systematic Review and Meta-Analysis
Copyright © 2024 Elsevier Inc. All rights reserved..
INTRODUCTION: Cerebral vasospasm in patients after aneurysmal subarachnoid hemorrhage (aSAH) continues to be a major source of morbidity despite significant clinical and basic science research. The removal of blood and its degradation products from the subarachnoid space through prophylactic lumbar drainage (LD) is a favorable option. However, several studies have delivered conflicting conclusions on its efficacy after aSAH.
METHODS: Systematic searches of Medline, Embase, and Cochrane Central Register of Controlled Trials were performed. The primary outcome was a good functional outcome (modified Rankin scale score, 0-2). Secondary outcomes included symptomatic vasospasm, secondary cerebral infarction, and mortality.
RESULTS: A total of 14 studies reporting on 2473 patients with aSAH were included in the meta-analysis. Compared with the non-LD group, no significant differences were found in the rates of good functional outcomes in the LD group at discharge to 1 month (risk ratio [RR], 1.28; 95% confidence interval [CI], 0.64-2.58) or at 6 months (RR, 1.12; 95% CI, 0.97-1.41). These findings were consistent in the subgroup analyses of only randomized controlled trials or observational studies. LD was associated with lower rates of symptomatic vasospasm (RR, 0.61; 95% CI, 0.48-0.77), secondary cerebral infarction (RR, 0.59; 95% CI, 0.45-0.79), and mortality at discharge to 1 month (RR, 0.58; 95% CI, 0.41-0.82). The effect on mortality diminished at 6 months (RR, 0.70; 95% CI, 0.34-1.45). However, when analyzing only randomized controlled trials, the benefit of LD on lower rates of mortality continued even at 6 months (RR, 0.75; 95% CI, 0.58-0.99).
CONCLUSIONS: For aSAH patients, the use of LD is associated with benefits in the rates of vasospasm, secondary cerebral infarctions, and mortality, without an increased risk of adverse events.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:183 |
|---|---|
| Enthalten in: |
World neurosurgery - 183(2024) vom: 01. März, Seite 246-253.e12 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Lee, Keng Siang [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Aneurysm |
|---|
| Anmerkungen: |
Date Completed 13.03.2024 Date Revised 21.03.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.wneu.2024.01.062 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM367370190 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM367370190 | ||
| 003 | DE-627 | ||
| 005 | 20240321235911.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240122s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.wneu.2024.01.062 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1338.xml |
| 035 | |a (DE-627)NLM367370190 | ||
| 035 | |a (NLM)38246528 | ||
| 035 | |a (PII)S1878-8750(24)00074-3 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Lee, Keng Siang |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effectiveness of Cerebrospinal Fluid Lumbar Drainage Among Patients with Aneurysmal Subarachnoid Hemorrhage |b An Updated Systematic Review and Meta-Analysis |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 13.03.2024 | ||
| 500 | |a Date Revised 21.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 Elsevier Inc. All rights reserved. | ||
| 520 | |a INTRODUCTION: Cerebral vasospasm in patients after aneurysmal subarachnoid hemorrhage (aSAH) continues to be a major source of morbidity despite significant clinical and basic science research. The removal of blood and its degradation products from the subarachnoid space through prophylactic lumbar drainage (LD) is a favorable option. However, several studies have delivered conflicting conclusions on its efficacy after aSAH | ||
| 520 | |a METHODS: Systematic searches of Medline, Embase, and Cochrane Central Register of Controlled Trials were performed. The primary outcome was a good functional outcome (modified Rankin scale score, 0-2). Secondary outcomes included symptomatic vasospasm, secondary cerebral infarction, and mortality | ||
| 520 | |a RESULTS: A total of 14 studies reporting on 2473 patients with aSAH were included in the meta-analysis. Compared with the non-LD group, no significant differences were found in the rates of good functional outcomes in the LD group at discharge to 1 month (risk ratio [RR], 1.28; 95% confidence interval [CI], 0.64-2.58) or at 6 months (RR, 1.12; 95% CI, 0.97-1.41). These findings were consistent in the subgroup analyses of only randomized controlled trials or observational studies. LD was associated with lower rates of symptomatic vasospasm (RR, 0.61; 95% CI, 0.48-0.77), secondary cerebral infarction (RR, 0.59; 95% CI, 0.45-0.79), and mortality at discharge to 1 month (RR, 0.58; 95% CI, 0.41-0.82). The effect on mortality diminished at 6 months (RR, 0.70; 95% CI, 0.34-1.45). However, when analyzing only randomized controlled trials, the benefit of LD on lower rates of mortality continued even at 6 months (RR, 0.75; 95% CI, 0.58-0.99) | ||
| 520 | |a CONCLUSIONS: For aSAH patients, the use of LD is associated with benefits in the rates of vasospasm, secondary cerebral infarctions, and mortality, without an increased risk of adverse events | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Aneurysm | |
| 650 | 4 | |a Cerebrospinal fluid drainage | |
| 650 | 4 | |a Ischemia | |
| 650 | 4 | |a Lumbar drain | |
| 650 | 4 | |a Meta-analysis | |
| 650 | 4 | |a Subarachnoid hemorrhage | |
| 650 | 4 | |a Vasospasm | |
| 700 | 1 | |a Chari, Aswin |e verfasserin |4 aut | |
| 700 | 1 | |a Motiwala, Mustafa |e verfasserin |4 aut | |
| 700 | 1 | |a Khan, Nickalus R |e verfasserin |4 aut | |
| 700 | 1 | |a Arthur, Adam S |e verfasserin |4 aut | |
| 700 | 1 | |a Lawton, Michael T |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t World neurosurgery |d 2010 |g 183(2024) vom: 01. März, Seite 246-253.e12 |w (DE-627)NLM197924441 |x 1878-8769 |7 nnns |
| 773 | 1 | 8 | |g volume:183 |g year:2024 |g day:01 |g month:03 |g pages:246-253.e12 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.wneu.2024.01.062 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 183 |j 2024 |b 01 |c 03 |h 246-253.e12 | ||