May 1, 1989

Indications for cisternal drainage in conjunction with early surgery in ruptured aneurysms and timing of its discontinuation

Neurologia Medico-chirurgica
I YamamotoM Hara

Abstract

The efficacy of cisternal drainage in association with early aneurysmal surgery remains highly controversial. The authors attempted to clarify the indications for this procedure and the proper timing of drainage removal in a series of 205 patients with no evidence of intracerebral hematoma who underwent surgical obliteration of bleeding aneurysms within 72 hours after subarachnoid hemorrhage. The 136 patients in whom cisternal drainage was performed constituted Group A and the remaining 69 patients Group B. The acid-base balance and lactate concentration were measured serially in cisternal cerebrospinal fluid (CSF) and arterial blood of 33 patients. Subarachnoid blood demonstrated by computed tomography (CT) was graded according to the system of Fisher et al. The outcome at 6 months did not differ significantly between Groups A and B among patients of preoperative CT grade 2 and clinical grades I-II. However, among patients of CT grade 3 or clinical grade III, those in Group A had better outcomes. The rates of symptomatic vasospasm in Groups A and B were 39.7% and 40.6%, respectively. However, persistent vasospasm was more frequent in Group B (11.8% vs. 26.1%), particularly in CT grade 3 patients. Ventricular enlargement was mo...Continue Reading

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Mentioned in this Paper

Arterial Blood pH Measurement
Evaluation of Acid-base Balance
Aneurysm, Ruptured
Lactate
Structure of Cisterna Magna
Cerebrospinal Fluid pH
Aneurysm
Intracerebral Hematoma
X-Ray Computed Tomography
G2 Stage (Tumor Staging)

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