Effect of Continuous External Ventricular Drainage on Delayed Ischemic Neurologic Deficits after Aneurysmal Clipping in Spontaneous Subarachnoid Hemorrhage

ABSTRACT

OBJECTIVE: The purpose of this reports is to describe the influence of continuous external ventricular drainage (EVD) on delayed ischemic neurologic deficit (DIND) after early surgery in ruptured aneurysmal patients. METHODS: The authors reviewed 229 patients with aneurysmal subarachnoid hemorrhage (SAH) who had been treated with clipping at a single institution between 1998 and 2004. Of these, 121 patients underwent continuous EVD (Group A) postoperatively, whereas 108 patients did not (Group B). EVD was performed at ipsilateral Kocher's point and maintained 2 to 14 days postoperatively. RESULTS: DIND occurred in 15.7% (19 cases) of patients in Group A, 25% (27 cases) from Group B (P value=0.112). Compared with Group A, Group B was more likely to suffer acute symptom of DIND and showed poor response to 3- H therapy. Major symptoms of DIND in Group A were mild confusion (36.8%) and mild deterioration of mental state (26.3%), contrary to weakness of extremities (59.2%) in Group B. At discharge, Glasgow Outcome Scales (GOS) of Group A were good recovery (63.2%), moderately disabled (21%), severely disabled (10.5%), dead (5.3%) and Group B good recovery (48.1%), moderately disabled (37%), severely disabled (14.8%) and dead (0%). Of 121 patients from group A, 35 patients (28.9%) suffered ventriculitis. CONCLUSION: Continuous EVD after aneurysmal clipping in patients with SAH reduced the risk of DIND and its sequelae, relieved its symptoms, and improved the outcome.