THE SAFETY OF INTRAOPERATIVE LUMBAR SUBARACHNOID DRAINAGE FOR ACUTELYRUPTURED INTRACRANIAL ANEURYSM - TECHNICAL NOTE

Recently, some concern has arisen regarding the safety of intraoperati ve spinal drainage for brain relaxation in aneurysm surgery, due to an ecdotal association with both aneurysmal rebleeding and increases in s ymptomatic vasospasm. To address these concerns, we reviewed our exper ience with frequent spinal drainage and early surgery in 432 consecuti ve cases of surgically treated aneurysmal subarachnoid hemorrhage. Unl ess contraindicated by mass effect or associated pathology, all grade I-III patients referred within 14 days were treated with spinal draina ge at surgery. In this cohort (n = 314), there were no cases of mening itis or nerve root injury. Only one case of intraoperative rebleeding could be associated with spinal drain placement (0.3%). In grade IV-V patients, 47% required preoperative ventriculostomy, and 11% were inel igible for spinal drainage due to mass effect. There were, however, no complications related to spinal drainage in the remaining 23 patients . Permanently-shunted hydrocephalus (8%) and symptomatic vasospasm (19 %) were infrequent overall. When analyzed by grade, spinal drains were generally associated with equal or reduced incidence of these develop ments when compared to patients without spinal drainage. We conclude t hat brain relaxation can be safely and effectively obtained using intr aoperative spinal drains during early aneurysm surgery. (C) 1997 by El sevier Science Inc.