Efficacy and Rebleeding Risk of Preoperative Ventriculostomy in Aneurysmal Subarachnoid Hemorrhage.

Lee, Young Jin; Min, Kyung Soo; Lee, Mou Seop; Kim, Dong Ho; Kim, Young Gyu

Original Article

Journal of Korean Neurosurgical Society 2007;41(2): 100-104.

Young Jin Lee, Kyung Soo Min, Mou Seop Lee, Dong Ho Kim, Young Gyu Kim

Department of Neurosurgery, Chungbuk National University College of Medicine, Cheongju, Korea. ygk@chungbuk.ac.kr

ABSTRACT

OBJECTIVE
Despite the widespread use of preoperative ventriculostomy in aneurysmal subarachnoid hemorrhage (SAH), there is no general consensus regarding the risk of bleeding associated with its use before aneurysm repair. This study was conducted to define the efficacy and rebleeding risk of ventriculostomy in aneurysmal SAH.
METHODS
The authors reviewed 339 consecutive patients with aneurysmal SAH who were treated at our hospital between January 1998 and December 2004.
RESULTS
Preoperative ventriculostomy was performed on 73 patients for acute hydrocephalus after aneurysmal SAH. The Hunt-Hess (H-H) grades of patients who underwent ventriculostomy were higher. Out of the 73 patients who underwent preoperative ventriculostomy, 58 (79%) demonstrated immediate clinical improvement after ventriculostomy. Of those same 73 patients, 22 (30%) suffered aneurysmal rebleeding, whereas only 11 (4%) of the 266 patients who did not undergo ventriculostomy showed preoperative aneurysm rebleeding. The causes of rebleeding in the 22 patients who underwent ventriculostomy before surgery were related to the ventriculostomy procedure itself, subsequent cerebrospinal fluid (CSF) drainage, angiography and patient care procedures, such as endotracheal suction and nursing care. The mean time interval between SAH and surgery in the patients who underwent ventriculostomy was not statistically different from those who did not receive preoperative ventriculostomies (44.66 compared with 42.13 hours; p=0.73).
CONCLUSION
The preoperative ventriculostomy improved patients' clinical condition but increased the risk of rebleeding after aneurysmal SAH. When necessary, however, rapid change in transmural pressure during ventriculostomy must be avoided, careful management during ventricular drainage is needed, and surgery should be performed as soon as possible to prevent or reduce the incidence of rebleeding.

Key Words: Ventriculostomy; Subarachnoid hemorrhage; Rebleeding; Intracranial aneurysm