The relationship of ventricular drainage to aneurysmal rebleeding

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✓ Given the widespread use of continuous external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage (SAH), this investigation was undertaken to define the relationship of ventricular drainage to aneurysmal rebleeding. A historical cohort study of 128 patients with confirmed aneurysmal SAH was performed using a multivariate stepwise logistic regression analysis to examine the relationship between aneurysmal rerupture and ventricular drainage, while controlling for important clinical and radiological independent variables. The variables for ventricular drainage selected in the regression analysis were clinical grade, aneurysm size, and presence of hydrocephalus. The rate of rerupture was significantly higher in cases with ventricular drainage (odds ratio 5.31:1, p < 0.05), poor clinical grade (odds ratio 4.90:1, p < 0.02), and large aneurysm size (odds ratio 11.25:1, p < 0.01). The significant effect of ventricular drainage was limited to patients with hydrocephalus. The increased risk of aneurysmal rebleeding in patients undergoing ventricular drainage may result from both: 1) a rise in aneurysmal transmural pressure, since intracranial pressure is lowered by ventricular drainage; and 2) an association between ventricular drainage and a more severely disrupted aneurysm which is more prone to rebleed as part of its natural history. This study found an increased risk of aneurysmal rebleeding among patients undergoing ventricular drainage, particularly in the presence of hydrocephalus.

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Address reprint requests to: Richard Leblanc, M.D., Montreal Neurological Hospital, 3801 University Street, Montreal, Quebec H3A 2B4, Canada.

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References

1.

Aoyagi NHayakawa I: Analysis of 223 ruptured intracranial aneurysms with special reference to rerupture. Surg Neurol 21:4454521984Aoyagi N Hayakawa I: Analysis of 223 ruptured intracranial aneurysms with special reference to rerupture. Surg Neurol 21:445–452 1984

2.

Breslow NEDay NE: Fundamental measures of disease occurrence and association in Breslow NEDay NE (eds): Statistical Methods in Cancer Research Vol 1. The Analysis of Case-Control Studies. Lyon: International Agency for Research on Cancer1980 pp 4281Breslow NE Day NE: Fundamental measures of disease occurrence and association in Breslow NE Day NE (eds): Statistical Methods in Cancer Research Vol 1. The Analysis of Case-Control Studies. Lyon: International Agency for Research on Cancer 1980 pp 42–81

3.

Canham PBFerguson GG: A mathematical model for the mechanics of saccular aneurysms. Neurosurgery 17:2912951985Canham PB Ferguson GG: A mathematical model for the mechanics of saccular aneurysms. Neurosurgery 17:291–295 1985

4.

Crompton MR: Recurrent haemorrhage from cerebral aneurysms and its prevention by surgery. J Neurol Neurosurg Psychiatry 29:1641701966Crompton MR: Recurrent haemorrhage from cerebral aneurysms and its prevention by surgery. J Neurol Neurosurg Psychiatry 29:164–170 1966

5.

Drake CG: Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg 68:9859861988 (Letter)Drake CG: Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg 68:985–986 1988 (Letter)

6.

Ferguson GG: Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. J Neurosurg 37:6666771972Ferguson GG: Physical factors in the initiation growth and rupture of human intracranial saccular aneurysms. J Neurosurg 37:666–677 1972

7.

Galera GRGreitz T: Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms. J Neurosurg 32:6346411970Galera GR Greitz T: Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms. J Neurosurg 32:634–641 1970

8.

Grote EHassler W: The critical first minutes after subarachnoid hemorrhage. Neurosurgery 22:6546611988Grote E Hassler W: The critical first minutes after subarachnoid hemorrhage. Neurosurgery 22:654–661 1988

9.

Gyldensted C: Measurements of the normal ventricular system and hemispheric sulci of 100 adults with computed tomography. Neuroradiology 14:1831921977Gyldensted C: Measurements of the normal ventricular system and hemispheric sulci of 100 adults with computed tomography. Neuroradiology 14:183–192 1977

10.

Hahn FJYRim K: Frontal ventricular dimensions on normal computed tomography. AJR 126:5935961976Hahn FJY Rim K: Frontal ventricular dimensions on normal computed tomography. AJR 126:593–596 1976

11.

Hasan DVermeulen MWijdicks EFMet al: Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke 20:7477531989Hasan D Vermeulen M Wijdicks EFM et al: Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke 20:747–753 1989

12.

Haug G: Age and sex dependence of the size of normal ventricles on computed tomography. Neuroradiology 14:2012041977Haug G: Age and sex dependence of the size of normal ventricles on computed tomography. Neuroradiology 14:201–204 1977

13.

Hayashi MHanda YKobayashi Het al: Prognosis of intraventricular hemorrhage due to rupture of intracranial aneurysm. Zentralbl Neurochir 50:1321371989Hayashi M Handa Y Kobayashi H et al: Prognosis of intraventricular hemorrhage due to rupture of intracranial aneurysm. Zentralbl Neurochir 50:132–137 1989

14.

Hijdra ABraakman Rvan Gijn Jet al: Aneurysmal subarachnoid hemorrhage. Complications and outcome in a hospital population. Stroke 18:106110671987Hijdra A Braakman R van Gijn J et al: Aneurysmal subarachnoid hemorrhage. Complications and outcome in a hospital population. Stroke 18:1061–1067 1987

15.

Hijdra AVermeulen Mvan Gijn Jet al: Rerupture of intracranial aneurysms: a clinicoanatomic study. J Neurosurg 67:29331987Hijdra A Vermeulen M van Gijn J et al: Rerupture of intracranial aneurysms: a clinicoanatomic study. J Neurosurg 67:29–33 1987

16.

Hosmer DW JrLemeshow S: Assessing the fit of the model in Hosmer DW JrLemeshow S (eds): Applied Logistic Regression. Toronto: John Wiley & Sons1989 pp 135175Hosmer DW Jr Lemeshow S: Assessing the fit of the model in Hosmer DW Jr Lemeshow S (eds): Applied Logistic Regression. Toronto: John Wiley & Sons 1989 pp 135–175

17.

Inagawa TKamiya KOgasawara Het al: Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28:93991987Inagawa T Kamiya K Ogasawara H et al: Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28:93–99 1987

18.

Jennett BBond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:4804841975Jennett B Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484 1975

19.

Juvela S: Rebleeding from ruptured intracranial aneurysms. Surg Neurol 32:3233261989Juvela S: Rebleeding from ruptured intracranial aneurysms. Surg Neurol 32:323–326 1989

20.

Kassell NFBoarini DJ: Patients with ruptured aneurysm: pre- and postoperative management in Wilkins RHRengachary SS (eds): Neurosurgery. New York: McGraw-Hill1985 Vol 2 pp 13671371Kassell NF Boarini DJ: Patients with ruptured aneurysm: pre- and postoperative management in Wilkins RH Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill 1985 Vol 2 pp 1367–1371

21.

Kassell NFTorner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:4794811983Kassell NF Torner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479–481 1983

22.

Kassell NFTorner JCHaley EC Jret al: The International Cooperative Study on the timing of aneurysm surgery. Part 1: Overall management results. J Neurosurg 73:18361990Kassell NF Torner JC Haley EC Jr et al: The International Cooperative Study on the timing of aneurysm surgery. Part 1: Overall management results. J Neurosurg 73:18–36 1990

23.

Maurice-Williams RS: Ruptured intracranial aneurysms: has the incidence of early rebleeding been over-estimated? J Neurol Neurosurg Psychiatry 45:7747791982Maurice-Williams RS: Ruptured intracranial aneurysms: has the incidence of early rebleeding been over-estimated? J Neurol Neurosurg Psychiatry 45:774–779 1982

24.

Milhorat TH: Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 20:15201987Milhorat TH: Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 20:15–20 1987

25.

Nornes H: The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm. J Neurosurg 39:2262341973Nornes H: The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm. J Neurosurg 39:226–234 1973

26.

O'Neill PWest CRChadwick DWet al: Recurrent aneurysmal subarachnoid haemorrhage: incidence, timing and effects. A re-appraisal in a surgical series. Br J Neurosurg 2:43481988O'Neill P West CR Chadwick DW et al: Recurrent aneurysmal subarachnoid haemorrhage: incidence timing and effects. A re-appraisal in a surgical series. Br J Neurosurg 2:43–48 1988

27.

Richardson AEJane JAYashon D: Prognostic factors in the untreated course of posterior communicating aneurysms. Arch Neurol 14:1721761966Richardson AE Jane JA Yashon D: Prognostic factors in the untreated course of posterior communicating aneurysms. Arch Neurol 14:172–176 1966

28.

Rosenørn JEskesen VSchmidt Ket al: The risk of rebleeding from ruptured intracranial aneurysms. J Neurosurg 67:3293321987Rosenørn J Eskesen V Schmidt K et al: The risk of rebleeding from ruptured intracranial aneurysms. J Neurosurg 67:329–332 1987

29.

Rosenørn JWestergaard LHansen PH: Mannitol-induced rebleeding from intracranial aneurysm. Case report. J Neurosurg 59:5295301983Rosenørn J Westergaard L Hansen PH: Mannitol-induced rebleeding from intracranial aneurysm. Case report. J Neurosurg 59:529–530 1983

30.

Sundbärg GPontén U: ICP and CSF absorption impairment after subarachnoid hemorrhage in Beks JWFBosch DABrock M (eds): Intracranial Pressure III. Berlin: Springer-Verlag1976 pp 139146Sundbärg G Pontén U: ICP and CSF absorption impairment after subarachnoid hemorrhage in Beks JWF Bosch DA Brock M (eds): Intracranial Pressure III. Berlin: Springer-Verlag 1976 pp 139–146

31.

Troupp H: Intracranial pressure in hydrocephalus after subarachnoid hemorrhage. Zentralbl Neurochir 36:11171975Troupp H: Intracranial pressure in hydrocephalus after subarachnoid hemorrhage. Zentralbl Neurochir 36:11–17 1975

32.

van Gijn JHijdra AWijdicks EFMet al: Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 63:3553621985van Gijn J Hijdra A Wijdicks EFM et al: Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 63:355–362 1985

33.

Voldby BEnevoldsen EM: Intracranial pressure changes following aneurysm rupture. Part 3: Recurrent hemorrhage. J Neurosurg 56:7847891982Voldby B Enevoldsen EM: Intracranial pressure changes following aneurysm rupture. Part 3: Recurrent hemorrhage. J Neurosurg 56:784–789 1982

34.

von Holst HBergstrand G: The amount of blood in CSF and degree of hydrocephalus studied with CT as compared to clinical condition and concentrations of various substances in human CSF after subarachnoid hemorrhage. Acta Neurochir 94:38411988von Holst H Bergstrand G: The amount of blood in CSF and degree of hydrocephalus studied with CT as compared to clinical condition and concentrations of various substances in human CSF after subarachnoid hemorrhage. Acta Neurochir 94:38–41 1988

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