Summary
Enhanced cisternal drainage was performed following early aneurysm surgery in patients with Hunt and Kosnik grades I–III, to effect continuous wash-out of subarachnoid blood clots and reduce symptomatic vasospasm. Following extensive evacuation of the cisternal blood clots, the Liliequist's membrane was opened extensively and a third ventriculostomy was effected by opening the lamina terminals. The drainage effect was considered as poor, moderate or fair, depending on the average amount of CSF drainage/day. SAH was graded into 0–III depending on the severity of cisternal haematoma in the pre-operative CT. No symptomatic vasospasm occurred in patients with SAH grade I. In SAH grade II +III patients symptomatic vasospasm occurred in 78,60 and 42% of patients with a poor, moderate and fair drainage effect, respectively. Nine patients who developed symptomatic vasospasm were treated by hypertensive/hypervolemic therapy (HHT). The HHT was effective in 7 patients with fair and moderate CSF drainage and ineffective in 2 patients with poor a drainage effect. It seems, that enhanced post-operative cisternal drainage can reduce the incidence of symptomatic vasospasm and be of benefit to the outcome of early aneurysm surgery.
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Ito, U., Tomita, H., Yamazaki, S. et al. Enhanced cisternal drainage and cerebral vasospasm in early aneurysm surgery. Acta neurochir 80, 18–23 (1986). https://doi.org/10.1007/BF01809552
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DOI: https://doi.org/10.1007/BF01809552