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Intracranial Pressure and Brain Monitoring XV pp 55–59Cite as

CSF Lumbar Drainage: A Safe Surgical Option in Refractory Intracranial Hypertension Associated with Acute Posttraumatic External Hydrocephalus

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Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 122))

Abstract

Introduction: External lumbar drainage (ELD) of cerebrospinal fluid (CSF) in posttraumatic refractory intracranial hypertension (ICHT) is controversial. We report our experience of ELD in ICHT associated with acute disturbance of CSF flow within subarachnoid spaces (SASs). Materials and Methods: Four adult patients admitted to the neurointensive care unit for severe TBI who presented with secondary ICHT are retrospectively reported. When refractory to second-tier therapy, if external ventricular drainage were not possible or failed, and in the absence of an indication for craniotomy to treat a mass lesion or decompressive craniectomy, we assessed the evolution of CSF volume within cranial SAS and checked the presence of basal cisterns and the absence of tonsillar herniation to evaluate interest in and the safety of ELD. Results: As second-tier therapy failed to lower intracranial pressure (ICP; mean ICP 37 ± 5 mmHg), and computed tomography (CT) showed abnormally enlarged cranial SAS following traumatic subarachnoid hemorrhage, patients received ELD. ICP decreased, with immediate and long-term effect (mean ICP 5 mmHg ± 2 mmHg). There were no complications to report. Discussion: Acute traumatic external hydrocephalus may explain some of the specific situations of secondary increased ICP, with a “normal” CT scan, that is refractory to medical treatment. In these situations, lumbar drainage should be considered to be a safe, minimally invasive, and effective surgical option.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Étienne, France

    R. Manet & F. Vassal

  2. Service de neurochirurgie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raimond, Saint-Priest-en-Jarez, 42 270, France

    R. Manet

  3. Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France

    E. A. Schmidt

  4. Department of Anesthesiology and Intensive Care, University Hospital of Saint Etienne, Saint-Étienne, France

    D. Charier & L. Gergelé

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  1. R. Manet
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  2. E. A. Schmidt
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  5. L. Gergelé
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Correspondence to R. Manet .

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Editors and Affiliations

  1. Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore

    Beng-Ti Ang

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Manet, R., Schmidt, E.A., Vassal, F., Charier, D., Gergelé, L. (2016). CSF Lumbar Drainage: A Safe Surgical Option in Refractory Intracranial Hypertension Associated with Acute Posttraumatic External Hydrocephalus. In: Ang, BT. (eds) Intracranial Pressure and Brain Monitoring XV. Acta Neurochirurgica Supplement, vol 122. Springer, Cham. https://doi.org/10.1007/978-3-319-22533-3_11

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  • DOI: https://doi.org/10.1007/978-3-319-22533-3_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22532-6

  • Online ISBN: 978-3-319-22533-3

  • eBook Packages: MedicineMedicine (R0)

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