Using external lumbar CSF drainage to treat communicating external hydrocephalus in adult patients after acute traumatic or non-traumatic brain injury

  • Romain Manet
  • Jean-François Payen
  • Romain Guerin
  • Orianne Martinez
  • Serge Hautefeuille
  • Gilles Francony
  • Laurent Gergelé
Original Article - Brain Injury
  • 25 Downloads

Abstract

Background

Despite various treatments to control intracranial pressure (ICP) after brain injury, patients may present a late onset of high ICP or a poor response to medications. External lumbar drainage (ELD) can be considered a therapeutic option if high ICP is due to communicating external hydrocephalus. We aimed at describing the efficacy and safety of ELD used in a cohort of traumatic or non-traumatic brain-injured patients.

Methods

In this multicentre retrospective analysis, patients had a delayed onset of high ICP after the initial injury and/or a poor response to ICP treatments. ELD was considered in the presence of radiological signs of communicating external hydrocephalus. Changes in ICP values and side effects following the ELD procedure were reported.

Results

Thirty-three patients with a median age of 51 years (25-75th percentile: 34–61 years) were admitted after traumatic (n = 22) or non-traumatic (n = 11) brain injuries. Their initial Glasgow Coma Scale score was 8 (4–11). Eight patients underwent external ventricular drainage prior to ELD. Median time to ELD insertion was 5 days (4–8) after brain insult. In all patients, ELD was dramatically effective in lowering ICP: 25 mmHg (20–31) before versus 7 mmHg (3–10) after (p < 0.001). None of the patients showed adverse effects such as pupil changes or intracranial bleeding after the procedure. One patient developed an ELD-related infection.

Conclusions

These findings indicate that ELD may be considered potentially effective in controlling ICP, remaining safe if a firm diagnosis of communicating external hydrocephalus has been made.

Keywords

Post traumatic hydrocephalus Intracranial hypertension Lumbar cerebrospinal fluid drainage Traumatic brain injury Subarachnoid haemorrhage 

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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  1. 1.Service de Neurochirurgie B, Hôpital Neurologique et Neurochirurgical WertheimerCentre Hospitalier Universitaire de LyonLyon CedexFrance
  2. 2.Service de Neurochirurgie, Clinique Mutualiste ChirurgicaleSaint-EtienneFrance
  3. 3.Grenoble Institut des Neurosciences, GINUniversity Grenoble AlpesGrenobleFrance
  4. 4.Pôle Anesthésie RéanimationCHU Grenoble AlpesGrenobleFrance
  5. 5.INSERM, U1216GrenobleFrance
  6. 6.Service de Réanimation, Hôpital LapeyronieCHU MontpellierMontpellierFrance
  7. 7.Service de réanimationCentre Hospitalier Annecy GenevoisAnnecyFrance
  8. 8.Département d’Anesthésie RéanimationCHU Saint-EtienneSaint Priest en JarezFrance

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