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Aneurysm rebleeding after placement of external ventricular drainage: a systematic review and meta-analysis

  • Review Article - Vascular
  • Published:
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Abstract

Background

The association between external ventricular drainage (EVD) and aneurysm rerupture is still a controversial issue. We performed a systematic review and meta-analysis of published series reporting data of EVD placement in aneurysmal subarachnoid hemorrhage (SAH) with the aim to evaluate the relationship between ventricular drainage and aneurysm rebleeding.

Method

PRISMA/MOOSE guidelines were followed. The Newcastle-Ottawa Scale was used to assess the quality of the studies. We conducted a comprehensive literature search of three databases (PubMed, Ovid MEDLINE, and Ovid EMBASE) on series reporting patients with EVD placement and aneurysmal SAH. The reported studies were analyzed with a primary aim to calculate the strength of the association (odds ratio) between rebleeding and EVD placement in patients with SAH.

Results

Our systematic review included 16 articles with a total of 6804 patients with SAH of which 595 (8.7%) had aneurysmal rebleeding. Ventricular drainage was inserted in 19% of patients. Rebleeding occurred in 18.8% (95% CI = 16.4–20.6%) of patients requiring EVD and in 6.4% (95% CI = 5.8–7.1%) of patients who did not require EVD (OR = 3.92, p < 0.0001). The mean time between EVD placement and rebleeding was 1 h (range, 0–8 h). The maximal aneurysm diameter of patients with rerupture was larger when compared with patients without rerupture (9.9 mm vs. 7.5 mm; p < 0.04). High Fisher grades (III–IV) were present in 75% of patients with rerupture and in 60% of patients without aneurysmal rerupture (p < 0.0001).

Conclusions

Our study conclusively defined an association between EVD and rebleeding. However, the effective role of EVD in aneurysm rebleeding is insufficiently investigated in the literature. Other significant factors of rebleeding are usually observed in patients requiring ventricular drainage. According to our findings, a causal relationship between EVD and aneurysm rebleeding could be a plausible hypothesis, at least in certain cases.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy

    Federico Cagnazzo, Carlo Gambacciani & Paolo Perrini

  2. Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy

    Riccardo Morganti

Authors
  1. Federico Cagnazzo
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  2. Carlo Gambacciani
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  3. Riccardo Morganti
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  4. Paolo Perrini
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Correspondence to Federico Cagnazzo.

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This article does not contain any studies with human participants performed by any of the authors.

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Cagnazzo, F., Gambacciani, C., Morganti, R. et al. Aneurysm rebleeding after placement of external ventricular drainage: a systematic review and meta-analysis. Acta Neurochir 159, 695–704 (2017). https://doi.org/10.1007/s00701-017-3124-1

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  • DOI: https://doi.org/10.1007/s00701-017-3124-1

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