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

  • Original Article - Brain Injury
  • Published:
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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.

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Acknowledgements

We wish to thank the colleagues and personnel of each centre participating in this study for their hard work and dedication. We also warmly thank Marek Czosnyka, PhD (Department of Clinical Neurosciences, University of Cambridge, UK), for his valuable comments on the manuscript.

Author information

Authors and Affiliations

  1. Service de Neurochirurgie B, Hôpital Neurologique et Neurochirurgical Wertheimer, Centre Hospitalier Universitaire de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France

    Romain Manet

  2. Service de Neurochirurgie, Clinique Mutualiste Chirurgicale, Saint-Etienne, France

    Romain Manet

  3. Grenoble Institut des Neurosciences, GIN, University Grenoble Alpes, 38000, Grenoble, France

    Jean-François Payen

  4. Pôle Anesthésie Réanimation, CHU Grenoble Alpes, 38000, Grenoble, France

    Jean-François Payen, Romain Guerin & Gilles Francony

  5. INSERM, U1216, 38000, Grenoble, France

    Jean-François Payen

  6. Service de Réanimation, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France

    Orianne Martinez

  7. Service de réanimation, Centre Hospitalier Annecy Genevois, Annecy, France

    Serge Hautefeuille

  8. Département d’Anesthésie Réanimation, CHU Saint-Etienne, Saint Priest en Jarez, France

    Laurent Gergelé

Authors
  1. Romain Manet
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  2. Jean-François Payen
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  3. Romain Guerin
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  4. Orianne Martinez
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  5. Serge Hautefeuille
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  7. Laurent Gergelé
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Corresponding author

Correspondence to Romain Manet.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board approved the study design on the 25 July 2016 (ref. no. 472016) and, given its pure observational nature, waived the requirements for written informed consent from each patient. Electronic database access was granted by the French data protection authority (CNIL) (ref. no. 1979453).

Consent for publication

Not applicable. This study did not contain any individual person’s data in any form.

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Manet, R., Payen, JF., Guerin, R. et al. Using external lumbar CSF drainage to treat communicating external hydrocephalus in adult patients after acute traumatic or non-traumatic brain injury. Acta Neurochir 159, 2003–2009 (2017). https://doi.org/10.1007/s00701-017-3290-1

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  • DOI: https://doi.org/10.1007/s00701-017-3290-1

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