Summary
The effect of continuous cisternal drainage on cerebral vasospasm was studied under strict criteria in 140 patients with ruptured intracranial aneurysms. The degree of subarachnoid haemorrhage (SAH) on the computed tomography scan was graded from I to IV. The patients were classified according to the total amount of cisternal drainage into three groups, regardless of the duration of the drainage and whether or not it was accompanied by irrigation; i.e., those with less than 500 mL (group 1∶57 cases), those with 500–3000 mL (group 2∶ 44 cases), and those with 3000–9500 mL (group 3∶ 39 cases).
While correlations could be found between both clinical and SAH grades with the severity of vasospasm, closer correlation could be found in the SAH grades. In analyzing the cases with subarachnoid haemorrhage grades III–IV (severe clots), the angiographic vasospasm was less severe in groups 2 and 3 than in group 1, and the incidences of permanent symptomatic vasospasm and low-density area on computed tomography were lower in groups 2 and 3 than in group 1. Regarding the surgical outcome in cases with SAH grades III–IV, the mortality rate was lower in groups 2 and 3 (22% and 19%) than in group 1 (33%). Further, the rate of good recovery was higher in groups 2 and 3 (61% and 57%) than in group 1 (28%). However, there were no differences between groups 2 and 3 in cerebral vasospasm or in surgical outcome. As a shortcoming of continuous cisternal drainage, the need for shunt operation was higher in groups 2 and 3 than in group 1.
Similar content being viewed by others
References
Alexander E III, Black PM, Liszczak TM, Zervas NT (1985) Delayed CSF lavage for arteriographic and morphological vasospasm after experimental SAH. J Neurosurg 63: 949–958
Auer LM (1984) Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15: 57–66
Awad IA, Carter LP, Spetzler RF, Medina M, Williams FW Jr (1987) Clinical vasospasm after subarachnoid haemorrhage: response to hypervolemic hemodilution and arterial hypertension. Stroke 18: 365–372
Hashi K, Aoyama I, Nin K, Shimotake K (1985) Further trial of cisternal clot removal for severe subarachnoid haemorrhage. In: Auer LM (ed) Timing of aneurysm surgery. Walter de Gruyter, Berlin, pp 373–379
Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20
Inagawa T (1990) Effect of early operation on cerebral vasospasm. Surg Neurol 33: 239–246
Inagawa T, Kamiya K, Ogasawara H, Yano T (1987) Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28: 93–99
Inagawa T, Yamamoto M, Kamiya K (1990) Effect of clot removal on cerebral vasospasm. J Neurosurg 72: 224–230
Inagawa T, Yamamoto M, Kamiya K, Ogasawara H (1988) Management of elderly patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 69: 332–339
Ito U, Tomita H, Yamazaki S, Takada Y, Inaba Y (1986) Enhanced cisternal drainage and cerebral vasospasm in early aneurysm surgery. Acta Neurochir (Wien) 80: 18–23
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484
Kaneko M, Hosaka Y, Koga H (1980) Experience of per-acute operation for severe type of ruptured intracranial aneurysm: application of repeated irrigation of basal cistern. Neurol Med Chir 20: 915–921 (Jpn)
Kawakami Y, Shimamura Y (1987) Cisternal drainage after early operation of ruptured intracranial aneurysm. Neurosurgery 20: 8–14
Kodama N, Sasaki T, Watanabe Z, Yamanobe K, Sato M (1986) Prevention of vasospasm: cisternal irrigation therapy with urokinase and ascorbic acid. In: Kikuchi Het al (eds) Intracranial aneurysms-surgical timing and techniques. Nishimura, Niigata, pp 228–242
Ljunggren B, Brandt L, Kagström E, Sundbärg G (1981) Results of early operations for ruptured aneurysms. J Neurosurg 54: 473–479
Mizukami M, Kawase T, Usami T, Tazawa T (1982) Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10: 301–307
Ogura K, Hara M, Tosaki F, Hirai N (1988) Effect of cisternal drainage after early operation for ruptured intracranial aneurysms. Surg Neurol 30: 441–444
Saito I, Ueda Y, Sano K (1977) Significance of vasospasm in the treatment of ruptured intracranial aneurysms. J Neurosurg 47: 412–429
Sakaki S, Ohta S, Kuwabara H, Shiraishi M (1987) The role of ventricular and cisternal drainage in the early operation for ruptured intracranial aneurysms. Acta Neurochir (Wien) 88: 87–94
Sano K, Saito I (1978) Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm. Acta Neurochir (Wien) 41: 49–60
Sato J, Sato O, Kamitani H, Kanazawa I, Kokunai T (1979) Intracranial surgery and postoperative management of patients with ruptured aneurysm in acute and subacute satage: basal cisternal drainage and lumbar subarachnoid drainage. Neurol Med Chir 19: 173–179 (Jpn)
Shigeno T, Saito I, Aritake K, Kaneko M, Mima T, Sasaki M, Nagashima T, Watanabe E, Noguchi M, Tanishima T, Sano K (1979) Hydrocephalus following early operation on ruptured cerebral aneurysms: significance of long-term monitoring of intracranial pressure. Neurol Med Chir 19: 529–535 (Jpn)
Shiobara R, Kawase T, Toya S, Ebato K, Miyahara Y (1985) “Scavenger surgery” for subarachnoid hemorrhage. (II) Continuous ventriculo-cisternal perfusion using artificial cerebrospinal fluid with urokinase. In: Auer LM (ed) Timing of aneurysm surgery. Walter de Gruyter, Berlin, pp 365–372
Sonobe M, Takahashi S, Otsuki T, Kubota Y (1981) Preventive effect on intracranial arterial vasospasm using combined ventriculo -cisternal and cisternal drainage. No Shinkei Geka 9: 1393–1397 (Jpn)
Suzuki J, Onuma T, Yoshimoto T (1979) Results of early operation on cerebral aneurysms. Surg Neurol 11: 407–412
Suzuki J, Yoshimoto T, Onuma T (1978) Early operation for ruptured intracranial aneurysms-study of 31 cases operated on within the first four days after ruptured aneurysm. Neurol Med Chir 18 (Part I): 83–89
Taneda M (1982) Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms. J Neurosurg 57: 622–628
Yamamoto I, Hara M, Ogura K, Suzuki Y, Nakane T, Kageyama N (1983) Early operation for ruptured intracranial aneurysms: comparative study with computed tomography. Neurosurgery 12: 169–174
Yamamoto I, Shimoda M, Yamada S, Ikeda A, Shibuya N, Tsugane R, Sato O, Hara M (1989) Indications for cisternal drainage in cunjunction with early surgery for ruptured aneurysms and timing of its discontinuation. Neurol Med Chir 29: 407–413
Yoshida Y, Hayashi T, Amoh M, Ahagon A, Kusuno K, Uno T, Ogino T, Kobayashi H, Shibata N, Ueki S (1983) Postoperative intrathecal irrigation with plasminogen activator (urokinase) after early stage operation on ruptured cerebral aneurysm. Neurol Med Chir 23: 659–666 (Jpn)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Inagawa, T., Kamiya, K. & Matsuda, Y. Effect of continuous cisternal drainage on cerebral vasospasm. Acta neurochir 112, 28–36 (1991). https://doi.org/10.1007/BF01402451
Issue Date:
DOI: https://doi.org/10.1007/BF01402451