Efficacy and safety of lumbar drainage in the microsurgical treatment of aneurysmal subarachnoid hemorrhage

Background. Lumbar drainage (LD) is an important treatment modality after aneurysmal subarachnoid hemorrhage (SAH), particularly to reduce the risk of cerebral vasospasm (CV) and delayed cerebral ischemia (DCI). Despite potential complications such as meningitis, LD improves functional outcomes and promotes recovery of neurological deficits. However, its use does not reduce mortality in patients with aneurysmal SAH. Purpose – to determine the features of early LD added to the standard treatment for patients with SAH. Materials and Methods. In a retrospective cohort study, the medical records of 259 patients with aneurysmal SAH treated between 2000 and 2023 were analyzed. Patients were divided into three groups depending on the fact of LD placement and its duration: 1 – LD to ensure surgical access, 2 – prolonged LD until complete cerebrospinal fluid drainage, and 3 – without LD. The study included an analysis of the efficacy and safety of LD by assessing demographic data, LD duration, clinical manifestations, incidence of hydrocephalus and meningitis, as well as CV, DCI, and treatment outcomes. Results. Patients with short-term LD demonstrated better grades on the m-WFNS scale on the first postoperative day. Patients with meningeal signs required LD more often, while general cerebral neurological symptoms limited its use. A one-day use of LD did not increase the frequency of meningitis. Long-term use of LD did not affect the development of CV and DCI. Conclusions. The LD placement should be based on the patient’s clinical profile, considering the meningeal syndrome and the extent of hemorrhage. LD has demonstrated efficacy and safety as an adjunctive treatment for SAH.