Protective effect of external ventricular drainage on cerebral vasospasm. A retrospective study on aneurysmal SAH treated endovascularly

• In our series, patients without external ventricular drain were found to have a higher occurrence of vasospasm.
• Patients who did not receive CSF diversion had a higher risk for vasospasm at lower Fisher grades compared to patients with ventricular drainage with higher Fisher grades.
• We conclude that CSF diversion may be beneficial in SAH patients, either in the form of a lumbar drain in the absence of hydrocephalus, and in the form of an external ventricular drain when there is hydrocephalus.

ObjectiveCerebral vasospasm (VS) is one of the factors that can most significantly worsen the prognosis after aneurysmal subarachnoid hemorrhage (SAH). A substantial body of evidence supports the idea that CSF diversion could prevent VS, even if this issue is still much debated. External ventricular drainage (EVD) is the recommended procedure for post-hemorrhagic hydrocephalus. In this study we analyzed whether EVD, placed for acute hydrocephalus, is effective in reducing the incidence of clinical and radiological cerebral vasospasm in patients who underwent endovascular treatment for aneurysmal SAH.Patients and methodsWe retrospectively studied the incidence of radiologically confirmed VS in 141 patients treated endovascularly for aneurysmal SAH: 80 underwent EVD for hydrocephalus, 61 did not undergo EVD.ResultsVS occurred in 8.75% of cases (7 patients) in the first groups, while in 22.95% (14 patients) in the second group. In addition, patients not treated with EVD display a prevalence of VS in lower Fisher grades compared to the other group.ConclusionOur data indicate that CSF drainage reduces the risk of vasospasms in patients with endovascular treatment for aneurysmal SAH.