Increased rate of ventriculostomy-related hemorrhage following endovascular treatment of ruptured aneurysms compared to clipping
Acutely ruptured aneurysms can be treated by endovascular intervention or via surgery (clipping). After endovascular treatment, the risk of thromboembolic complications is reduced by the use of anticoagulative agents, which is not required after clipping. The aim of the study is to investigate the rate of ventriculostomy-related hemorrhage after endovascular treatment and clipping.
A consecutive series of 99 patients treated for a ruptured aneurysm which required an external ventricular drainage between 2010 and 2015 were included. Their CT scans were investigated retrospectively for ventriculostomy-related hemorrhage. Furthermore, the extent of bleeding, the rate of revision surgery, and the rate of bacterial ventriculitis have been analyzed.
Ventriculostomy-related hemorrhage was observed in 20 of 45 patients after endovascular treatment compared to 7 of 54 patients after clipping (chi-squared test, p < 0.001). Revision surgery was indicated in 75%. In 50% of these patients, revision surgery was required more than once and nearly 50% developed additional cerebral infections. Intraventricular or intracerebral extension of the bleeding was observed only in the endovascular treatment group (chi-squared test, p = 0.003). Glasgow outcome scale showed a significant better outcome in the surgical group (t test, p = 0.005).
Ventriculostomy-related hemorrhage is an underestimated complication after endovascular treatment leading to revision surgeries, bacterial infections, and may have a negative impact on long-term outcome. The probability of occurrence is increased when anticoagulation is performed by heparin in combination with antiplatelet drugs as compared to heparin alone. Lumbar drainage should be considered as an alternative for treatment of acute hydrocephalus in patients with Hunt and Hess grade 1–3.
KeywordsVentriculostomy-related hemorrhage External ventricular drain Coiling Stenting Anticoagulation Clipping Endovascular treatment
Compliance with ethical standards
For this type of study, formal consent is not required.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Alcalá-Cerra G, Paternina-Caicedo Á, Díaz-Becerra C, Moscote-Salazar LR, Gutiérrez-Paternina JJ, Niño-Hernández LM, en representación del Grupo de Investigación en Ciencias de la Salud y Neurociencias (CISNEURO) (2016) External lumbar cerebrospinal fluid drainage in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of controlled trials. Neurologia 31:431–444CrossRefPubMedGoogle Scholar
- 6.Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology et al (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737CrossRefPubMedGoogle Scholar
- 7.Fountas KN, Kapsalaki EZ, Machinis T, Karampelas I, Smisson HF, Robinson JS (2006) Review of the literature regarding the relationship of rebleeding and external ventricular drainage in patients with subarachnoid hemorrhage of aneurysmal origin. Neurosurg Rev 29:14–18 discussion 19-20CrossRefPubMedGoogle Scholar
- 19.Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group et al (2005) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817CrossRefPubMedGoogle Scholar
- 20.Panni P, Fugate JE, Rabinstein AA, Lanzino G (2017) Lumbar drainage and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review. J Neurosurg Sci 61:665–672Google Scholar
- 25.Scholz C, Hubbe U, Deininger M, Deininger MH (2013) Hemorrhage rates of external ventricular drain (EVD), intracranial pressure gauge (ICP) or combined EVD and ICP gauge placement within 48 h of endovascular coil embolization of cerebral aneurysms. Clin Neurol Neurosurg 115:1399–1402CrossRefPubMedGoogle Scholar