Role of Ommaya Reservoir Placement in Hydrocephalus Management following Aneurysmal Subarachnoid Hemorrhage, an Initial Experience

Brazilian Neurosurgery

article

Vikas Chandra Jha¹  Shahnawaz Alam¹ 

[1] Department of Neurosurgery, All India Institute of Medical Sciences

关键词: shunt dependent hydrocephalus;    subarachnoid hemorrhage;    aneurysm rupture;    continuous and intermittent drainage;    external ventricular drainage;    Ommaya;   

DOI  :  10.1055/s-0042-1742717

学科分类：社会科学、人文和艺术（综合）

来源: Thieme

【 摘 要 】

Introduction Weaning from external ventricular drainage (EVD) of cerebrospinal fluid (CSF) in hydrocephalus induced by aneurismal subarachnoid hemorrhage (SAH) had been proposed either through the rapid, gradual or intermittent approaches. There are no uniform guidelines for it. Given this, we planned to study the comparative outcome between EVD drainage with intermittent clamping versus EDV followed by Ommaya reservoir.Material and Methods The present retrograde observational study was conducted from July 2018 to March 2021 in the department of neurosurgery with 67 patients who developed hydrocephalus following SAH after aneurysm rupture. We divided the patients into two groups. Group 1 had only EVD placed for CSF drainage with intermittent clamping before the placement of the ventriculoperitoneal (VP) shunt, and, in group 2, an Ommaya reservoir was placed after EVD before the shunt.Result There were 38 patients in group 1 and 29 in group 2. They were age-matched, with a mild male predominance in group 1. Shunt dependency was significantly reduced in group 2 patients (p = 0.011), along with reduced length of stay in ICU (p = 0,001) and length of stay in Hospital (p = 0.019). We found improved Glasgow outcome score in group 2 patients (p = 0.006) together with reduced incidence of infarct (p = 0.0095).Conclusion We may infer from the present study that continuous drainage through EVD, initially, in hydrocephalus induced by SAH following aneurysm rupture, increases cerebral perfusion pressure (CPP) and decreases intracranial pressure (ICP) leading to decreased infarct rate and intermittent drainage through Ommaya following EVD reservoir, decreases shunt dependency, reduces ICU and hospital stay, with improved Glasgow outcome score on follow-up, but these findings need to be validated in a prospective randomized control trial.

【 授权许可】

CC BY|CC BY-NC-ND