Lumbar Drainage of Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage: A Prospective, Randomized, Controlled Trial (LUMAS)

• Published in: Stroke (1970) Vol. 43; no. 3; pp. 677 - 682
• Main Authors: AL-TAMIMI, Yahia Z, BHARGAVA, Deepti, FELTBOWER, Richard G, HALL, Gregory, GODDARD, Anthony J. P, QUINN, Audrey C, ROSS, Stuart A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.03.2012
• Subjects: Adult; Aged; Biological and medical sciences; Biotechnology; Cohort Studies; Double-Blind Method; Drainage - methods; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Gene therapy; Health. Pharmaceutical industry; Humans; Industrial applications and implications. Economical aspects; Intention to Treat Analysis; Lumbosacral Region; Male; Medical sciences; Middle Aged; Nervous System Diseases - etiology; Nervous System Diseases - prevention & control; Neurology; Prospective Studies; Subarachnoid Hemorrhage - cerebrospinal fluid; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - therapy; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Stroke; Nervous system diseases; Subarachnoid hemorrhage; Vasoconstriction; Cardiovascular disease; Cerebrospinal fluid; Cerebral disorder; randomized controlled trial; Vascular disease; Drainage; Ischemia; Bypass; aneurysmal subarachnoid hemorrhage; Central nervous system disease; Vasospasm; Cerebrovascular disease; lumbar drain; cerebrospinal fluid drainage; delayed ischemic neurological deficit
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.111.625731

A single-center prospective randomized controlled trial has been conducted to determine if lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage reduces the prevalence of delayed ischemic neurological deficit and improves clinical outcome. Patients with World Federation of Neurological Surgeons Grade 1 to 3 aneurysmal subarachnoid hemorrhage and modified Fisher Grades 2, 3, 4, and 3+4 were randomized to either the study group of standard therapy plus insertion of a lumbar drain or the control group of standard therapy alone. The primary outcome measure was the prevalence of delayed ischemic neurological deficit. Two hundred ten patients with aneurysmal subarachnoid hemorrhage (166 female, 44 male; median age, 54 years; interquartile range, 45-62 years) were recruited into the control (n=105) and study (n=105) groups of the trial. World Federation of Neurological Surgeons grade was: 1 (n=139), 2 (n=60), and 3 (n=11); Fisher grade was: 2 (n=87), 3 (n=85), and 4 (n=38). The prevalence of delayed ischemic neurological deficit was 35.2% and 21.0% in the control and study groups, respectively (P=0.021). The prevalence of a modified Rankin Scale score of 4, 5, or 6 at Day 10 and 6 months, respectively, was 62.5% and 18.6% in the control group and 44.8% and 19.8% in the study group (P=0.009 and 0.83, respectively). Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage has been shown to reduce the prevalence of delayed ischemic neurological deficit and improve early clinical outcome but failed to improve outcome at 6 months after aneurysmal subarachnoid hemorrhage. URL: www.clinicaltrials.gov. Unique identifier: NCT00842049.