CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(03): e224-e231
DOI: 10.1055/s-0042-1742717
Original Article

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

Papel da colocação do reservatório de Ommaya no tratamento da hidrocefalia após hemorragia subaracnoidea aneurismática, uma experiência inicial
1   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
,
1   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
› Author Affiliations

Abstract

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.

Resumo

Introdução O desmame da drenagem ventricular externa (DVE) do líquido cefalorraquidiano (LCR) na hidrocefalia induzida por hemorragia subaracnóidea aneurismática (HSA) foi proposto pelas abordagens rápida, gradual ou intermitente. Não há diretrizes uniformes para isso. Diante disso, planejamos estudar o resultado comparativo entre drenagem DVE com pinçamento intermitente versus DVE seguido de reservatório de Ommaya.

Materiais e métodos O presente estudo observacional retrógrado foi realizado de julho de 2018 a março de 2021 no departamento de neurocirurgia com 67 pacientes que desenvolveram hidrocefalia após HSA consequente de ruptura de aneurisma. Dividimos os pacientes em dois grupos. O grupo 1 teve apenas DVE colocado para drenagem do líquor com pinçamento intermitente antes da colocação da derivação ventrículo-peritoneal (VP) e, no grupo 2, um reservatório de Ommaya foi colocado após a DVE antes da derivação.

Resultado Havia 38 pacientes no grupo 1 e 29 no grupo 2. Eles eram pareados por idade, com leve predominância do sexo masculino no grupo 1. A dependência de shunt foi significativamente reduzida nos pacientes do grupo 2 (p = 0,011), juntamente com menor tempo de internação na UTI (p = 0,001) e tempo de permanência no Hospital (p = 0,019). Encontramos melhora no escore de Glasgow nos pacientes do grupo 2 (p = 0,006) juntamente com redução da incidência de infarto (p = 0,0095).

Conclusão Podemos inferir do presente estudo que a drenagem contínua por DVE, inicialmente, na hidrocefalia induzida por HSA após ruptura de aneurisma, aumenta a pressão de perfusão cerebral (PPC) e diminui a pressão intracraniana (PIC) levando à diminuição da taxa de infarto e drenagem intermitente por Ommaya após DVE reservatório, diminui a dependência do shunt, reduz a permanência na UTI e no hospital, com melhora do escore de Glasgow no acompanhamento, mas esses achados precisam ser validados em um estudo prospectivo randomizado de controle.

Contribution of the Authors

Conceptualization, clinical work, data collection, data analysis, manuscript drafting and revision were done by Jha V. C. Data collection and analysis were done by Jha V. C, and Shahnawaz A. Data analysis and manuscript supervision were performed by Jha V. C, MSA and NJ. All authors have read and approved the final version of the manuscript. This manuscript has neither been presented as a whole nor part in any conference or scientific meeting. This article is neither published nor under consideration for publication anywhere else.




Publication History

Received: 20 July 2021

Accepted: 13 October 2021

Article published online:
05 September 2022

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