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JOURNAL OF NEUROSURGICAL SCIENCES
A Journal on Neurosurgery
Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651
Journal of Neurosurgical Sciences 2017 February;61(1):53-63
Copyright © 2015 EDIZIONI MINERVA MEDICA
The hemorrhage risk of prophylactic external ventricular drain insertion in aneurysmal subarachnoid hemorrhage patients requiring endovascular aneurysm treatment: a systematic review and meta-analysis
Xia ZHU ✉
University of Toronto, Toronto, Canada
INTRODUCTION: Endovascular treatment of acutely ruptured aneurysms requires the administration of antiplatelet and/or anticoagulant medication to prevent thrombosis. For patients who require an external ventricular drain (EVD) insertion to treat hydrocephalus stemming from aneurysm subarachnoid hemorrhage (aSAH), the administration of the medication may increase risk of hemorrhage in patients. It has become a practice for neurosurgeons to insert EVDs in patients with aSAH before endovascular treatment. However, the benefits and risks of this practice have not been fully assessed. The aim of this study was to compare and quantify the hemorrhagic risks associated with endovascular treatment of patients with sSAH before and after EVD.
EVIDENCE ACQUISITION: This is a systematic review and meta-analysis. The literature was searched for studies with EVD and non-EVD patients with ruptured aneurysms undergoing endovascular treatment of aneurysms. A qualitative and quantitative assessment of EVD-related hemorrhage risk before and after endovascular treatment was undergone.
EVIDENCE SYNTHESIS: There seemed to be a stronger correlation between EVD-related hemorrhage and EVD insertion after endovascular treatment (cumulative relative risk: 9.61; 95% CI: 2.29, 40.24) compared to EVD insertion before endovascular treatment (cumulative relative risk: 2.37; 95% CI: 0.57, 9.81).
CONCLUSIONS: EVD-related hemorrhage risk may increase with administration of antiplatelet and/or anticoagulant medication for endovascular treatment of ruptured aneurysms in aSAH patients.
KEY WORDS: Subarachnoid hemorrhage - Drainage - Hemorrhage - Endovascular procedures