Turkish Neurosurgery 2013 , Vol 23 , Num 5
Clinical Characteristics and Outcomes of Patients with Cerebral Herniation During Continuous Lumbar Drainage
Ke WANG, Zhiyu LIU, Xianzhen CHEN, Meiqing LOU, Jia YIN
Shanghai Tenth People’s Hospital, Department of Neurosurgical, Shanghai, China DOI : 10.5137/1019-5149.JTN.7954-13.0 AIM: The aim of this study was to investigate the clinical characteristics and outcomes of patients who developed cerebral herniation after continuous lumbar cerebrospinal fluid (CSF) drainage.

MATERIAL and METHODS: We retrospectively reviewed eight patients who developed cerebral herniation after receiving continuous lumbar drainage between January 2009 and March 2012 in our department.

RESULTS: All eight patients were male, aged from 21 to 66 years old. All eight patients received surgical treatment and exhibited impaired consciousness before lumbar drainage, and five (62.5%) also underwent decompressive craniectomy. The average drainage speed in these patients varied from 8.3 mL/h to 20.0 mL/h, demonstrating an inverse correlation with the latency period of brain herniation after initiation of the drainage (p=0.017). Four (50.0%) patients experienced cardiopulmonary instability at the onset of cerebral herniation, requiring immediate resuscitation. After drainage clamping and supportive treatment, seven (87.5%) patients displayed complete reversal of cerebral herniation within 48 h.

CONCLUSION: Cerebral herniation induced by continuous lumbar drainage is mostly reversible if early identification and prompt management are realized. Faster drainage speed may be associated with earlier occurrence of brain herniation during lumbar drainage. Keywords : Cerebral herniation, Transtentorial herniation, Lumbar drainage, Lumbar puncture, Decompressive craniectomy

Corresponding author : Jia Yn, trizzt@gmail.com