British Journal of Neurosurgery, August 2011; 25(4): 536

LETTER TO THE EDITOR

Management of acute hydrocephalus following aneurysmal

subarachnoid haemorrhage: the role of serial lumbar puncture
and continuous lumbar drainage

HANI MARCUS, CHRIS UFF, MARY MURPHY & LEWIS THORNE

Department of Neurosurgery, Royal Free Hospital, London, UK

Br J Neurosurg Downloaded from informahealthcare.com by Mcmaster University on 10/16/11

We read with interest the recent article by Gigante
et al.1 published in Br J Neurosurg 2010;24(6):625–
32. While we agree that external ventricular drainage
plays an important role in the management of
aneurysmal subarachnoid haemorrhage, we were
surprised that serial lumbar puncture and continuous
lumbar drainage were not mentioned as alternative
For personal use only.
different techniques are sparse and a randomised
controlled study on the use of serial lumbar
puncture, continuous lumbar drainage and external
ventricular drainage in patients with aneurysmal
subarachnoid haemorrhage would provide more
robust evidence to guide management.

methods of cerebrospinal fluid drainage in select
patients. Some clinicians have argued that the use of
serial lumbar puncture may be limited by the inability
to ensure adequate drainage has been achieved
between procedures, particularly in patients with a
reduced level of consciousness. Nevertheless, both
serial lumbar puncture and continuous lumbar
drainage are safe in patients with communicating
hydrocephalus, can be performed rapidly by the
bedside avoiding the risk of sedation or general
anaesthesia and are associated with a very low risk of
ventriculitis and rebleeding.2 There is also some
evidence to suggest that continuous lumbar drainage
may reduce the risk of delayed ischaemic neurologi-
cal deficits.3 Direct comparisons between these
Declaration of interest: The authors report no
conflicts of interest. The authors alone are respon-
sible for the content and writing of the paper.
References
1. Gigante P, Hwang BY, Appelboom G, Kellner CP, Kellner
MA, Connolly ES. External ventricular drainage following
aneurysmal subarachnoid haemorrhage. Br J Neurosurg 2010;
24(6):625–32.
2. Hasan D, Lindsay KW, Vermeulen M. Treatment of acute
hydrocephalus after subarachnoid hemorrhage with serial
lumbar puncture. Stroke 1991;22(2):190–4.
3. Klimo P, Jr., Kestle JR, MacDonald JD, Schmidt RH. Marked
reduction of cerebral vasospasm with lumbar drainage of
cerebrospinal fluid after subarachnoid hemorrhage. J Neuro-
surg 2004;100(2):215–24.

Correspondence: Lewis Thorne, Consultant Neurosurgeon, Department of Neurosurgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
E-mail: lewisthorne@nhs.net

Received for publication 8 January 2011. Accepted 25 April 2011.

ISSN 0268-8697 print/ISSN 1360-046X online Ó 2011 The Neurosurgical Foundation
DOI: 10.3109/02688697.2011.584639