Lumbar Continuous Drainage of the Cerebrospinal Fluid Therapy for Subarachnoid Hemorrhage:A Systematic Review

Objectives To assess the effectiveness and safety of lumbar continuous drainage of the cerebrospinal fluid therapy for subarachnoid hemorrhage(SAH).Methods The method of Cochrane systematic review was used to evaluate the randomized controlled trials(RCTs)of lumbar contiunous drainage of the cerebrospinal fluid therapy for SAH.Results We included 7 RCTs involving 390 patients.The methodological quality of all the trials was poor.The poor outcome and adverse event evaluation of the SAH patients at the end of long-term follow-up(at least three months)were not reported in all studies.Meta-analysis of fatality showed a better effect of lumbar continuous drainage of the cerebrospinal fluid therapy for SAH than the control group with statistical significance [RR=0.32,95%CI(0.15,0.70)].Meta-analysis of complications also showed a better effect of lumbar continuous drainage of the cerebrospinal fluid therapy for SAH than the control group with statistical significance(except re-bleeding)[cerebral vasospasm RR=0.15,95%CI(0.06,0.33),hydrocephalus RR=0.22,95%CI(0.10,0.52),cerebral infarction RR=0.25,95%CI(0.08,0.82)].Only one trial reported the adverse events of lumbar continuous drainage of the cerebrospinal fluid therapy including intracranial infection and intracranial hypotension reaction,while the other trials did not report the adverse events.Conclusion With poor quality of the most included trials,insufficient evidence is obtained to support the conclusion that lumbar continuous drainage of the cerebrospinal fluid therapy is safe and effective in the treatment of SAH.Further high-quality RCTs should be carried out to provide more reliable evidence.