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Acta Neurochirurgica

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01-04-2017 | Review Article - Vascular

Aneurysm rebleeding after placement of external ventricular drainage: a systematic review and meta-analysis

Authors: Federico Cagnazzo, Carlo Gambacciani, Riccardo Morganti, Paolo Perrini

Published in: Acta Neurochirurgica | Issue 4/2017

Abstract

Background

The association between external ventricular drainage (EVD) and aneurysm rerupture is still a controversial issue. We performed a systematic review and meta-analysis of published series reporting data of EVD placement in aneurysmal subarachnoid hemorrhage (SAH) with the aim to evaluate the relationship between ventricular drainage and aneurysm rebleeding.

Method

PRISMA/MOOSE guidelines were followed. The Newcastle-Ottawa Scale was used to assess the quality of the studies. We conducted a comprehensive literature search of three databases (PubMed, Ovid MEDLINE, and Ovid EMBASE) on series reporting patients with EVD placement and aneurysmal SAH. The reported studies were analyzed with a primary aim to calculate the strength of the association (odds ratio) between rebleeding and EVD placement in patients with SAH.

Results

Our systematic review included 16 articles with a total of 6804 patients with SAH of which 595 (8.7%) had aneurysmal rebleeding. Ventricular drainage was inserted in 19% of patients. Rebleeding occurred in 18.8% (95% CI = 16.4–20.6%) of patients requiring EVD and in 6.4% (95% CI = 5.8–7.1%) of patients who did not require EVD (OR = 3.92, p < 0.0001). The mean time between EVD placement and rebleeding was 1 h (range, 0–8 h). The maximal aneurysm diameter of patients with rerupture was larger when compared with patients without rerupture (9.9 mm vs. 7.5 mm; p < 0.04). High Fisher grades (III–IV) were present in 75% of patients with rerupture and in 60% of patients without aneurysmal rerupture (p < 0.0001).

Conclusions

Our study conclusively defined an association between EVD and rebleeding. However, the effective role of EVD in aneurysm rebleeding is insufficiently investigated in the literature. Other significant factors of rebleeding are usually observed in patients requiring ventricular drainage. According to our findings, a causal relationship between EVD and aneurysm rebleeding could be a plausible hypothesis, at least in certain cases.

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Title: Aneurysm rebleeding after placement of external ventricular drainage: a systematic review and meta-analysis
Authors: Federico Cagnazzo
Carlo Gambacciani
Riccardo Morganti
Paolo Perrini
Publication date: 01-04-2017
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 4/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-017-3124-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Aneurysm rebleeding after placement of external ventricular drainage: a systematic review and meta-analysis

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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