Skip to main content

ORIGINAL RESEARCH article

Front. Surg.
Sec. Neurosurgery
Volume 11 - 2024 | doi: 10.3389/fsurg.2024.1403668

Bleeding Complications Related to External Ventricular Drain Placement in Patients with Ruptured Intracranial Aneurysms: a Single-Center Study

Provisionally accepted
Tang Yue Tang Yue 1*Zhong X. ping Zhong X. ping 2Lin T. ting Lin T. ting 1Zuo F. jun Zuo F. jun 1Fu Min Fu Min 1Wang Li Wang Li 1Yu X. du Yu X. du 1Liu Dong Liu Dong 1Zhang J. can Zhang J. can 1
  • 1 Changsha Fourth Hospital, Changsha, Hunan Province, China
  • 2 Yongzhou Central Hospital, Yongzhou, Hunan, China

The final, formatted version of the article will be published soon.

    Objective: Acute aneurysmal rupture can be treated with endovascular therapy or surgical clipping. For patients with concurrent acute hydrocephalus, the placement of an external ventricular drain (EVD) is required. This study aims to investigate the impact of pre-treatment EVD placement on rebleeding in ruptured aneurysms and to examine the influence of dual antiplatelet therapy and the sequencing of dual antiplatelet therapy with EVD placement on EVD-related hematomas.We reviewed the clinical data of 83 patients with ruptured aneurysms who underwent EVD placement from a total of 606 aneurysm patients consecutively admitted between January 2018 and January 2023. The analysis focused on the impact of pretreatment EVD placement on aneurysmal rebleeding and the effect of dual antiplatelet therapy and its sequencing with EVD placement on EVD-related hematomas.Results: Among the 503 patients with ruptured aneurysms, 83 required EVD placement. EVD was placed before aneurysm treatment in 63 patients and after treatment in 20 patients. The number of aneurysmal rebleeding cases in the pre-treatment EVD group and non-EVD group was 1 (1.6%) and 20 (4.8%), respectively (p=0.406). 31 patients (37.3%) underwent stent-assisted embolization or flow diversion requiring dual antiplatelet therapy, while 52 patients (62.7%) underwent simple embolization or surgical clipping without antiplatelet therapy. EVD-related hematomas occurred in 14 patients (16.9%), with 10 cases (32.3%) in those receiving dual antiplatelet therapy and 4 cases (7.7%) in those not receiving antiplatelet therapy (p=0.01). Among 16 patients who had EVD placed before dual antiplatelet therapy, 4 (25%) developed EVD-related hematomas. Of the 15 patients who had EVD placed after dual antiplatelet therapy, 6 (40%) developed EVD-related hematomas (p=0.458).In patients with aneurysmal subarachnoid hemorrhage (aSAH) and acute hydrocephalus, the placement of EVD before aneurysm treatment does not increase the risk of rebleeding. However, dual antiplatelet therapy increases the risk of EVD-related hematoma, and the sequence of EVD placement relative to dual antiplatelet therapy does not appear to significantly affect the outcome of EVD-related hematoma.

    Keywords: aneurysmal subarachnoid Hemorrhage, External ventricular drainage, Rebleeding, antiplatelet, Hematoma

    Received: 19 Mar 2024; Accepted: 25 Sep 2024.

    Copyright: © 2024 Yue, ping, ting, jun, Min, Li, du, Dong and can. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Tang Yue, Changsha Fourth Hospital, Changsha, 410006, Hunan Province, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.