Role of Continuous Cisternal Drainage in Addition to Cisternostomy in the Surgical Management of Ruptured Aneurysms - A Retrospective Analysis of Clinical Outcomes

Abstract

ABSTRACT Introduction: Subarachnoid haemorrhage is the major factor in morbidity and mortality following aneurysm ruptures. Thick subarachnoid haemorrhage in cisternal spaces increases risk of vasospasm, delayed cerebral ischaemia and incidence of hydrocephalus following surgery. Continuous cisternal drainage in addition to opening of basal cisterns during clipping of aneurysm helps in continuous drainage of cisternal blood thus improving the clinical outcome. Materials and Methods: We conducted a retrospective review of 50 consecutive cases of ruptured aneurysms treated by microsurgical clipping between January 2020 and February 2023. Patients were stratified into two groups: Group 1 included patients with only cisternostomy (opening all the cisterns around major vessels) and Group 2 included patients with additional continuous cisternal drainage (CCD). We compared their baseline characteristics and clinical outcomes. Results: There were no statistically significant differences between the two groups in terms of epidemiological characteristics, WFNS score, Fisher’s scale and presence of intraventricular haemorrhage. Patients in group two (cisternostomy with continuous cisternal drainage) showed less incidence of vasospasm and hydrocephalus. Conclusion: Cisternostomy with continuous cisternal drainage (CCD) allows the effective removal of subarachnoid blood, thereby reducing vasospasm, arachnoid inflammation and fibrosis.