Short summary

Subarachnoid hemorrhage (SAH) is a life threatening disease. If the patient survives the primary hemorrhage, the patient is at risk for rebleeding, hydrocephalus and vasospasms. Rebleeding can be prevented by treating the aneurysm surgically with clip or endovascular with coils. Hydrocephalus can be treated with a drain for CSF (cerebrospinal fluid) removal. When it comes to vasospasms, current treatment methods are often at a loss. The risk of vasospasms is proportional with the size of the hemorrhage and the volume of blood in the subarachnoid space. CSF removal is the traditional treatment for unconscious patients with hydrocephalus; the treatment also removes blood from the subarachnoid space. The drain may be placed in a lateral ventricle (external drain - ED) or lumbar (lumbar drain - LD). Previous studies imply that LD is related to a better immediate clinical outcome, thus these studies is fraught with uncertainty, since patients who candidate to lumbar drain treatment, often will be patients with less hemorrhage and no blood in significant parts of the brain's fluid-filled cavities.

Rationale

Compared with ED, LD is associated with...

1. earlier removal of blood from the subarachnoid space
2. less vasospasms
3. fewer permanent shunt implantations 

The cohort will consist of approx. 20 unconscious adult patients (18+) admitted to the Department of Neurosurgery, OUH with aneurysmal SAH and in need of CSF removal, but without clots in the 3^th or 4^th ventricle. Patients are randomized for either ED or LD using the tool OPEN Randomize.

1. Excretion of blood from the subarachnoid  space in a 7-10 days period
2. Flow velocities at transcranial Doppler examination (TCD)/registration of clinical vasospasms
3. Number of shunt implantations during primary hospitalization

Description of the cohort

Spectrophotometric CSF analyses for hemoglobin derivates, plasma-hemoglobin, relevant patient data including intracranial pressure monitoring data, TCD data, registration of shunt implantations, registration of complications potentially related to drain placement. CSF samples will be collected in Neurologic OPEN biobank for future research.

Collaborating researchers and departments

Department of Neurosurgery, Odense University Hospital

• Peter Birkeland, MD
• Senior Hospital Physician Frantz Rom Poulsen, PhD

Center for Coagulation and Hemostasis, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital

• Senior Hospital Physician Mads Nybo, PhD

Unit of Neuroanesthesiology, Department of Anesthesiology and Intensive Care, Odense University Hospital

• Senior Hospital Physician Peter Martin Hansen