ObjectiveTo assess the effectiveness and safety of continuous lumbar drainage of cerebrospinal fluid for subarachnoid hemorrhage (SAH). MethodsThe Cochrane Library (January 1992 to May 2013), Medline (January 1950 to May 2013), SinoMed (January 1979 to May 2013), CNKI (January 1979 to May 2013), and Wanfang Database (January 1979 to May 2013) were searched for randomized controlled trials (RCTs) on continuous lumbar drainage for SAH. The method of Cochrane systematic review was used to evaluate all the included RCTs. ResultsTwelve RCTs (857 patients) met the inclusion criteria, but the general methodological quality of trials was poor. Only two studies addressed the outcomes about SAH patients' death, vegetative state or disability and other adverse events at the end of the follow-up period (at least 3 months). Meta-analysis of fatality showed a better effect of lumbar continuous drainage of the cerebrospinal fluid for SAH than the control group with statistical significance [RR=0.27, 95%CI (0.12, 0.59), P=0.001]. Meta-analysis of complications also showed a better effect of lumbar continuous drainage of the cerebrospinal fluid for SAH than the control group with statistical significance (except re-bleeding) [cerebral vasospasm: RR=0.20, 95%CI (0.14, 0.30), P<0.000 01; hydrocephalus: RR=0.24, 95%CI (0.13, 0.41), P<0.000 01; cerebral infarction: RR=0.27, 95%CI (0.16, 0.45), P<0.000 01]. Only one trial reported the adverse events of lumbar continuous drainage of the cerebrospinal fluid including intracranial infection and intracranial hypotension reaction, while the others did not report the adverse events. ConclusionWith poor quality of the most included trials, insufficient evidence is obtained to support the conclusion that lumbar continuous drainage of the cerebrospinal fluid is safe and effective in the treatment of SAH. Further high-quality RCTs should be carried out to provide more reliable evidences.
ObjectiveTo systematically review the clinical effectiveness of continuous lumbar drainage for CSF leakage. MethodsA comprehensive literature search was conducted in PubMed, The Cochrane Library (Issue 1, 2014), EMbase, CNKI, CBM, VIP and WanFang Data from January 1994 to January 2014 for randomized or non-randomized controlled trials on the comparison between lumbar drainage and conventional treatment in the effectiveness of CSF leakage treatment. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. ResultsSeven non-randomized controlled trials were finally included, involving 465 patients. The results of meta-analysis showed that:compared with conventional treatment, lumbar drainage was better in effectiveness (RR=3.78, 95%CI 1.91 to 7.50, P=0.000 1), CNS infection rates (RR=0.48, 95%CI 0.24 to 0.95, P=0.04), and hospital stay (MD=-6.66, 95%CI-10.09 to-3.23, P=0.000 1). However, no significant difference was found in the incidence of headache caused by hypotensive cranial pressure (RR=1.32, 95%CI 0.65 to 2.69, P=0.45). ConclusionCurrent evidence suggests that continuous lumbar drainage is superior to conventional treatment in total effectiveness rates, prevention of CNS infection and in reducing hospital stay, which is an effective treatment intervention of CSF leakage. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality studies.