Neuroanesthesia & neurocritical care
Cerebrospinal fluid (CSF) diversion after aneurysmal sub-arachnoid hemorrhage: towards personalized treatment strategies
Authors' conclusion
Given the heterogeneity of aSAH presentations and the limitations of existing evidence, individualized selection of CSF diversion techniques is warranted.
Study context
- Population
- Patients with aneurysmal SAH requiring CSF diversion
- Comparison
- Lumbar puncture vs lumbar drain vs cisternal drain vs external ventricular drain
Methodological detailsproposed decision-making algorithm
- Proposed decision-making algorithm
Main finding
As reported in the abstract
- RCT evidence supports lumbar drainage as the only intervention that significantly reduces delayed cerebral ischemia (DCI) and improves functional outcomes; preferred first-line in suitable patients
- External ventricular drains remain indispensable in obstructive hydrocephalus or reduced consciousness
- Lumbar puncture may be considered in carefully selected low-risk patients
- Cisternal drains a potential adjunct in surgical clipping
- Without hydrocephalus, lumbar drains the only strategy with demonstrated long-term benefit
Original publication
CSF diversion after aneurysmal sub-arachnoid hemorrhage: towards personalized treatment strategies. Crit Care. Published 2 December 2025. doi:10.
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