Efficacy And Safety Of Lumbar Drainage Versus Lumbar Puncture In The Treatment Of Aneurysmal Subarachnoid Haemorrhage:a Meta-analysis

Objectives With the improvement of cerebral aneurysm diagnosis,early operation and neurocritical care,the mortality of cerebral aneurysm has decreased compared with the previous period.However,patients with aneurysmal subarachnoid hemorrhage(a SAH)still have many complications after surgery that seriously affect the prognosis.Active prevention and treatment of complications is an important part of a SAH treatment.Lumbar drainage and lumbar puncture are widely used clinically as the main methods of external cerebrospinal fluid drainage after a SAH.This article uses the method of Meta analysis to systematically review the efficacy and safety of lumbar drainage versus lumbar puncture in the treatment of aneurysmal subarachnoid hemorrhage.Methods Pub Med,The Cochrane Library,EMbase,Sino Med,VIP,CNKI,and Wan Fang Data databases were electronically searched to collect randomized controlled trials(RCT),prospective or retrospective cohort studies on the efficacy and safety of lumbar drainage versus lumbar puncture for the treatment of a SAH patients from inception to December 2019.Two reviewers independently screened the literature,extracted the data,and assessed the risk of bias of included studies,meta-analysis was performed by using Rev Man 5.3 software.Results A total of 28 studies were involving 2315 patients were included.The results of meta-analysis show that,compared with lumbar puncture,lumbar drainage could shorten headache time(MD =-3.33,95%CI-3.71 to-2.95,P <0.000 01),reduce cerebral vasospasm incidence rate(RR = 0.47,95% CI 0.40 to 0.55,P <0.000 01),reduce the incidence of hydrocephalus(OR = 0.29,95% CI 0.22 to 0.38,P <0.000 01),improve the short-term prognosis(OR=1.78,95%CI 1.40 to 2.26),P <0.000 01).The intracranial infection rate(RR = 2.18,95% CI 1.28 to 3.74,P=0.004)in the lumbar cistern drainage group was higher than that in the lumbar puncture group.The differences were statistically significant.There was no statistically significant difference both in the incidence of cerebral infarction(OR = 0.70,95% CI 0.47 to 1.03,P =0.07),mortality(OR = 0.5,95% CI 0.23 to 1.09,P =0.08)and rebleeding(OR = 0.74,95% CI 0.39 to 1.40,P =0.35).Conclusions Current evidence shows that compared with lumbar puncture,lumbar drainage for treatment of aneurysmal subarachnoid hemorrhage can shorten the time of headache,reduces the incidence of cerebral vasospasm and hydrocephalus,improve the short-term prognosis,and can not further reduces the incidence of cerebral infarction and mortality.There was no statistically significant in the incidence of rebleeding,but lumbar drainage has a higher risk of intracranial infection.Due to limited quality and quantity of the included studies,more high quality randomized controlled trials are required to verify above conclusions.