Lumbar Cerebrospinal Fluid Drainage in Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review

Dr. Ranjith HK

Abstract: Aneurysmal subarachnoid hemorrhage (aSAH) remains a neurosurgical emergency associated with high morbidity and mortality despite advances in management. The EARLYDRAIN trial by Wolf et al. (2023) introduced prophylactic lumbar cerebrospinal fluid (CSF) drainage as an adjunct to standard care, reporting a reduction in unfavourable outcomes at 6 months and a lower incidence of secondary infarctions. This review critically evaluates the trial?s methodology, clinical implications, and underlying physiologic rationale from a Neuroanaesthesiology and neurocritical care perspective, comparing the findings with similar studies such as the LUMAS trial and retrospective analyses, while considering current standards and potential future directions.

Keywords: aneurysm, csf, vasospasm, dci, lumbar drain, sah