Lumbar Drainage Compared with Extraventricular Drainage of Cerebral Spinal Fluid in Treatment of Patients with Subarachnoid Hemorrhage - a Prospective Randomized Controlled Trial

This study will be a prospective randomized controlled trial. Participants will be patients admitted at UCSD Hillcrest or Thornton Hospital for subarachnoid hemorrhage. Patients will be recruited by the Endovascular Neurosurgical treatment team. Since there are no existing guidelines existing for procedural drainage of subarachnoid blood from the intracranial cisterns, patients are currently treated with either lumbar drain or extraventricular drain. This study would randomize the process of assigning patients to either LD or EVD as part of their treatment package for subarachnoid hemorrhage.

Both EVD and LD are regularly performed at UCSD. Both procedures are equally likely to take place if patients do not have randomization. There is currently no gold standard that dictates whether EVD should be done over LD and vice versa.

Patients will be consented to partake in the study while they are also consented for their usual care in SAH. Briefly, inclusion criteria are patients with Fisher Grade II, III, IV SAH or any aneurysmal SAH patients with radiographic evidence of hydrocephalus. Briefly, exclusion criteria are patients with obstructive hydrocephalus or mass lesion that would preclude lumbar drain placement. Pregnant patients or minors of age <18 will not be included in this study.

There will be two arms of the study: patients randomly assigned to LD and patients randomly assigned to EVD. Randomization will account for Fisher Grade. The two treatment arms will have CSF diversion for 7 days. For patients treated with lumbar drain, patients will have CSF drainage of 10cc/hour for lumbar drain while patients treated with EVD at 15cm above the tragus.

Both an extraventricular drain and a lumbar drain are defined as significant risk devices however both devices are FDA approved and will be utilized in the exact manner that they are intended. Both devices are already regularly utilized and a part of the standard of care for sub arachnoid hemorrhage management and will not be utilized in any novel way. LD and EVD assignment will be randomized through the protocol of the study.