This randomized clinical trial addressed the question of whether continuous or intermittent CSF drainage was superior for reducing vasospasm in aneurysmal subarachnoid hemorrhage patients who required an EVD. Patients were randomized to undergo continuous CSF drainage (CD) with intermittent ICP monitoring or continuous ICP monitoring with intermittent CSF drainage (ID). While the study was powered for 86 patients, it was stopped early after an interim analysis of 60 patients showed a significantly higher complication rate in the CD group (52.9%) versus the ID group (23.1%)(OR 3.75, 95% CI 1.21–11.66, p = 0.022). The composite of ventriculitis and/or nonpatent EVD was noted in 50% of the CD group and 15.4% of the ID group. There was no significant difference in vasospasm between the CD group and the ID groups (64.7% and 80.8%, respectively; OR 0.44, 95% CI 0.13–1.45).
Journal of Neurosurgery