• Xia Zhu.
• University of Toronto, Toronto, Canada - alicexia.zhu@mail.utoronto.ca.
• J Neurosurg Sci. 2017 Feb 1; 61 (1): 53-63.

IntroductionEndovascular treatment of acutely ruptured aneurysms requires the administration of antiplatelet and/or anticoagulant medication to prevent thrombosis. For patients who require an external ventricular drain (EVD) insertion to treat hydrocephalus stemming from aneurysm subarachnoid hemorrhage (aSAH), the administration of the medication may increase risk of hemorrhage in patients. It has become a practice for neurosurgeons to insert EVDs in patients with aSAH before endovascular treatment. However, the benefits and risks of this practice have not been fully assessed. The aim of this study was to compare and quantify the hemorrhagic risks associated with endovascular treatment of patients with sSAH before and after EVD.Evidence AcquisitionThis is a systematic review and meta-analysis. The literature was searched for studies with EVD and non-EVD patients with ruptured aneurysms undergoing endovascular treatment of aneurysms. A qualitative and quantitative assessment of EVD-related hemorrhage risk before and after endovascular treatment was undergone.Evidence SynthesisThere seemed to be a stronger correlation between EVD-related hemorrhage and EVD insertion after endovascular treatment (cumulative relative risk: 9.61; 95% CI: 2.29, 40.24) compared to EVD insertion before endovascular treatment (cumulative relative risk: 2.37; 95% CI: 0.57, 9.81).ConclusionsEVD-related hemorrhage risk may increase with administration of antiplatelet and/or anticoagulant medication for endovascular treatment of ruptured aneurysms in aSAH patients.

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