Cerebrospinal Fluid Drainage: Weighing Survival Against Infection Risks

The study posits that cerebrospinal fluid drainage (CSFD) correlates with improved clinical outcomes in patients suffering from aneurysmal subarachnoid haemorrhage (aSAH). However, these findings rely on aggregated data from 20 observational and clinical studies, necessitating a cautious interpretation of the procedure's safety profile.

Researchers analysed records for 3,442 patients up to July 2025. The cohort was divided into those receiving the intervention (2,258) and a control group (1,184). By calculating odds ratios, the authors sought to measure the impact of drainage on mortality and secondary complications. It is worth noting that while statistical significance was achieved in several domains, the heterogeneity of the included studies imposes limits on broader generalisation.

Efficacy of cerebrospinal fluid drainage vs infection risks

The numbers present a stark dichotomy. Pooled analysis indicates that CSFD is associated with a reduction in mortality (OR: 0.54) and a lower incidence of cerebral vasospasm. This appears beneficial. Yet, the intervention is not benign. The data measured a substantial increase in the risk of intracranial infection (OR: 2.31). This is a serious complication.

Furthermore, while the procedure suggests a mitigation of delayed cerebral ischaemia, it failed to demonstrate any preventative effect against hydrocephalus. Subgroup analysis revealed further inconsistencies. While the reduction in vasospasm remained constant across different drainage methods, other outcomes fluctuated depending on the study design. This variability implies that the specific protocol used—lumbar versus ventricular—may influence patient trajectories significantly. Consequently, the authors rightly conclude that high-quality randomised controlled trials are required to isolate true efficacy from potential confounding variables.