[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-455793-105":59,"doc-detail-455793-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","csf-diversion-after-aneurysmal-sub-arachnoid-hemorrhage-towards-personalized-treatment-strategies","CSF diversion after aneurysmal sub-arachnoid hemorrhage - towards personalized treatment strategies","","Aneurysmal subarachnoid hemorrhage (aSAH) is life-threatening and is followed by high morbidity and mortality, with survivors often facing persistent neurological and functional deficits. Cerebrospinal fluid (CSF) diversion is central in acute care for hydrocephalus treatment and for preventing delayed cerebral ischemia (DCI) by clearing blood breakdown products. Four main modalities are used: lumbar puncture, lumbar, cisternal, and external ventricular drainage. Evidence from randomized trials supports lumbar drainage as the preferred first-line option in suitable patients. Case selection should be individualized to balance effectiveness and iatrogenic risks, using a pragmatic algorithm for decision-making.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/csf-diversion-after-aneurysmal-sub-arachnoid-hemorrhage-towards-personalized-treatment-strategies/455793/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/csf-diversion-after-aneurysmal-sub-arachnoid-hemorrhage-towards-personalized-treatment-strategies/455793.png","ImageObject",300,407,{"name":92,"@type":93},"Connor ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",17,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the clinical purpose of CSF diversion in aSAH?","Question",{"text":113,"@type":114},"CSF diversion is used for acute hydrocephalus management and to prevent delayed cerebral ischemia (DCI) by clearing blood breakdown products.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which CSF diversion technique is supported as the preferred first-line option?",{"text":118,"@type":114},"High-quality randomized trial evidence supports lumbar drainage as the only intervention that significantly reduces DCI incidence and improves functional outcomes in suitable patients.",{"name":120,"@type":111,"acceptedAnswer":121},"How should CSF diversion modality selection be handled given patient heterogeneity?",{"text":122,"@type":114},"Because aSAH presentations vary and existing evidence has limitations, individualized selection is warranted, guided by a pragmatic decision-making algorithm to optimize outcomes while minimizing complications.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},455793,1790791501,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},687207022233,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Klug etal. Critical Care (2026) 30:10 Critical Care  \n[https://doi.org/10.1186/s13054-025-05788-8](https://doi.org/10.1186/s13054-025-05788-8)  \nPERSPECTIVE Open Access  \nCSF diversion after aneurysmal sub-arachnoid hemorrhage: towards personalized treatment strategies  \nJulian Klug 1,2*, Roland Roelz3, Giulia Cossu4, Nawfel Ben-Hamouda 1, Stefan Wolf5 and Urs Pietsch6,7  \nAbstract  \nAneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition associated with high morbidity and mortality, with survivors often experiencing long-term neurological and functional deficits. Cerebrospinal fluid (CSF) diversion plays a pivotal role in the acute management of aSAH, both for the treatment of hydrocephalusand for the prevention of delayed cerebral ischemia (DCI) through clearance of blood breakdown products. Four principal modalities are currently employed: lumbar puncture, lumbar, cisternal, and external ventricular drain.  \nEach technique differs in its mechanism of drainage, monitoring capacity, complication profile, and influence on shunt dependency and long-term outcome. High-quality evidence from randomized controlled trial s now supports lumbar drainage as the only intervention that significantly reduces the incidence of DCI and has been shown to improve functional outcomes, making it the preferred first-line approach in suitable patients. External ventricular drains remain indispensable in cases of obstructive hydrocephalus or reduced consciousness, while lumbar puncture may be considered in carefully selected low-risk patients. Cisternal drains represent a potential adjunct in those undergoing surgical clipping of the aneurysm. In patients without hydrocephalus, lumbar drains remain the only strategy with demonstrated long-term benefit. Given the heterogeneity of aSAH presentations and the limitations of existing evidence, individualized selection of CSF diversion techniques is warranted. We propose a pragmatic decision-making algorithm to optimize patient outcomes while minimizing iatrogenic complications, which can be adapted to institutional practices and further refined through prospective evaluation.  \nKeywords Aneurysmal subarachnoid hemorrhage, Cerebrospinal fluid, Hydrocephalus, External ventricular drain. lumbar drain, Lumbar puncture, Cisternal drain, Delayed cerebral ischemia, Intracranial hypertension  \n*Correspondence: Julian Klug  \njulian.klug@chuv.ch  \n1Department of Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland  \n2Stroke Research Group, Department of Clinical Neurosciences, Faculty of Medicine, University Hospital, Geneva, Switzerland  \n3Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany  \n4Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland  \n5Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany  \n6Division of Perioperative Intensive Care Medicine, Gallen, Cantonal Hospital St. Gallen, St, Switzerland  \n7Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://c","cbCaiaycM540m9wB","https://ap.wps.com/l/cbCaiaycM540m9wB","pdf",1249809,11,"English","# Abstract\n# Background\n## Pathophysiology and contributors to DCI\n## Hydrocephalus and treatment implications","[{\"question\":\"What is the clinical purpose of CSF diversion in aSAH?\",\"answer\":\"CSF diversion is used for acute hydrocephalus management and to prevent delayed cerebral ischemia (DCI) by clearing blood breakdown products.\"},{\"question\":\"Which CSF diversion technique is supported as the preferred first-line option?\",\"answer\":\"High-quality randomized trial evidence supports lumbar drainage as the only intervention that significantly reduces DCI incidence and improves functional outcomes in suitable patients.\"},{\"question\":\"How should CSF diversion modality selection be handled given patient heterogeneity?\",\"answer\":\"Because aSAH presentations vary and existing evidence has limitations, individualized selection is warranted, guided by a pragmatic decision-making algorithm to optimize outcomes while minimizing complications.\"}]","CSF diversion after aneurysmal sub-arachnoid hemorrhage - towards personalized treatment strategies | PDF",1790744354,28]