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• W4367302845 abstract "<h3>Objective:</h3> We present the novel use of the CSF Neurapheresis™ CSF Management System as a safe, controlled CSF diversion system to manage ICP elevation in acute aneurysmal subarachnoid hemorrhage. <h3>Background:</h3> Aneurysmal Subarachnoid Hemorrhage (aSAH) often presents with elevated intracranial pressure (ICP) and communicating hydrocephalus, resulting in increased morbidity/mortality. The PILLAR-XT clinical trial of the Neurapheresis™ CSF Management System (NP) (an automated lumbar drain with an option to divert blood/waste products and return filtered CSF) highlighted its ability to filter and reduce blood/contaminants in the CSF of aSAH patients. We present the novel use of NP as a safe, controlled CSF diversion system to manage ICP elevation in these patients. <h3>Design/Methods:</h3> After enrollment, NP was successfully placed in a 58-year-old female presenting with a high grade ruptured saccular aneurysm (PCoA, Hunt/Hess grade 4), which was coiled. Two days post-admission, the patient experienced refractory ICP elevation (>22mmHg) due to acute communicating hydrocephalus and aSAH. The neuro-intensivist adjusted CSF filtration and waste rates using the NP system to successfully treat ICP elevation. The patient was discharged home without complications and did not require a shunt. <h3>Results:</h3> This case illustrates the novel use of NP to control and manage ICP in acute aSAH while filtering blood/contaminants from the CSF. <h3>Conclusions:</h3> Patients with acute aSAH face high risk complications due to ICP-elevation, and directly related to rupture grade. Current standard of care offers tiers-based approach therapies for ICP management with the use of external ventricular devices (EVDs) for CSF diversion. EVDs are manual, non-specific, and prevent real-time ICP monitoring during CSF diversion, often resulting in incorrect drainage. PILLAR-XT highlighted the potential of NP as a tool for CSF diversion and filtration of RBCs/inflammatory-mediators that are instrumental in common secondary complications. This is the first case of utilizing NP device to divert and filter CSF and also concurrently treat ICP elevation. <b>Disclosure:</b> Dr. Babi has nothing to disclose. Spiros Blackburn has nothing to disclose. Andrew Grande has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Omar Choudri has nothing to disclose. Erick Hauck has nothing to disclose. Christopher Kellner has nothing to disclose." @default.
• W4367302845 created "2023-04-29" @default.
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• W4367302845 date "2023-04-25" @default.
• W4367302845 modified "2023-09-26" @default.
• W4367302845 title "Refractory intracranial pressure elevation (ICP) treatment in acute aneurysmal subarachnoid hemorrhage via the novel neurapharesis CSF management system (P13-7.004)" @default.
• W4367302845 doi "https://doi.org/10.1212/wnl.0000000000203057" @default.
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