HOT TOPICS: Cerebrospinal Fluid Filtration After Subarachnoid Hemorrhage

In this episode of the NCS Podcast Hot Topics series, host Richard Choi, DO, FNCS, speaks with Katharina Busl, MD, MS, FNCS, division chief of neurocritical care at the University of Florida and assistant editor for Neurocritical Care journal. They explore new research on cerebrospinal fluid (CSF) clearance after aneurysmal subarachnoid hemorrhage. They also discuss the study Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage: The Lumbar Catheter Extension (PILLAR XT) Trial, which evaluates a dual-lumen intrathecal catheter designed to filter CSF and accelerate removal of red blood cells and inflammatory byproducts. Their conversation highlights the rationale behind CSF drainage, how prior work like the Early Drain trial shaped the field, and what this early-phase device trial reveals about feasibility, safety, and reductions in CSF RBC and protein levels. Dr. Bussel and Dr. Choi also touch on implementation challenges and the need for larger trials before this approach can move into broader clinical use. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.