Management of intracranial aneurysms (IAs) often requires complex neurosurgical interventions, with some patients necessitating postoperative cerebrospinal fluid (CSF) drainage. Identifying predictive factors for CSF drainage can enhance patient outcomes through targeted interventions and improved perioperative care.

In this retrospective study, 151 patients who underwent surgical treatment for IAs were included. Demographic data, clinical presentation (Hunt-Hess grade and modified Fisher score), surgical details (operative time and intraoperative complications), and postoperative outcomes were reviewed. Both univariate and multivariable logistic regressions were conducted to identify predictors of postoperative CSF drainage. A subgroup analysis compared patients with anterior versus posterior circulation aneurysms.

Overall, 67 patients required postoperative CSF drainage. On multivariable analysis, age ≥60 years, high Hunt-Hess grade, operative time >5 hours, and intraoperative aneurysm rupture significantly increased the odds of drainage (P < 0.05). Subgroup analysis revealed that these risk factors conferred an even higher likelihood of CSF drainage in posterior circulation aneurysms. Gender and modified Fisher score did not show significant associations with drainage.

Advanced age, high Hunt-Hess grade, prolonged operative time, and intraoperative rupture predict postoperative CSF drainage in patients with IAs. Incorporating both global and subgroup-based risk assessments can help refine perioperative strategies to reduce complications and improve patient outcomes.

Cerebrospinal fluid drainage

Intracranial aneurysms

Neurosurgical interventions

Postoperative outcomes

Predictive factors

Subarachnoid hemorrhage

Variance inflation factors

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