Role of External Ventricular Drainage (EVD) in Treating Spontaneous Intraventricular Haemorrhage

Background: There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). This study is planned to describe the role of external ventricular drainage in treating patients of spontaneous, either primary or secondary, intraventricular haemorrhage with hydrocephalus.Material & Methods:A hospital based prospective interventional study was conducted in the Department of Neurosurgery of Dhaka Medical College Hospital, which is a tertiary level hospital, from April 2016 to September 2017.Total 42 patients of spontaneous intraventricular haemorrhage, either primary or secondary, with hydrocephalus were selected for this study. All the collected data were entered into IBM SPSS software, Version 24. For statistical analysis, paired t-test to compare the preoperative GCS with postoperative GCS at 24 hours was done.Results:Among 42 patients, age range was 26-75 years with the mean age 65.2 � 10.87 years. Male were 26 (61.9%) and female were 16 (38.1%). Male-Female ratio was 1.625:1. No patient needed conversion of EVD into VP shunt. EVD drain became blocked in 5 cases which were managed accordingly. 5 patients developed ventriculitis among which 2 patients died and rest 3 improved with antibiotics.Conclusions:The results of present study shows that EVD has a good role in the treatment of spontaneous IVH with hydrocephalus when ICH volume is low (<30ml) and modified Graeb Score is low (?10 found in this in this study. Preoperative higher GCS or initial improvement in GCS or initial improvement in GCS at 24 hours positively correlates with Glasgow outcome scale which is an indication of good function outcome.

Infecciones asociadas a drenaje ventricular al exterior: incidencia y factores de riesgo / Infections associated with external ventricular drainage: incidence and risk factors

Introducción: La utilización de drenajes ventriculares al exterior (DVE) es uno de los procedimientos más frecuentes dentro de la neurocirugía. Los DVE presentan una elevada tasa de infección, con valores que van desde 3-22 %. Las publicaciones que hablan acerca de los factores de riesgo asociados a IAD son limitadas al hemisferio norte, por lo tanto, los resultados no son tan fácilmente trasladables a nuestro medio. Creemos que es importante conocer los factores de riesgo que predisponen a las IAD en nuestra comunidad, para poder prevenirlas y evitarlas. Materiales y métodos: Estudio analítico retrospectivo de una cohorte de 66 pacientes pediátricos que recibieron 137 DVE. Se analizaron los factores considerados de riesgo para infección asociada al drenaje (IAD). Resultados: De los 66 pacientes analizados con DVE, 15 (22.7%; IC 95%: 14-34,5) presentaron una IAD. Los pacientes que presentaron fístula de LCR (65,2% vs 0%; p <0,0001), desconexión del sistema (60% vs 16% p<0,007), obstrucción (75% vs 19% p=0,03), menor edad (2 vs 9 p=0,03), internación prolongada (68 vs 42; p=<0.000), mayor tiempo en quirófano (462 vs 113; p=<0,000), y mayor número de recambios (4 vs 1; p=<0,000) mostraron una incidencia de IAD significativamente superior. Conclusión: La incidencia anual de IAD en nuestra población fue del 22,7%.La fístula de LCR junto con la desconexión y la obstrucción del sistema parecerían ser factores de riesgo para IAD. La edad, el tiempo de internación, la duración de la cirugía y el número de recambios parecerían ser también factores de riesgo para las IAD.

Introduction: The use of external ventricular drainage (EVD) is one of the most frequent procedures within neurosurgery. EVDs present a high infection rate, with values ranging from 3-22%.Information about risk factors associated with EVD are limited to the northern hemisphere, therefore, the results are not so easily transferable to our environment. We believe that it is important to know the risk factors that predispose EVD ́s infections in our community, in order to prevent and avoid them. Materials and methods: We performed a retrospective analytical study of a cohort of 66 pediatric patients who received 137 EVD. Risk factors for EVD infections were analyzed. Results: Of the 66 patients analyzed with EVD, 15 (22.7%; 95% CI: 14-34.5) presented an EVD infection. CSF fistula (65.2% vs 0%; p <0.0001), disconnection (60% vs 16% p <0.007), obstruction (75% vs 19% p = 0.03) , younger age (2 vs 9 p = 0.03), prolonged hospitalization (68 vs 42; p = <0.000), longer time in the operating room (462 vs 113; p = <0.000), and greater number of replacements (4 vs 1; p = <0.000) showed a significantly higher incidence of EVD infections. Conclusion: The annual incidence of ADI in our population was 22.7%. CSF fistula along with system disconnection and obstruction, younger age, length of stay, surgery duration, and number of replacements appear to be risk factors for EVD infections.

Cerebrospinal Fluid Infection with External Ventricular Drainage: Analysis of the Risk Factors in 110 Patients of a Single Institution

Objectives External ventricular drainage (EVD) is extensively used in the neurosurgical practice with the purpose of monitoring the intracranial pressure and draining the cerebrospinal fluid (CSF). Despite its remarkable benefits, the technique is not devoid of risks, notably infections, which have been reported in up to 45% of the cases. Methods A retrospective analysis of the main risk factors for CSF infection in neurosurgical patients submitted to EVD at a single institution. We recorded and submitted to statistical comparison every risk factor for CSF infection present or absent in each of the 110 EVD patients enrolled, 53 males and 57 females, with an average age of 52.9 years, with different underlying neurosurgical conditions. Results Infection of the CSF occurred in 32 patients (29%). The rate of mortality related to CSF infection was of 18.7% (6 of 32). The risk factors that showed statistical significance for CSF infection in this series were: emergency surgery; length of stay at the intensive care unit (UCI); duration of the EVD; parenchymal and/or intraventricular hemorrhage; simultaneous infections; time of bladder catheterization; and the use of non-disposable adhesive drapes as part of the preparation of the wound area. Conclusions Infection of the CSF in patients submitted to EVD is multifactorial and a challenge in terms of prevention. Further studies proposing scores with blended risk factors may be useful to prevent and reduce the morbidity and mortality associated with CSF infection.

Weaning rápido vs. weaning gradual de ventriculostomía externa en hidrocefalia secundaria a hemorragia subaracnoidea: Revisión sistemática de la literatura y metaanálisis / Weaning fast vs. Gradual Weaning of External Ventriculostomy in Hydrocephalus Secondary to Subarachnoid Hemorrhage: A Systematic Review of the Literature and Meta-analysis

Objetivo: Realizar una revisión sistemática comparando dos estrategias de weaning de Derivación Ventricular externa (DVE) en pacientes con hidrocefalia aguda y su asociación con la proporción de derivación definitiva, infección del sistema nervioso central y duración de la estancia hospitalaria en cada una de las estrategias. Diseño: Revisión sistemática de la literatura. Fuentes de datos: Se realizaron búsquedas en PubMed, Embase, Lilacs. Se incluyò literatura gris, realizando búsquedas en Google académico, Dialnet, Open gray, Teseo y Worldcat hasta el 10 de septiembre de 2019. Métodos: Se realizó una búsqueda exhaustiva de estudios de los últimos 20 años en inglés, español y portugués, que compararan dos estrategias de weaning de DVE: rápida (WR) vs gradual (WG) en pacientes con hidrocefalia aguda. El resultado primario para esta Revisión Sistemática fue la proporción de derivación definitiva en cada uno de los regímenes. Se evaluó además, la proporción de infección del sistema nervioso central y la duración de la estancia hospitalaria. Dos investigadores extrajeron de forma independiente la información de los estudios y los resultados en concordancia con la Guía PRISMA. Resultados: La revisión arrojó en total 3 artículos que cumplían con los criterios de inclusión y que se consideraron de calidad metodológica aceptable, con un número de 1198 participantes no superpuestos, 569 que fueron sometidos a weaning rápido (WR), 629 en el grupo de weaning gradual (WG). No se encontró asociación estadisticamente significativa entre las estrategias de weaning y DVP OR 0.78 (Intervalo de confianza del 95% 0.3 a 2.06; P= 0.001; I2=85%), ni para infección del sistema nervioso central OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) pero si se encontró diferencia estadísticamente significativa en la duración de la estancia hospitalaria a favor de la estrategia de weaning ràpido, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusión: Con la evidencia disponible actualmente no es posible concluir cuál es la mejor estrategia de weaning para DVE con respecto a la proporción de derivación definitiva o infecciones del sistema nervioso central; sin embargo, si se observa una tendencia clara frente a la duración de la estancia hospitalaria en la estrategia de WR. Se requiere establecer criterios claros en cuanto a la definición de WR o WG y a crear estándares en cuanto los tiempos y la definiciòn precisa de falla terapeutica respecto a estas pruebas, para posteriormente integrar y probar estos métodos en estudios idealmente prospectivos y aleatorizados.

Objective: To conduct a systematic review by comparing two strategies of external ventricular drain (EVD) in patients with acute hydrocephalus and its association with the proportion of definite drain, infection of the central nervous system, and duration of hospital stay in each strategy. Design: Systematic review of literature.Data sources: PubMed, Embase, Lilacs. Grey literature was included by conducting searches through Scholar Google, Dialnet, Open Gray, Teseo and Worldcat until the 10th September, 2019. Methods: An exhaustive search of studies was done of the last 20 years in English, Spanish and Portuguese, which compares two strategies of external ventricular drain weaning (EVD): Rapid (WR) Vs Gradual (WG)in patients with acute hydrocephalus. The primary result for this systematic review was the proportion of Ventriculoperitoneal (VP) shunt placement in each of the regimes. Besides, the proportion of the infection of the central nervous system and the duration of the hospital stay was evaluated. Two researchers extracted in an independent way the information of the studies and results according to the guide PRISMA. Results: The review produced 3 articles in total which followed with the criteria of inclusion and which were considered of acceptable methodological quality, with 1198 non-superimposed participants, 569 who were subjected to rapid weaning (RW), 629 in the group of Gradual Weaning (GW). There were no significant differences between the 2 weaning ́s groups and DVP OR 0.78 (IC 95% 0.3 a 2.06; P= 0.001; I2=85%), for the infection of the Central Nervous System (CNS) OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) but a significant differences was found in the duration of the hospital stay in favour of the strategy of RW, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusion: With the current available evidence is not possible to conclude which is the best strategy of weaning for EVD regarding to the proportion of definite shunt or infections of the CNS; but if there is a clear trend regarding the length of hospital stay in the WR strategy. It is necessary to establish clear criteria as to the definition of WR or WG and to create standards as to the times and the precise definition of therapeutic failure with respect to these tests, to later integrate and test these methods in ideally prospective and randomized studies.

An analysis of factors determining the requirement of ventriculoperitoneal shunt surgery in the children suffering from posterior fossa tumour: a single centre retrospective review

Background: Hydrocephalus is a relatively common occurrence in a children suffering from the posterior fossa tumour (PFTm). However, there is a divided opinion regarding the ventriculoperitoneal shunt (VPS) surgery before the posterior fossa tumour resection in a child. For the better clinical outcome, we should be able to predict which patient will require VPS following the resection of PFTm. Purpose of our retrospective analysis is to analyse various factors that predicts the necessity of VPS following PFTm resection.Methods: A consecutive series of twenty-six patients who underwent PFTm resection without undergoing VPS preoperatively are analysed in our series.Results: In our series, we found that the younger age at presentation, incomplete tumour resection, longer period of artificial ventilatory support, insertion of external ventricular drain (EVD) and its duration during the postoperative period correlate the necessity of VPS following PFTm resection. However, the severity of hydrocephalus prior to tumor surgery, tumour size, anatomical location of the tumour, tumour dissemination, use of Dural grafts during closure and histopathological type do not predict the requirement of the VPS following PFTm.Conclusions: Patients who are younger at diagnosis should be treated with utmost importance. Gross total resection should be the goal. Factors which predict the likelihood of the EVD which parallels the likelihood of postresection hydrocephalus must be prevented for the better clinical outcome.

Discussion on prevention of external ventricular drainage-associated infection / 中华创伤杂志

External ventricular drainage ( EVD ) is a common treatment method in neurosurgery. EVD-associated infections are severe complications of EVD catheterization. How to optimize catheterization and postoperative management to reduce EVD-associated infections remains a difficult clinical issue. In this article, the pathogenesis of EVD-associated infection, preoperative preparation and surgical process of EVD, fixation and maintenance of drainage tubes, nursing, preventive use of antibiotics, and disease status of patients are expounded, so as to provide reference for better reducing EVD-associated infections.

A Retrospective Study on the First Cerebrospinal Fluid Taken from External Ventricular Drainage Insertion in Meningitis Patients with Hydrocephalus

@#Background: Ventriculoperitoneal (VP) shunting is a permanent form of cerebrospinal fluid (CSF) diversion that can be performed for hydrocephalus. Sterility of the CSF is an important prerequisite for permanent shunt placement. It has been hypothesised that in early stage of meningitis, ventricular CSF remains sterile. A study is conducted on the first CSF sample taken from patients suspected to have meningitic hydrocephalus. Method: A retrospective review case records of patients who had undergone external ventricular drainage (EVD) for suspected meningitic hydropcephalus in Hospital Sultanah Aminah Johor Bahru (HSAJB), Johor, Malaysia. Results: Fifty-one cases were analysed. Mean age of patients was 37.27 years old, with 64.7% of them was male. Univariate analysis revealed that the main parameters to determine CSF sterility were CSF glucose (95% CI, 0.852, 10.290, P = 0.001), CSF protein (CI 95%, 0.722, 14.898, P < 0.001), CSF gram stain (95% CI, 16.437, 0.877, P < 0.001 ) and CSF appearance ( 0.611, 6.362, P = 0.012). Multivariate analysis had proven that gram stain was the main parameter in the CSF analysis (CI 95%, 16.437, 0.029, P = 0.016). No significant differences in CSF results were observed from EVD and lumbar puncture. Conclusion: The most significant parameter in CSF to determine infection was gram stain.

Technique of external ventricular drainage with intraventricular administration of recombinant tissue plasminogen activator for patients with secondary intraventricular hemorrhage - Case series in a single institution

INTRODUCTION@#Intraventricular hemorrhage (IVH) as an extension of spontaneous intracerebral hemorrhage is an independent predictor of mortality. The Clot Lysis: Evaluating Accelerated Resolution of IVH phase 3 (CLEAR III) trial is a randomized, double-blinded, placebocontrolled, multiregional trial recently conducted to determine whether external ventricular drainage (EVD) plus intraventricular recombinant tissue plasminogen activator (rtPA, alteplase) improved outcome, in comparison to EVD plus saline. This study is an application of the rationale and principles of management in CLEAR III trial and related literature.@*METHODS@#There are five patients described in this case series. Report followed the PROCESS guidelines.@*RESULTS@#30-day mortality in this series is 2 out of 5 while actual allcause mortality is 4 out of 5. Modified Graeb scores and IVH scores of all subjects have decreased after the intervention. However, good functional status defined as modified Rankin scale (mRS) score of 0-3 has not been achieved with the intervention. Efficacy of completely resolving IVH and hydrocephalus has been achieved in 2 out of 5 which translated to a benefit of survival to one of the two. Shunt dependence has been avoided by the subjects except for the one with the caudate intracerebral hemorrhage. Complications related to the intervention have been noted and discussed@*CONCLUSION@#In this single-institution study, patients for which rtPA was used for intraventricular fibrinolysis of IVH clot in addition to EVD as surgical treatment for hydrocephalus resulted to a 30-day survival of 3 out of 5 in this series, while actual survival is 1 out of 5. The intervention was efficacious in decreasing the Modified Graeb scores and IVH scores of all study subjects at end of treatment. Functional status of mRS 5 is the highest score achieved among survivors.

Comparison and contrast of different treatments for severe spontaneous cerebellar hemorrhage with intraventricular hemorrhage in elderly patients / 中华老年医学杂志

Objective To compare four therapies for elderly patients with cerebellar hemorrhage breaking into the ventricles.Methods Clinical data of 158 elderly patients with severe spontaneous cerebellar hemorrhage breaking into the ventricles were retrospectively analyzed.There were 28 cases in the conservative management (CM) group and 130 cases in the surgical therapy (ST) group with an external ventricular drainage (EVD) subgroup (n=40),an external ventricular drainage combined with intraventricular fibrinolysis (EVD + IVF) subgroup (n =43),and a clot evacuation (CE) subgroup (n=47).The mortality at 1 month and modified Rankin Scale (mRS) at 6 months were employed to evaluate clinical effectiveness.In addition,statistical analysis of correlative factors for prognosis was conducted.Results The 1-month mortality (x2 =7.529,P =0.006) and 6-month mRS in the CM group (x2 =4.819,P =0.028) were significantly higher than those in the ST group.There was no significant difference in mortality after one month among the three ST subgroups (x2 =0.143,P=0.931),whereas significant differences were observed in 6-month mRS among them (x2 =7.209,P=0.027),and the scale in the EVD+IVF subgroup was significantly lower than in the CE and EVD subgroups.The incidence of complications such as pulmonary infections and stress ulcers in the CM group was significantly higher than in the ST group.Statistical differences were found in the incidence of pulmonary infections among the three ST subgroups (x2 =6.694,P=0.035),and the incidences in the EVD subgroup and the EVD+IVF subgroup were lower than the incidence in the CE subgroup.Nevertheless,there was no significant difference in the incidence of stress ulcers among the three ST subgroups (x2 =0.547,P=0.776).Conclusions EVD+ IVF is an effective treatment for cerebellar hemorrhage breaking into the ventricles in elderly patients,especially for those who cannot withstand a craniotomy or those who have primary diseases.It may speed up the absorption of hematoma,and decrease the operative risk and the incidence of postoperative complications.

Safety of external ventricular drainage after stent-assisted embolization for poor-grade ruptured aneurysm / 医学研究生学报

Objective The management of poor-grade ruptured aneurysm is important and challenging in intravascular inter-vention. This study aimed to investigate the safety of external ventricular drainage(EVD)after stent-assisted embolization for patients with poor-grade ruptured aneurysm in the acute stage. Methods From January 2015 to July 2017,27 patients with poor-grade rup-tured aneurysm underwent EVD after endovascular embolization by stent-assisted coiling(n=14)or simple coiling(n=13). We com-pared the clinical data about and the postoperative complications between the two groups of patients. Results There were no statisti-cally significant differences in the patients'age,gender,Glasgow Coma Scale(GCS)scores before embolization and discharge,the in-terval between EVD and the end of embolization,preoperative intraventricular hemorrhage and hydrocephalus,puncture-related bleed-ing after EVD,catheter-indwelling time,perioperative bleeding in other parts,or poor prognosis between the stent-assisted coiling and simple coiling groups(all P>0.05). Conclusion EVD after stent-assisted embolization is a relatively safe strategy for the treatment of poor-grade ruptured aneurysm in the acute stage.

Prevalence of Shunt Dependency and Clinical Outcome in Patients with Massive Intraventricular Haemorrhage Treated with Endoscopic Washout and External Ventricular Drainage

Background: Intraventricular haemorrhage (IVH) causes blockage of ventricular conduits leading to hydrocephalus, increased intracranial pressure (ICP), and a reduced level of consciousness. The current standard management of IVH is insertion of an external ventricular drainage (EVD) catheter. However, this procedure addresses only the problems of acute hydrocephalus and raised ICP. Endoscopic washout allows for a more complete removal of the intraventricular clot. This study compared these two types of treatment in terms of shunt dependency and relevant clinical outcomes. Methods: Patients who were 10–80 years old and presented with a Graeb score of more than six were randomised into endoscopic washout and EVD treatment groups. A CT brain was repeated on each patient within 24 hours after surgery, and if a patient’s Graeb score was still more than six, a repeat endoscopic washout was performed to clear the remaining clots. All patients were monitored for shunt dependency at two weeks and three months, and clinical outcomes were measured at six months after the procedure. Results: A total of 39 patients were recruited; 19 patients were randomised into the endoscopic washout group, and 20 were randomised into the EVD group. However, three patients in the endoscopic group refused that treatment and opted for EVD insertion. Patients treated with endoscopic washout had significantly less drainage dependency at two weeks (P < 0.005) and at three months (P < 0.004) as compared to patients in the external ventricular drainage group. The reduction in Graeb scores was also significantly greater in the endoscopic washout group (P < 0.001). However, the functional outcome at six months measured via a modified Rankin scale score was no different in the two groups of patients. The difference in the functional outcome of the patients was mainly dependent on the initial pathology, with those presenting with a thalamic bleed with IVH showing a poor functional outcome. This parameter was also influenced by the Glasgow Coma Scale (GCS) score on admission, with those patients with a score of 12 or less having a poor functional outcome (MRS 5–6) at three and six months after the surgery. Conclusions: The use of neuroendoscopy in patients with a massive IVH significantly reduced drainage dependency. However, it did not alter the final functional outcome.

Clinical application of external ventricular drainage for ruptured anterior communicating artery aneurysms / 局解手术学杂志

Objective To investigate the clinical effect of external ventricular drainage on the prognosis of anterior communicating artery aneurysms.Methods Retrospectively collected and analyzed 96 patients of anterior communicating artery aneurysms who were treated in our hospital from June 2013 to October 2015,and they were divided into the observation group which was given external ventricular drainage treatment and the control group which was not given external ventricular drainage treatment.These patients were followed up for 6 months to 2 years,and the results of the 2 groups were graded according to the analysis of postoperative complications and the Glasgow prognostic score (GOS).Meanwhile,evaluated the general function of the patients according to the KPS score.Results The the incidence rate of complications after treatment in observation group was 54.17％,which was lower than 86.96％ in the control group,and the difference was statistically significant(P ＜ 0.05).The cure rate of observation group was 79.16％,which was higher than 50％ in the control group,and the difference was statistically significant (P ＜ 0.05).The postoperative KPS score in the observation group was (79.68 ± 13.24) points,which was higher than (62.57 ± 12.72) points in the control group,and the differences were statistically significant (P ＜ 0.05).Conclusion External ventricular drainage can reduce the compression injury of the brain tissue to a minimum degree,reduce intracranial pressure,relieve cerebral edema caused by intracranial pressure,reduce complications,and improve the prognosis of patients and the cure rate.

Curative effect of hematoma evacuation combined with external ventricular drainage in treatment of patients with intraventricular hemorrhage secondary to hypertensive intracerebral hemorrhage / 第二军医大学学报

Objective To investigate the curative effects of hematoma evacuation (HE) combined with external ventricular drainage (EVD) and simple EVD in the treatment of patients with intraventricular hemorrhage secondary to hypertensive intracerebral hemorrhage (HICH). Methods We retrospectively analyzed the clinical data of 70 patients who were diagnosed with HICH from Jun. 2012 to Jun. 2015 in Changzheng Hospital of Second Military Medical University. The patients were divided into EVD combined with HE group (EVD+HE group, n=31) and EVD group (n=39) according to the different choices of operation. The Glasgow Coma Scale (GCS) score, length of neurointensive intensive care units (NICU) stays, in-hospital mortality, incidences of lung infection, intracranial infection and rebleeding, and modified Rankin Scale (mRS) scores and Glasgow Outcome Scale (GOS) scores after 6 months were compared between two groups. Then we screened the patients with supratentorial hematoma volume greater than 30 mL in the EVD+HE group (n=20) and EVD group (n=13), and compared the above clinical indicators between two groups. Results The in-hospital mortality rate of patients in the EVD+HE group was significantly higher than that in the EVD group (29.0% vs 5.1%, P=0.008). The survival patients were included in the subsequent research, including 22 cases in the EVD+HE group and 37 in the EVD group. The improved GCS (ΔGCS) scores of survival patients in the EVD+HE group was significantly higher than that in the EVD group (3.9±3.5 vs 1.2±3.3, P0.05). After screening, the patients with supratentorial hematoma volume greater than 30 mL in the EVD+HE group had significantly higher improved GCS (ΔGCS) scores (3.8±4.0 vs 1.1±2.4, P=0.044), lower 6-month mRS scores (4.2±1.6 vs 5.3±0.7, P=0.025) and higher 6-month GOS scores (3.1±2.0 vs 1.7±0.7, P=0.030) than those in the EVD group. The length of NICU stays, incidences of rebleeding, lung infection and intracranial infection of patients were not significantly different between the EVD+HE and EVD groups (P>0.05). Conclusion For patients with supratentorial hematoma volume greater than 30 mL, HE combined with EVD is superior to simple EVD in treating intraventricular hemorrhage secondary to hypertensive intracranial hemorrhage.

Predisposing Factors and Clinical Impact of Linear Intracrania l Calcification Following External Ventricular Drainage / 계명의대학술지

External ventricular drainage (EVD) is a common procedure performed in neurosurgical field. The purpose of this study was to introduce the linear intracranial calcification formed along EVD tract and to investigate its incidence, predisposing factors, and clinical impact. A total of 59 patients who underwent EVD insertion over a 1-year period were included in this study. The clinical factors and radiographic features between the occurrence and the non-occurrence groups were analyzed to investigate the predisposing factors and clinical impact related to the linear intracranial calcification in EVD tract. The linear intracranial calcification following EVD insertion occurred in 7 patients (11.9%). Among various risk factors assessed, only usage of bone dust (p =0.003) had contributed to linear intracranial calcification with statistical significance in univariate logistic regression analysis. Housefield unit (HU) scale was different between calcification (872.57 ± 46.15 HU) and EVD catheter (169.00 ± 61.35 HU). This study indicates that using bone dust for sealing a burr hole is the only predisposing factor for linear intracranial calcification formed in EVD tract.

Sphingomonas Paucimobilis: A Rare Infectious Agent Found in Cerebrospinal Fluid

Sphingomonas paucimobilis (S. paucimobilis) is a gram negative bacillus. It has existed in soil, drinking water and plants. It has been isolated from distilled water tanks, respirators, and hemodialysis devices at the hospital setting. Patients with chronic disorders or immune suppression may be susceptible to infections with it. This microorganism has also been reported to infect healthy persons. Both nosocomial and community-acquired infections have been reported. So far, a variety of infections have been reported, including sepsis, septic pulmonary embolism, septic arthritis, peritonitis, and endophthalmitis. Only 2 cases of meningitis have been reported so far in the literature. So far, no previous reports of culture proliferation have been reported in patients with external ventricular drains, as was the case in our patient. Therefore, our case is the first to have S. paucimobilis proliferation in cerebrospinal fluid culture during intensive care unit stay for an external ventricular drain.

Device for Catheter Placement of External Ventricular Drain

To introduce a new device for catheter placement of an external ventricular drain (EVD) of cerebrospinal fluid (CSF). This device was composed of three portions, T-shaped main body, rectangular pillar having a central hole to insert a catheter and an arm pointing the tragus. The main body has a role to direct a ventricular catheter toward the right or left inner canthus and has a shallow longitudinal opening to connect the rectangular pillar. The arm pointing the tragus is controlled by back and forth movement and turn of the pillar attached to the main body. Between April 2012 and December 2014, 57 emergency EVDs were performed in 52 patients using this device in the operating room. Catheter tip located in the frontal horn in 52 (91.2%), 3rd ventricle in 2 (3.5%) and in the wall of the frontal horn of the lateral ventricle in 3 EVDs (5.2%). Small hemorrhage along to catheter tract occurred in 1 EVD. CSF was well drained through the all EVD catheters. The accuracy of the catheter position and direction using this device were 91% and 100%, respectively. This device for EVD guides to provide an accurate position of catheter tip safely and easily.

Primary Intracerebral Haematoma Evacuation: A Case Report.

Spontaneous intracerebral hemorrhage is one of the most devastating types of stroke, leading to disability and high mortality rate. Besides blood pressure reduction and intensive medical and surgical treatment, immediate coagulopathy reversal is vital. On the other hand, the haemostatic disturbances may contribute to improve the recovery. We describe the evacuation of intracerebral hemorrhage with the insertion of external ventricular drainage in a patient suffering from deep hypertensive intracerebral haemorrhage and haematocephalus.

Risk factors for intracranial infection after external ventricular drainage by Logistic regression / 中国神经精神疾病杂志

Objective To investigate the risk factors for intracranial infection after external ventricular drainage and provide basis for preventing and controlling the drainage-associated intracranial infection. Metheds the clinical data from three hundred sixty-seven cases of ventricular hemorrhage patients were retrospectively analyzed, using Logis?tic regression to screen risk factors of intracranial infection after external ventricular drainage. Results There were 29 cases with intracranial infection and infection rate was 8.19%, 8.04% and 7.32% at ventricle drainage tube indwelling 1-week group, 2-week group and 3 week-group, respectively. Glasgow coma score (GCS) [OR= 2. 569 CI (1.792 3.378) %, P< 0.05), urokinase perfusion (OR= 2.897, 95%CI (1.297 5.061), P< 0.05), cerebrospinal fluid sampling (OR= 3.399, 95%CI (2.705 4.175), P< 0.01] and comorbidities [OR= 3.751, 95%CI (2.032 5.371), P< 0.01] were risk factors for ventricle drainage operation. Conclusion Ventricle drainage tube indwelling 3 weeks is safe. Less use of urokinase perfusion and cerebrospinal fluid sampling and active treatment of comorbidities diseases can reduce the intra?cranial infection incidence of external ventricular drainage after Intraventricular hemorrhage .

Hemorrhagic Complications Induced by External Ventricular Draining Catheters / 대한뇌혈관외과학회지

BACKGROUND: External ventricular drainage (EVD) is one of the most frequently performed operative procedures in neurosurgery. A retrospective analysis was conducted for patients who underwent EVD to determine the incidence rate of post-procedural intracranial hemorrhage and to identify underlying risk factors. METHODS: Patients who underwent EVD between January 2003 and January 2011 were selected. Catheter-induced hemorrhage (CIH) was defined as any evidence of new hemorrhage on the post-procedural computerized tomography (CT) scan obtained within 24 hours of catheter insertion. The rate of hemorrhage was calculated, and the possible risk factors were statistically analyzed. RESULTS: The data of 229 patients were analyzed. Twenty-one patients developed CIH, for an incidence rate of 9.17%. The factors that increased the rate of CIH were age > or =60 years, bilateral catheter insertion, and pre-existing heart disease. The patients > or =60 years of age had a 2.8-fold increased risk of CIH. A history of heart disease contributed to a 20-fold increased risk of CIH (p or =60 years, bilateral catheter insertion, and a history of heart disease are the three most significant risk factors for CIH. Since these risk factors are not modifiable, all possible contributors should be considered to minimize the risk such as skilled maneuvers and techniques or high blood pressure.

Hemorrhagic Complications Induced by External Ventricular Draining Catheters / 대한뇌혈관외과학회지

BACKGROUND: External ventricular drainage (EVD) is one of the most frequently performed operative procedures in neurosurgery. A retrospective analysis was conducted for patients who underwent EVD to determine the incidence rate of post-procedural intracranial hemorrhage and to identify underlying risk factors. METHODS: Patients who underwent EVD between January 2003 and January 2011 were selected. Catheter-induced hemorrhage (CIH) was defined as any evidence of new hemorrhage on the post-procedural computerized tomography (CT) scan obtained within 24 hours of catheter insertion. The rate of hemorrhage was calculated, and the possible risk factors were statistically analyzed. RESULTS: The data of 229 patients were analyzed. Twenty-one patients developed CIH, for an incidence rate of 9.17%. The factors that increased the rate of CIH were age > or =60 years, bilateral catheter insertion, and pre-existing heart disease. The patients > or =60 years of age had a 2.8-fold increased risk of CIH. A history of heart disease contributed to a 20-fold increased risk of CIH (p or =60 years, bilateral catheter insertion, and a history of heart disease are the three most significant risk factors for CIH. Since these risk factors are not modifiable, all possible contributors should be considered to minimize the risk such as skilled maneuvers and techniques or high blood pressure.