Accuracy and Safety of Ventriculostomy Using Two Different Procedures of External Ventricular Drainage: A Single-Center Series

Abstract

Background and Study Aims Patients with acute hydrocephalus are treated by either insertion of a conventional external ventricular drain (EVD) or percutaneous needle trephination (PNT) at our institution, depending on the acuteness of intervention and the severity of illness. We compared both procedures regarding accuracy and safety necessitating surgical revision of EVD or PNT.

Methods Between January 2012 and January 2014, 451 ventriculostomies were performed in 301 patients at our institution. All patients underwent routine computed tomography after insertion of the ventricular drain during the treatment course. Patient characteristics, underlying pathology, ventriculostomy modality, radiologic features, catheter tip location, and treatment-related complications were analyzed.

Results A total of 307 of 451 ventriculostomy procedures (68%) were performed as conventional EVD, and 144 (32%) were performed as PNT. Overall, 11% of patients with conventional EVD underwent surgical revision due to lacking accuracy, infection, or hemorrhage; 7% of patients with PNT underwent surgical revision (p = 0.2). However, multivariate analysis revealed that only “hospital stay > 21 days” as an independent variable was significantly associated with surgical revision after ventriculostomy.

Conclusion The present data indicate that PNT has a similar safety profile in emergency situations in critically ill patients who need immediate treatment for acute hydrocephalus when compared with the conventional EVD procedure.

Keywords

external ventricular drain - acute hydrocephalus - ventriculostomy - percutaneous needle trephination

• References

• 1 Fichtner J, Jilch A, Stieglitz LH, Beck J, Raabe A, Z′ Graggen WJ. Infection rate of emergency bolt-kit vs. non-emergency conventional implanted silver bearing external ventricular drainage catheters. Clin Neurol Neurosurg 2014; 122: 70-76
• 2 Fried HI, Nathan BR, Rowe AS. , et al. The insertion and management of external ventricular drains: an evidence-based consensus statement : a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care 2016; 24 (01) 61-81
• 3 Gautschi OP, Smoll NR, Kotowski M. , et al. Non-assisted versus neuro-navigated and XperCT-guided external ventricular catheter placement: a comparative cadaver study. Acta Neurochir (Wien) 2014; 156 (04) 777-785 ; discussion 785
• 4 Nesvick CL, Khan NR, Mehta GU, Klimo Jr P. Image guidance in ventricular cerebrospinal fluid shunt catheter placement: a systematic review and meta-analysis. Neurosurgery 2015; 77 (03) 321-331 ; discussion 331
• 5 Thomale UW, Knitter T, Schaumann A. , et al. Smartphone-assisted guide for the placement of ventricular catheters. Childs Nerv Syst 2013; 29 (01) 131-139
• 6 Moringlane JR, von Wild K, Samii M. Clinical value of percutaneous needle trephination (PNT). Acta Neurochir (Wien) 1980; 54 (3–4): 181-189
• 7 Wiesmann M, Mayer TE. Intracranial bleeding rates associated with two methods of external ventricular drainage. J Clin Neurosci 2001; 8 (02) 126-128
• 8 Hassler W, Zentner J. Ventricle puncture for external CSF drainage and pressure measurement using a modified puncture needle. Acta Neurochir (Wien) 1988; 94 (1–2): 93-95
• 9 Meyer B, Schaller K, Rohde V, Hassler W. Percutaneous needle trephination. Experience in 200 cases. Acta Neurochir (Wien) 1994; 127 (3-4): 232-235
• 10 Schödel P, Proescholdt M, Ullrich OW, Brawanski A, Schebesch KM. An outcome analysis of two different procedures of burr-hole trephine and external ventricular drainage in acute hydrocephalus. J Clin Neurosci 2012; 19 (02) 267-270
• 11 Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF. Safety and accuracy of bedside external ventricular drain placement. Neurosurgery 2008; 63 (01) (Suppl. 01) ONS162-ONS166 ; discussion ONS166–ONS167
• 12 Lozier AP, Sciacca RR, Romagnoli MF, Connolly Jr ES. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 2008; 62 (Suppl. 02) 688-700
• 13 Fichtner J, Güresir E, Seifert V, Raabe A. Efficacy of silver-bearing external ventricular drainage catheters: a retrospective analysis. J Neurosurg 2010; 112 (04) 840-846
• 14 Foreman PM, Hendrix P, Griessenauer CJ, Schmalz PG, Harrigan MR. External ventricular drain placement in the intensive care unit versus operating room: evaluation of complications and accuracy. Clin Neurol Neurosurg 2015; 128: 94-100
• 15 Woernle CM, Burkhardt JK, Bellut D, Krayenbuehl N, Bertalanffy H. Do iatrogenic factors bias the placement of external ventricular catheters?--a single institute experience and review of the literature. Neurol Med Chir (Tokyo) 2011; 51 (03) 180-186
• 16 Stangl AP, Meyer B, Zentner J, Schramm J. Continuous external CSF drainage--a perpetual problem in neurosurgery. Surg Neurol 1998; 50 (01) 77-82
• 17 Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus--evaluation of risk factors. Neurosurgery 1992; 31 (05) 898-903 ; discussion 903–904
• 18 Anderson RC, Kan P, Klimo P, Brockmeyer DL, Walker ML, Kestle JR. Complications of intracranial pressure monitoring in children with head trauma. J Neurosurg 2004; 101 (1, Suppl): 53-58
• 19 Ngo QN, Ranger A, Singh RN, Kornecki A, Seabrook JA, Fraser DD. External ventricular drains in pediatric patients. Pediatr Crit Care Med 2009; 10 (03) 346-351
• 20 Saladino A, White JB, Wijdicks EF, Lanzino G. Malplacement of ventricular catheters by neurosurgeons: a single institution experience. Neurocrit Care 2009; 10 (02) 248-252
• 21 Paramore CG, Turner DA. Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien) 1994; 127 (1–2): 79-84
• 22 Pople I, Poon W, Assaker R. , et al. Comparison of infection rate with the use of antibiotic-impregnated vs standard extraventricular drainage devices: a prospective, randomized controlled trial. Neurosurgery 2012; 71 (01) 6-13
• 23 Lewis A, Wahlster S, Karinja S, Czeisler BM, Kimberly WT, Lord AS. Ventriculostomy-related infections: the performance of different definitions for diagnosing infection. Br J Neurosurg 2016; 30 (01) 49-56