Articles: external-ventricular-drainage.
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Journal of neurosurgery · Jan 2025
Outcomes and complications of external ventricular drainage in primary and secondary intraventricular hemorrhage: a descriptive observational study.
Intraventricular hemorrhage (IVH) is a serious condition with high mortality rates and poor functional outcome in survivors. Treatment includes external ventricular drains (EVDs), which are associated with several complications. This study reports the clinical outcome and complication rate in patients with primary IVH (pIVH) and secondary IVH treated with EVDs. ⋯ This study provides a comprehensive historical reference of complications, mortality rate, and functional outcome of EVD-treated patients with pIVH and secondary IVH. These findings provide a baseline for evaluating novel catheter-based interventions in IVH management.
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External lumbar drainage (ELD) of cerebrospinal fluid may help control intracranial pressure following a traumatic brain injury. We aimed to assess the efficacy and safety of ELD in post-traumatic intracranial hypertension (IH). ⋯ ELD appears in our cohort to be a safe and effective strategy to control post-traumatic IH, with an acceptable benefit-risk ratio. Our analysis even suggests a potential outcome improvement in patients treated by ELD compared with those having no cerebrospinal fluid drainage.
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Cerebrospinal fluid diversion via shunt placement is a common neurosurgical intervention. Keen's Point is a widely used landmark for accessing the trigone of the lateral ventricle; however, it lacks clinical validation. This study re-evaluates Keen's Point scalp parameters using magnetic resonance imaging (MRI) to identify an ideal shunt entry point based on 3-dimensional reconstructions. ⋯ This modified Keen's Point is a reliable landmark for ventriculostomy. Incorporating PCA into preoperative planning enhances catheter placement accuracy, providing a prominent approach to shunting at Keen's Point.
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In poor-grade aneurysm subarachnoid hemorrhage (PaSAH), the use of external ventricular drainage (EVD) may be closely related to the occurrence of shunt-dependent hydrocephalus (SDHC). The purpose of this study was to investigate the effect of EVD on SDHC and prognosis after microsurgically clipping patients with PaSAH. ⋯ EVD implantation is an independent risk factor for SDHC after PaSAH, and a large drainage volume in the first 3 days after EVD implantation is an independent risk factor for SDHC after PaSAH. The drainage volume on the first day after surgery is the best predictor of SDHC after PaSAH. SDHC after PaSAH is the strongest independent risk factor for poor prognosis and prolongs hospital stay.
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Hydrocephalus remains a common sequela of intraventricular hemorrhage (IVH) despite adequate drainage of the hematoma, including endoscopic surgery, intraventricular fibrinolysis, and external ventricular drainage (EVD). Moreover, the appropriate timing for conversion from EVD to ventriculoperitoneal shunt (VPS) is uncertain. This study aimed to evaluate the predictors of shunt dependency in patients with IVH based on the early EVD weaning protocol in our institution. ⋯ This study showed that a large temporal horn diameter and a lower degree of IVH removal were predictors of shunt dependency in patients with IVH. In addition, early conversion from EVD to ventriculoperitoneal shunt is safe and feasible.