Coma due to malplaced external ventricular drain

Chai, Feng Yih; Fadzil, Farizal; Thanabalan, Jegan

doi:10.5137/1019-5149.jtn.5724-12.1

Cited by 6 publications

(11 citation statements)

References 8 publications

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“…In addition to the general complications of EVD implantation as hemorrhage and obstruction, the most common misplaced catheters are basal ganglion, thalamus, internal capsula, corpus callosum, and frontal lobe. [123456891011121314151617181920]…”

Section: Discussionmentioning

confidence: 99%

Surface anatomy for implantation of external ventricular drainage: Some surgical remarks

Mostofi¹,

Khouzani

2016

Surg Neurol Int

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Background:External ventricular drainage (EVD) is an emergency process intended to reduce intracranial hypertension resulting from the obstruction of cerebrospinal fluid (CSF) flow. This creates a temporary situation to extract CSF that cannot pass through normally. Knowing the surface anatomy for EVD implantation is important to prevent its inadvertent complications. The external landmarks have been designed in this anatomic study to review the classical landmarks and come up with new landmarks to improve this simple but lifesaving procedure.Methods:From November 1998 to October 2012, we implanted 439 EVDs.Results:In the first years, we employed usual landmarks to implant 97 EVDs. Since 2002, we used modified anatomical landmarks to implant 342 EVDs directly in the third ventricle.Conclusion:Using effective landmarks for EVD implementation allows the catheter to be inserted in the third ventricle. In addition, it permits more precise accuracy to ensure a safer procedure with fewer complications.

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Section: Discussionmentioning

confidence: 99%

Surface anatomy for implantation of external ventricular drainage: Some surgical remarks

Mostofi¹,

Khouzani

2016

Surg Neurol Int

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“…[ 4 5 7 ] Where image guidance is available, it may improve the accuracy of placement in the frontal horn of lateral ventricle. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

Improvised external ventricular drain in neurosurgery: A Nigerian tertiary hospital experience

Ojo

Asha

Bankole

et al. 2015

Journal of Neurosciences in Rural Practice

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Background:The most common type of hydrocephalus in developing countries is post infective hydrocephalus. Infected cerebrospinal fluid (CSF) however cannot be shunted for the reason that it will block the chamber of the ventriculo-peritoneal (VP) shunt due to its high protein content. In centers where standard external ventricular drain (EVD) sets are not available, improvised feeding tube can be used.Aim:The main focus of this study is to encourage the use of improvised feeding tube catheters for EVD when standard sets are not available to improve patients’ survival.Methodology:This was a prospective study. Consecutive patients with hydrocephalus that cannot be shunted immediately for high chances of shunt failure or signs of increasing intracranial pressure were recruited into the study. Other inclusion criteria were preoperative brain tumor with possibility of blocked CSF pathway and massive intraventricular hemorrhage necessitating ventricular drainage as a salvage procedure. Standard EVD set is not readily available and too expensive for most of the parents to afford. Improvised feeding tube is used to drain/divert CSF using the standard documented procedure for EVD insertion. Outcome is measured and recorded.Results:A total of 28 patients were recruited into the study over a time frame of 2 years. There were 19 (67.9%) male and 9 (32.1%) females with a ratio of about 2:1. Age ranges varied from as low as 7 days to 66 years. The median age of the study sample was 6.5 months while the mean was 173.8 months. Duration of EVD varied from 2 days to 11 days with a median of 7 while the average was 6 days. Eventual outcome following the procedure of EVD showed that 19 (67.9%) survived and were discharged either to go home or to have VP shunt afterwards while 8 (28.6%) of the patients died.Conclusions:External ventricular drain can and should be done when it is necessary. Potential mortalities could be reduced by the improvised drainage using a standard feeding tube as described.

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“…It allows reducing life-threatening intracranial hypertension, thus rapidly improving the patient’s clinical conditions and sometimes saving the patient’s life. The misplacement rate of the ventricular catheters reported in the literature varies widely, ranging from 12.3 to 60% ( Saladino et al, 2009 ; Toma et al, 2009 ; Park et al, 2011 ; Bergdal et al, 2013 ; Chai et al, 2013 ; Rehman et al, 2013 ; Phillips et al, 2014 ), with possible serious complications (e.g., cerebral hematomas, neurological deficits, and seizures) ( Woernle et al, 2011 ; Rosenbaum et al, 2013 ). This misplacement rate has been considered as the baseline for our results, and we aimed to obtain a lower misplacement rate in a simulation setting.…”

Section: Introductionmentioning

confidence: 99%

Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement

et al. 2021

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BackgroundExternal ventricular drain (EVD) placement is mandatory for several pathologies. The misplacement rate of the EVD varies widely in literature, ranging from 12.3 to 60%. The purpose of this simulation study is to provide preliminary data about the possibility of increasing the safety of one of the most common life-saving procedures in neurosurgery by testing a new device for EVD placement.MethodsWe used a novel guide for positioning the ventricular catheter (patent RM2014A000376). The trajectory was assessed using 25 anonymized head CT scans. The data sets were used to conduct three-dimensional computer-based and combined navigation and augmented reality-based simulations using plaster models. The data set inclusion criteria were volumetric head CT scan, without midline shift, of patients older than 18. Evans’ index was used to quantify the ventricle’s size. We excluded patients with slit ventricles, midline shift, skull fractures, or complex skull malformations. The proximal end of the device was tested on the cadaver.ResultsThe cadaveric tests proved that a surgeon could use the device without any external help. The multimodal simulation showed Kakarla grade 1 in all cases but one (grade 2) on both sides, after right and left EVD placement. The mean Evans’ index was 0.28. The geometric principles that explain the device’s efficacy can be summarized by studying the properties of circumference and chord. The contact occurs, for each section considered, at the extreme points of the chord. Its axis, perpendicular to the plane tangent to the spherical surface at the entry point, corresponds to the direction of entry of the catheter guided by the instrument.ConclusionAccording to our multimodal simulation on cadavers, 3D computer-based simulation, 3D plaster modeling, 3D neuronavigation, and augmented reality, the device promises to offer safer and effective EVD placement. Further validation in future clinical studies is recommended.

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Coma due to malplaced external ventricular drain

Cited by 6 publications

References 8 publications

Surface anatomy for implantation of external ventricular drainage: Some surgical remarks

Surface anatomy for implantation of external ventricular drainage: Some surgical remarks

Improvised external ventricular drain in neurosurgery: A Nigerian tertiary hospital experience

Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement

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