External Ventricular Drainage in Patients With Acute Aneurysmal Subarachnoid Hemorrhage After Microsurgical Clipping: Our 2006-2018 Experience and a Literature Review

Konovalov, A N; Shekhtman, O D; Pilipenko, Yury; Okishev, D N; Ershova, Olga; Ошоров, А В; Abramyan, Arevik; Kurzakova, I O; Eliava, Shalva

doi:10.7759/cureus.12951

Cited by 12 publications

(13 citation statements)

References 31 publications

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“…EVDs are frequently placed in patients with aSAH, yet optimal EVD management is a subject of debate, and currently there are no definitive guidelines. Studies have shown that aSAH patients in whom EVDs are placed seem to improve clinically in the short-term; however, the association between EVD use and long-term outcomes remains unclear [ 3 , 11 – 13 ]. EVD placement in SAH patients seems to be associated with improved long-term outcomes in some studies, [ 13 , 14 ] and presence of hydrocephalus was associated with decreased hospital mortality in another study (likely due to prompt treatment with EVDs) [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite advances in management, aneurysmal subarachnoid hemorrhage (aSAH) continues to be associated with high morbidity and mortality [ 1 ]. A substantial proportion (recent case series suggest 22–74% [ 2 , 3 ]) of aSAH patients undergo cerebrospinal fluid diversion via an external ventricular drain (EVD). An EVD can be lifesaving—for example in the management of hydrocephalus and elevated intracranial pressure [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…A substantial proportion (recent case series suggest 22–74% [ 2 , 3 ]) of aSAH patients undergo cerebrospinal fluid diversion via an external ventricular drain (EVD). An EVD can be lifesaving—for example in the management of hydrocephalus and elevated intracranial pressure [ 3 ]. However, EVDs are associated with a number of complications including intracranial hemorrhage, syndromes of overdrainage and underdrainage, and infection [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, EVDs are associated with a number of complications including intracranial hemorrhage, syndromes of overdrainage and underdrainage, and infection [ 4 , 5 ]. The overall association between EVD use and outcome following aSAH is complex and not well understood [ 3 ]. Here, we explored the relationship between EVD use and outcomes in a cohort of patients with aSAH.…”

Section: Introductionmentioning

confidence: 99%

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External ventricular drain use is associated with functional outcome in aneurysmal subarachnoid hemorrhage

Nelson

Suárez

Sigmon

et al. 2022

Neurol. Res. Pract.

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Purpose External ventricular drains (EVD) are commonly used in aneurysmal subarachnoid hemorrhage (aSAH) patients and can be life-saving by diverting cerebrospinal fluid. However, the overall relationship between EVD use and outcome is poorly understood. Methods In an exploratory analysis of an aSAH patient cohort, we examined EVD use in relation to modified Rankin Scale (mRS) at hospital discharge and at 6 months (unfavorable outcome = mRS > 2) using univariable and multivariable analyses. Results EVDs were placed in 31 of 56 (55.4%) patients and more often in women than men (66.7% vs 35.0%, p = 0.022) despite similar rates of hydrocephalus. Women had greater ICU [18 (13.5–25) vs 11.5 (6.5–18.5) days, p = 0.014] and hospital lengths of stay (LOS) [20.5 (16.5–34) vs 13.5 (10.5–27) days, p = 0.015] than men and greater mRS at discharge [4 (3–5) vs 3 (2–3.5), p = 0.011] although mRS at 6 months was similar. Patients with EVDs had longer ICU and hospital LOS and greater mRS at discharge [5 (3–6) vs 2 (2–3), p < 0.001] and at 6 months [4 (2–6) vs 1 (0–2), p = 0.001] than those without an EVD. In multivariable models, EVD use was associated with unfavorable 6-month outcome accounting for age, sex, and admission modified Fisher scale, but not in models adjusting for Hunt and Hess scale and World Federation of Neurological Surgeons scale. Conclusion In an aSAH cohort, the use of EVDs was associated with female sex and longer LOS, and may be linked to functional outcomes at discharge and at 6 months, although these associations warrant further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

External ventricular drain use is associated with functional outcome in aneurysmal subarachnoid hemorrhage

Nelson

Suárez

Sigmon

et al. 2022

Neurol. Res. Pract.

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“… 26 For patients with EVD, necessary to maintain adequate intracranial pressure or having a CSF shunt, the external persistence exists, making the meningitis difficult to cure. 27 The incidence of EVD infection ranges from 2 to 22%, 28 The best way to reduce infection risk is to remove the EVD as soon as it is no longer needed, thereby decreasing the duration of catheterization which is the most significant risk factor for ventriculitis. 29 The patient needs assisted breathing in the state of PNM, which means that the health of a patient is more serious, and that is one of the risk factors for death.…”

Section: Discussionmentioning

confidence: 99%

Nomogram Analysis of Clinical Characteristics and Mortality Risk Factor of Non-Fermentative Gram-Negative Bacteria-Induced Post-Neurosurgical Meningitis

Zheng¹,

Wang²,

Lv³

et al. 2022

IDR

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Objective To explore the clinical characteristics of post-neurosurgical meningitis (PNM) patients infected with nonfermenting Gram-negative bacilli (NFGNB) and to evaluate the related mortality risk factors. Methods A cohort analysis of PNM patients infected with NFGNB in Beijing Tiantan Hospital and Capital Medical University from 2012.1 to 2020.12. The microbial distribution, antimicrobial sensitivity and genotypes were tested, and potential mortality risk factors were evaluated using Mann–Whitney U or chi-squared tests. Independent risk factors for mortality were established by constructing a logistic model. Results A total of 2940 PNM patients were enrolled in this study, of whom 207 (17.1%) were infected with NFGNB. Among these patients, 29 died of NFGNB meningitis, with an overall mortality rate of 14.0%. The top three NFGNBs were Acinetobacter baumannii (105 cases, 50.7%), Pseudomonas aeruginosa (29 cases, 14.0%) and Acinetobacter lwoffii (20 cases, 9.7%). Nomogram analysis revealed that hypertension (OR 4.551, 95% CI: 1.464–14.154, P = 0.009), external ventricular drainage (EVD) (OR 3.944, 95% CI: 1.286–12.095, P = 0.016), and assisted mechanical ventilator (AMV) (OR 6.192, 95% CI: 1.737–22.081, P = 0.005) were independent risk factors for mortality. In addition, antibiotic prophylaxis was shown to play a vital role in NFGNB-induced PNM therapy. Conclusion PNM patients infected with NFGNB have a high mortality rate. Hypertension, EVD and AMV were independent mortality risk factors, and clinical attention should be paid to their prevention and treatment.

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Transient acute hydrocephalus after aneurysmal subarachnoid hemorrhage and aneurysm embolization: a single-center experience

et al. 2021

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External Ventricular Drainage in Patients With Acute Aneurysmal Subarachnoid Hemorrhage After Microsurgical Clipping: Our 2006-2018 Experience and a Literature Review

Cited by 12 publications

References 31 publications

External ventricular drain use is associated with functional outcome in aneurysmal subarachnoid hemorrhage

External ventricular drain use is associated with functional outcome in aneurysmal subarachnoid hemorrhage

Nomogram Analysis of Clinical Characteristics and Mortality Risk Factor of Non-Fermentative Gram-Negative Bacteria-Induced Post-Neurosurgical Meningitis

Transient acute hydrocephalus after aneurysmal subarachnoid hemorrhage and aneurysm embolization: a single-center experience

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