External ventricular drains in pediatric patients*

Ngo, Quang; Ranger, Adrianna; Singh, Richa; Kornecki, Alik; Seabrook, Jamie A.; Fraser, Douglas D.

doi:10.1097/pcc.0b013e3181a320cd

Cited by 84 publications

(60 citation statements)

References 38 publications

(62 reference statements)

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“…15,18) In our standardized protocol, the maximal insertion depth was 6 cm. Malplacement during the EVD procedure is a commonly described complication, 6,16) although previously published studies do not analyze the causes in full detail. In particular, notes or details on iatrogenic influence factors have been missing (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…3,5,6,8,10,12,[15][16][17][18][19][20][21] In particular, EVD-associated infections were found in 0% to 20% of patients in previous studies (Table 1), and the risk of surgery-associated hemorrhages or EVD device malplacements are often described. 3,5,6,10,12,[15][16][17][18][19][20][21] The highest reported complication rate of 33% shows the possible understatement of the catheter-associated complication risk. 15) The question still remains why this variety of perioperative complications is found and whether iatrogenic factors influence the surgical complication rate and thus the outcome.…”

Section: Introductionmentioning

confidence: 99%

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Do Iatrogenic Factors Bias the Placement of External Ventricular Catheters? -A Single Institute Experience and Review of the Literature-

Woernle

Burkhardt

Bellut

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Placement of external ventricular drainage (EVD) catheters is the gold standard for managing acute hydrocephalus, but the range of complications varies in different studies. The objective of this present single institute study is to analyze iatrogenic factors, which may influence the EVD device placement and the patient's outcome. A total of 137 EVD placements in 120 patients at the University Hospital Zurich were analyzed retrospectively. Discriminative findings between the pre-and postoperative imaging were obtained and evaluated in detail with regards to the postoperative course, ventriculostomyrelated infection, and acute neurological deterioration directly related to the EVD placement. These findings were correlated to iatrogenic factors including education level of the neurosurgeon and surgical setting. Overall EVD-related complication rate was 16.1%, including infection rate of 10.2%, catheter malplacement rate of 2.2%, and hemorrhage rate of 3.6%. Although not statistically significant, catheter-associated hemorrhages and malplacements were found mostly in primary EVD surgery, with a higher complication rate associated with junior residents as the performing surgeon. In contrast, ventriculostomy-related infection was most likely present in patients with more than one EVD placement and in patients treated by more experienced physicians. Complications related to EVD are common. The rate and character of the complication depends on the education level of the surgeon.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Do Iatrogenic Factors Bias the Placement of External Ventricular Catheters? -A Single Institute Experience and Review of the Literature-

Woernle

Burkhardt

Bellut

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…Ngo et al [6] reported some indications based on their experience, however, this study was limited by a small sample size and a lack of etiological description (causes were simply condensed into VPS failure, new onset hydrocephalus or traumatic brain injury). Moreover, by including secondary EVD placement after VPS failure, they were unable to adequately describe the true indications for primary EVDs.…”

Section: Introductionmentioning

confidence: 99%

Indications for Pediatric External Ventricular Drain Placement and Risk Factors for Conversion to a Ventriculoperitoneal Shunt

Walker

Stone²,

Jacobson³

et al. 2012

Pediatr Neurosurg

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Background/Aims: The external ventricular drain (EVD) is commonly used for the treatment of hydrocephalus and intracranial pressure (ICP) monitoring. In this study, we retrospectively reviewed indications for EVD placement over the last 20 years in pediatric patients at our institution. Additionally, we evaluated the rate that an EVD needed to be converted to a ventriculoperitoneal shunt (VPS) and ascertained how hydrocephalus etiology impacted long-term drainage requirements. Methods: Patients that received an EVD between 1990 and 2010 at our institution were identified using billing codes. Demographics, etiology of hydrocephalus, length of stay (LOS) and EVD duration were recorded. Only patients receiving their first EVD were included; those with any prior ventricular catheter (including prior shunts) were excluded from this study. Results: A total of 180 patients underwent first-time placement of an EVD over the 20-year period. Of these, 78.9% were placed on the right side and 81.7% were performed through a frontal burr hole site. The average age of all patients at their initial procedure was 9.3 years (median 9.8; range 0-18), hospital LOS was 22.5 days (median 16; range 1-174) and EVD duration was 7.8 days (median 7; range 1-37). Trauma (43.3%) and neoplasms (32.2%) were the most common indications. Approximately, one quarter of the patients were unable to become EVD independent and, therefore, required a VPS. Only patients receiving an EVD for traumatic brain injury were significantly less likely to be converted to a shunt than other causes of hydrocephalus (relative risk, RR = 0.18, 95% confidence interval, CI = 0.07-0.46). Conversely, patients with neoplasms (RR = 3.56, 95% CI = 1.74-7.31), obstructive hydrocephalus (RR = 5.48, 95% CI = 1.37-22.0) and intraventricular hemorrhage (RR = 9.86, 95% CI = 1.05-92.3) were more likely to need a shunt. Conclusion: Traumatic brain injuries and neoplasms represent the most common indications for EVD placement in the pediatric population. While patients with neoplasm were much more likely to need conversion to a VPS for long-term cerebrospinal fluid diversion, the majority of EVDs in patients with head injuries were successfully weaned.

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“…Almost all the reports are related to infections or hemorrhages, and the rate of misplacement is ranging from 12.3% to 60.1% [1]- [5]. Ngo et al reported the rate of malplacement in pediatric cases at approximately 3% [6]. Transient neurological complications are apparently very rare and to our best knowledge, there is only one case report of transient coma due to the direct compression of the brain stem by a drain [7].…”

Section: Introductionmentioning

confidence: 99%

An Unexpected Complication by Misplacement of an External Ventricular Drain; Transient Oculomotor Palsy Due to Direct Compression by a Drain—A Case Report

Anami¹,

Aihara²,

Takano³

et al. 2016

JBBS

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Background: Insertion of an external ventricular drain (EVD) is an important neurosurgical technique. There is a minor risk of misplacement, and complications including infections or hemorrhages have been reported. Transient neurological complications are, however, very rare, especially when EVD is placed under endoscope assistance. We report a case of unilateral transient oculomotor palsy after an EVD procedure. Case presentation: An 11-year-old boy with past medical history of moyamoya disease suffered from intraventricular hemorrhage and acute hydrocephalus. Insertion of EVD and hematoma removal was performed with endoscope assistance. After the surgery, transient oculomotor palsy occurred by the direct compression of the brain stem by the drainage tube. Conclusion: Transient unilateral oculomotor palsy due to the direct compression of the midbrain by an EVD tube is a very rare, but possible complication, even under endoscopic assistance. Attention through the procedure is required until skin closure to avoid tube dislocation.

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External ventricular drains in pediatric patients*

Cited by 84 publications

References 38 publications

Do Iatrogenic Factors Bias the Placement of External Ventricular Catheters? -A Single Institute Experience and Review of the Literature-

Do Iatrogenic Factors Bias the Placement of External Ventricular Catheters? -A Single Institute Experience and Review of the Literature-

Indications for Pediatric External Ventricular Drain Placement and Risk Factors for Conversion to a Ventriculoperitoneal Shunt

An Unexpected Complication by Misplacement of an External Ventricular Drain; Transient Oculomotor Palsy Due to Direct Compression by a Drain—A Case Report

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