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

Abstract

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.

Distant large acute epidural hematoma after closed cerebrospinal fluid tapping through the anterior fontanelle: A case report and its pathogenesis

“…[ 3 , 6 , 15 ] However, there are no reported cases in the literature about EDH occurrence after ventricular tapping, which is commonly used instead of the EVD to manage CSF infection in open anterior fontanelle patients. [ 13 , 14 ] The tapping was done through the right or left angles of the anterior fontanelle in a direction away from the superior sagittal sinus using a small-bore cannula at a rate of 2 ml/min. In the authors’ hospital, due to the low socioeconomic standards, the open anterior fontanelle infants are managed by IV antibiotics and anterior fontanelle tapping every 3 days for CSF drainage and analysis until the CSF is clear from infection.…”

Management of Infected Hydrocephalus in Infancy; Repeated Tapping versus External Ventricular Drain

“…A range of settings, including radiology departments, dedicated procedure areas, and patient care units, are used to perform neurological diagnostic procedures. Ventricular tapping is used to detect infections in the ventricle (Ojo, O. A. et al, 2015).…”

The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury

“…In resource-limited settings, commercially manufactured EVD sets are not always accessible and affordable. Improvisations using readily available apparatuses to monitor ICP and temporarily drain CSF have been reported in the literature with success and minimal complications [148,149,150]. At hospitals in Nigeria and India, feeding tubes have been reported as substitutes to EVD catheters whilst a sterile urine collection bag completes the closed drainage system [148,150].…”

“…Improvisations using readily available apparatuses to monitor ICP and temporarily drain CSF have been reported in the literature with success and minimal complications [148,149,150]. At hospitals in Nigeria and India, feeding tubes have been reported as substitutes to EVD catheters whilst a sterile urine collection bag completes the closed drainage system [148,150]. In an observational study in a Tunisian hospital, a 14-gauge central catheter assembled on a metal guide acted as a catheter, with the suture wings aiding fixation post-tunnelling [149].…”