Predictor of a permanent shunt after treatment of external ventricular draining in pediatric postinfective hydrocephalus—a retrospective cohort study

Zhang, Yi; Zhao, Rui; Wei, Shi; Zheng, Jicui; Li, Hao; Li, Zhihua

doi:10.1007/s00381-021-05054-6

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…Few exemptions include those patients who had a shunt system for occlusive hydrocephalus and who may benefit then from third ventriculostomy [ 44 ]. The overall shunt conversion rates of 51.6% in our series is comparable to the series of Zhang et al reporting a conversion rate of 64.5% [ 45 ]. When considering only the tumor and the hemorrhage groups, the conversion rates of 27.7% and 32% corresponded well with the data reported by Walker et al indicating a rate of 25% in 180 children [ 2 ].…”

Section: Discussionsupporting

confidence: 86%

External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates

Atallah,

Krauss,

Hermann

2024

Childs Nerv Syst

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Purpose Placement of an external ventricular drainage (EVD) is one of the most frequent procedures in neurosurgery, but it has specific challenges and risks in the pediatric population. We here investigate the indications, management, and shunt conversion rates of an EVD. Methods We retrospectively analyzed the data of a consecutive series of pediatric patients who had an EVD placement in the Department of Neurosurgery at Hannover Medical School over a 12-year period. A bundle approach was introduced to reduce infections. Patients were categorized according to the underlying pathology in three groups: tumor, hemorrhage, and infection. Results A total of 126 patients were included in this study. Seventy-two were male, and 54 were female. The mean age at the time of EVD placement was 5.2 ± 5.0 years (range 0–17 years). The largest subgroup was the tumor group (n = 54, 42.9%), followed by the infection group (n = 47, 37.3%), including shunt infection (n = 36), infected Rickham reservoir (n = 4), and bacterial or viral cerebral infection (n = 7), and the hemorrhage group (n = 25, 19.8%). The overall complication rate was 19.8% (n = 25/126), and the total number of complications was 30. Complications during EVD placement were noted in 5/126 (4%) instances. Complications during drainage time were infection in 9.5% (12 patients), dysfunction in 7.1% (9 patients), and EVD dislocation in 3.2% (4 patients). The highest rate of complications was seen in the hemorrhage group. There were no long-term complications. Conversion rates into a permanent shunt system were 100% in previously shunt-dependent patients. Conversion rates were comparable in the tumor group (27.7%) and in the hemorrhage group (32.0%). Conclusion EVD placement in children is an overall safe and effective option in children. In order to make further progress, carefully planned prospective and if possible randomized studies are needed controlling for multivariable aspects.

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Section: Discussionsupporting

confidence: 86%

External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates

Atallah,

Krauss,

Hermann

2024

Childs Nerv Syst

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“…Second, continuous ventricular drainage of CSF gradually cleared the CSF after placing a new extracellular ventricular drainage tube. 39 , 40 In our study, CSF biochemistry and routine results also indicated gradual improvement to normal. Third, IVT polymyxin B can bypass the blood-brain barrier and higher concentration accumulates in the CSF than with IV antibiotics alone, reaching a minimum inhibitory concentration of 0.5 g/mL.…”

Section: Discussionsupporting

confidence: 69%

Treatment of Carbapenem-Resistant Multidrug-Resistant Gram-Negative Bacilli with Intracerebroventricular Injection of Polymyxin B: A Retrospective Study

Liu¹,

Niu²,

Chen³

et al. 2022

IDR

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Purpose We evaluated the efficacy and administration time of intraventricular (IVT) polymyxin B in the treatment of carbapenem-resistant and multidrug-resistant/extensively drug-resistant (MDR/XDR) Gram-negative bacilli in central nervous system (CNS) infections and investigated prognostic factors. Patients and Methods This retrospective analysis comprised 41 post-surgical carbapenem-resistant CNS infections from October 2016 to October 2021. All patients were treated with effective intravenous antibiotics and IVT polymyxin B. Patient characteristics, therapeutic procedure, symptoms, cerebrospinal fluid (CSF) examination, laboratory tests, and complications were recorded. The effectiveness of IVT polymyxin B was evaluated using temperature, Glasgow Coma Scale, CSF contents, bacterial clearance rate, cure rate, and mortality. Mortality between early (7 days) and late administration of IVT polymyxin B was compared. Prognostic factors were evaluated using the pupillary light reflex and multiloculated hydrocephalus. Results The 41 patients acquired carbapenem-resistant MDR/XDR bacteria, including 24 Klebsiella pneumoniae , 15 Acinetobacter baumannii , 3 Pseudomonas aeruginosa , and 1 Enterobacter cloacae . The bacterial clearance rate was 32/41 (78.0%), and 9 patients (22.0%) with uncured bacterial infections died. Adverse events included 1 case of skin pigmentation. Among the 32 cured patients, 31 received a ventriculoperitoneal shunt, and 1 patient had an extraventricular drainage tube removed. Mortality in the late (>7 days) group was higher (39.1% vs 0%, P < 0.05). The group without pupillary light reflex showed a higher death rate (41.2% vs 8.3%; P < 0.05). The multiloculated hydrocephalus group had a higher mortality rate than that of the normal group (34.8% vs 5.6%, P < 0.05). All 32 cured patients were followed up for 9 to 66 months, and all survived without recurrent infections. Conclusion Intraventricular polymyxin B is an effective treatment for carbapenem-resistant MDR/XDR Gram-negative bacilli, with a 78% cure rate and significant mortality reduction if administered within 7 days of bacterial identification. Multiloculated hydrocephalus and the pupillary light reflex may be used as prognostic indicators of mortality.

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External ventricular drainage: indications and outcome among Sudanese Children

Elzain¹,

Ahmed²,

Salim³

2022

Sudan J Paed

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This study reflects on our experience in managing Sudanese children with different cranial conditions through external ventricular drain (EVD); indications for EVD, pathologies faced, and early outcome. A prospective review of cases operated at the National Center for Neurological Sciences was performed during the period from February 2014 to February 2016. The patients were closely followed till EVD removal and patient discharge. Thirty-five Sudanese children were included in the study (age range between 6 days to 7 years). The majority of the cases had posterior fossa tumor with obstructive hydrocephalus (n=19, 54.3%). Twenty patients (57.1%) presented with decreased level of consciousness while 28 (80%) patients presented with symptoms and signs of raised intracranial pressure (ICP). The decision for EVD was made preoperatively based on positive cranial computed tomography/magnetic resonance imaging (CT/MRI) findings in 10 patients (28.6%). Additionally, 28 patients (80%) responded to single injectable antibiotic therapy with an average duration of 22 days. Subsequently, 25 patients improved or got cured (71.4%), 5 deteriorated and 11 died. We concluded that EVD can be used for many indications including obstructive, post-infectious and post-meningitic hydrocephalus as well as intraventricular hemorrhage. Most patients may present with either deteriorating level of consciousness or symptoms and signs of raised ICP but few of them may have positive brain imaging findings and therefore the decision for EVD was made intra-operatively. The average duration for EVD use was 3 weeks with single antibiotic therapy use which was found as effective as when combined with intraventricular therapy.

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Predictor of a permanent shunt after treatment of external ventricular draining in pediatric postinfective hydrocephalus—a retrospective cohort study

Cited by 4 publications

References 22 publications

External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates

External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates

Treatment of Carbapenem-Resistant Multidrug-Resistant Gram-Negative Bacilli with Intracerebroventricular Injection of Polymyxin B: A Retrospective Study

External ventricular drainage: indications and outcome among Sudanese Children

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