Techniques and Complications of External Lumbar Drainage for Normal Pressure Hydrocephalus

Governale, Lance S.; Fein, Nicole; Logsdon, Jessica L; Black, Peter McL.

doi:10.1227/01.neu.0000327023.18220.88

Cited by 77 publications

(85 citation statements)

References 12 publications

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“…The risk factors associated with these drains include disconnection of the external drainage system and the presence of other infections. In a study involving 233 consecutive patients who underwent placement of an external lumbar drain for normal-pressure hydrocephalus testing, the rate of meningitis was low (0.8%) [22]. The investigators in that study used a strict protocol that called for no surveillance testing of CSF, drainage of CSF for a maximum of 5 days, sterile reconnection after disconnection or fracture of the drain, and permanent removal of the drain after a second disconnection or fracture.…”

Section: Cerebrospinal Fluid Drainsmentioning

confidence: 99%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

698

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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Section: Cerebrospinal Fluid Drainsmentioning

confidence: 99%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

698

671

View full text Add to dashboard Cite

show abstract

“…Extended lumbar drain (LD) for 72 hours has become a popular pre-shunt workup in many neurosurgical centers [59][60][61]. Its popularity stems from the findings of an excellent study which demonstrated the high specificity and sensitivity of predicting shunt response based on LD test outcome [60,62].…”

Section: Predicting Lumbar Drain Outcome From Icp Morphologymentioning

confidence: 99%

Real-Time Analysis of Intracranial Pressure Waveform Morphology

Scalzo¹,

Hamilton²,

Hu³

2012

Advanced Topics in Neurological Disorders

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“…The risk of meningitis associated with lumbar drain placement varies from 0% to 25.6% [14], and is highest when the drain is placed after subarachnoid or intraventricular hemorrhage, after disconnection of external drainage system, or in the presence of other infections.…”

Section: External Lumbar Cathetersmentioning

confidence: 99%

Healthcare-Associated Bacterial Meningitis

Laxmi

Tunkel

2011

Curr Infect Dis Rep

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Healthcare-associated bacterial meningitis may occur after neurosurgical procedures, head trauma, and following placement of external or internal ventricular catheters. The likely microorganisms that cause meningitis in this setting (ie, staphylococci and gram-negative bacilli) are different from those that cause meningitis in the community setting. Any clinical suspicion of healthcare-associated bacterial meningitis should prompt a diagnostic evaluation (neuroimaging and cerebrospinal fluid analysis) and appropriate management. Empiric antimicrobial therapy should be directed toward the likely infecting pathogen; based upon clinical response, intraventricular administration of specific agents may be required. With the emergence of resistant gram-negative bacilli (especially Acinetobacter baumannii) that may cause healthcare-associated meningitis, empiric therapy with a carbapenem, with or without an aminoglycoside administered by the intraventricular or intrathecal route, is recommended; colistin (given intravenously and/or intraventricularly) can be used if the organism is subsequently found to be resistant to carbapenems.

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Techniques and Complications of External Lumbar Drainage for Normal Pressure Hydrocephalus

Abstract: The rate of serious complications from external lumbar drainage for normal pressure hydrocephalus is low. It is hoped that continued evaluation of the procedure will lead to further reductions in the complication rate.

Cited by 77 publications

References 12 publications

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Real-Time Analysis of Intracranial Pressure Waveform Morphology

Healthcare-Associated Bacterial Meningitis

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