The history of external ventricular drainage

Abstract

External ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures. It was first performed as early as 1744 by Claude-Nicholas Le Cat. Since then, there have been numerous changes in technique, materials used, indications for the procedure, and safety. The history of EVD is best appreciated in 4 eras of progress: development of the technique (1850-1908), technological advancements (1927-1950), expansion of indications , and accuracy, training, and infection control (1995-present). While EVD was first attempted in the 18th century, it was not until 1890 that the first thorough report of EVD technique and outcomes was published by William Williams Keen. He was followed by H. Tillmanns, who described the technique that would be used for many years. Following this, many improvements were made to the EVD apparatus itself, including the addition of manometry by Adson and Lillie in 1927, and continued experimentation in cannulation/drainage materials. Technological advancements allowed a great expansion of indications for EVD, sparked by Nils Lundberg, who published a thorough analysis of the use of intracranial pressure (ICP) monitoring in patients with brain tumors in 1960. This led to the application of EVD and ICP monitoring in subarachnoid hemorrhage, Reye syndrome, and traumatic brain injury. Recent research in EVD has focused on improving the overall safety of the procedure, which has included the development of guidance-based systems, virtual reality simulators for trainees, and antibiotic-impregnated catheters.

Sonda uretral flexível como método alternativo para aferição invasiva da pressão intracraniana em trauma cranioencefálico induzido em coelhos

“…O princípio de mensuração da PIC pelo método intraventricular ocorre pelo deslocamento da coluna líquida e do grau de deformação da parede do cateter, que contribui para o deslocamento do LCE e resulta na leitura de um valor que é registrado pelo monitor multiparamétrico (Srinivasan et al, 2014). Acredita-se que a maneira de aferição da PIC com a utilização da sonda uretral flexível seja a mesma do cateter de ventriculostomia.…”

Traumatic Brain Injury: Current Treatment Strategies and Future Endeavors

“…25 The mainstay of ICP monitoring continues to be the external ventricular drain, which can be utilized for both therapeutic and diagnostic purposes. 26 If the patient's ventricles are too small and do not accommodate a ventricular drain, another option is to place a diagnostic fiberoptic ICP monitor. 27 New models are now being used on a more routine basis to monitor brain oxygen tension, as evidence exists that this parameter falls in cases of severe TBI.…”

Complications of invasive intracranial pressure monitoring devices in neurocritical care

“…1). 54 During the 18th and 19th centuries, the techniques and materials for ventriculostomy improved, and the indications expanded. In 1898, Fedor Krause described the use of ventricular drainage perioperatively in posterior fossa surgery, 52 and in 1918, Walter Dandy described ventriculography after injecting air into the ventricles.…”

“…External ventricular drains (EVDs) were being used for continuous ICP monitoring in patients with brain tumors by the 1960s and for patients with subarachnoid hemorrhage (SAH) and patients with traumatic brain injury (TBI) by the 1980s. 54 Currently, the Brain Trauma Foundation 4th edition guidelines provide a Level IIB recommendation for the use of ICP monitoring in the management of patients with severe TBI to reduce in-hospital and 2-week postinjury mortality. 9 Technical difficulties and complications associated with ventricular catheterization led to the development of fiberoptic and miniature strain-gauge sensors that could be placed in the subdural space, parenchyma, or ventricle for ICP monitoring.…”