The insertion and management of an external ventricular drain in pediatric patients with hydrocephalus associated with medulloblastoma

Zhang, Zaiyu; Wu, Yuxin; Zhao, Xiaofei; Zhou, Jianjun; Li, L; Zhai, Xuan; Liang, Ping

doi:10.1007/s10143-023-02080-7

Cited by 2 publications

(1 citation statement)

References 36 publications

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“…If an EVD is indicated, the drainage time should be reduced to a minimum not only to avoid EVD-related infection but probably also to lower the shunt conversion rate. The latter is exemplified by a recent publication by Zhang et al on a series of 120 children with a medulloblastoma in whom rapid weaning of the EVD lowered postoperative shunt dependence to 18.3% [ 20 ]. Whether or not EVDs should be placed in patients with tumors in the fourth ventricle who undergo surgery in the semi-sitting position needs further consideration.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

Atallah,

Krauss,

Hermann

2024

Childs Nerv Syst

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Modified ventriculoperitoneal shunt applied to temporary external ventricular drainage

Lin,

Chen,

Lin

et al. 2024

Sci Rep

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External ventricular drainage (EVD) is a common procedure in neurosurgical practice. Presently, the three methods used most often include direct EVD (dEVD), long-tunneled external ventricular drains (LTEVDs), and EVD via the Ommaya reservoir (EVDvOR). But they possess drawbacks such as limited duration of retention, vulnerability to iatrogenic secondary infections, and challenges in regulating drainage flow. This study aimed to explore the use of a modified ventriculoperitoneal shunt (mVPS)—the abdominal end of the VPS device was placed externally—as a means of temporary EVD to address the aforementioned limitations. This retrospective cohort study, included 120 cases requiring EVD. dEVD was performed for 31 cases, EVDvOR for 54 cases (including 8 cases with previously performed dEVD), and mVPS for 35 cases (including 6 cases with previously performed EVDvOR). The one-time success rate (no need for further other EVD intervention) for dEVD, EVDvOR, and mVPS were 70.97%, 88.89%, and 91.42%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Puncture needle displacement or detachment was observed in nearly all cases of EVDvOR, while no such complications have been observed with mVPS. Apart from this complication, the incidence of postoperative complications was 35.48%, 14.81%, and 8.5%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Mean postoperative retention for EVD was 14.68 ± 9.50 days, 25.96 ± 15.14 days, and 82.43 ± 64.45 days, respectively (P < 0.001). In conclusion, mVPS significantly extends the duration of EVD, which is particularly beneficial for patients requiring long-term EVD.

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The insertion and management of an external ventricular drain in pediatric patients with hydrocephalus associated with medulloblastoma

Cited by 2 publications

References 36 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

Modified ventriculoperitoneal shunt applied to temporary external ventricular drainage

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