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external_ventricular_drain

External ventricular drain

External ventricular drainage or ventriculostomy is a common neurosurgical technique and accurate placement of the ventricular catheter is one of the most important variables in the longevity of shunt survival 1) 2).

Indications

Cerebrospinal fluid (CSF) external drainage devices are used to drain CSF and to monitor the flow of CSF from the ventricular system in order (1) to control intracranial pressure (ICP), (2) to evaluate CSF chemistry and cytology, and (3) to provide temporary egress for CSF in patients with infected or malfunctioning cerebrospinal fluid shunts.

The optimal setting for EVD placement in regards to safety and accuracy of placement is poorly defined.

After days of use, a decision is made to remove the EVD or replace it with a shunt, involving EVD weaning and CT imaging to observe ventricular size and clinical status. This practice may lead to prolonged hospital stay, extra radiation exposure, and neurological insult due to ICP elevation.

Types

Plain catheter

Antibiotic impregnated catheter: Bactiseal.

Silver impregnated catheter.

Bolt-connected external ventricular drainage.

Ventriculostomy entry sites are commonly selected by freehand estimation of Kocher's point or approximations from skull landmarks and a trajectory toward the ipsilateral frontal horn of the lateral ventricles.

Endoscopic third ventriculostomy.

see Frontal ventriculostomy.

see Fourth ventriculostomy.


Tunneled external ventricular drainage.

Standard external ventricular drainage.

Techniques

Trials

A study design of a single center, prospective, randomized controlled trial to investigate whether guided ventriculostomy is superior to the standard freehand technique. One strength of this study is the prospective, randomized, interventional type of study testing a new easy-to-handle guided versus freehand ventricular catheter placement. A second strength of this study is that the power calculation is based on catheter accuracy using an available grading system for catheter tip location, and is calculated with the use of recent study results of our own population, supported by data from prominent studies 3).

Complications

Case series

1)
Wan KR, Toy JA, Wolfe R, Danks A. Factors affecting the accuracy of ventricular catheter placement. J Clin Neurosci. 2011 Apr;18(4):485-8. doi: 10.1016/j.jocn.2010.06.018. Epub 2011 Jan 20. PubMed PMID: 21256029.
2)
Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M. Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg. 2000 Jan;92(1):31-8. PubMed PMID: 10616079.
3)
Sarrafzadeh A, Smoll N, Schaller K. Guided (VENTRI-GUIDE) versus freehand ventriculostomy: study protocol for a randomized controlled trial. Trials. 2014 Dec 5;15:478. doi: 10.1186/1745-6215-15-478. PubMed PMID: 25480528; PubMed Central PMCID: PMC4289205.
external_ventricular_drain.txt · Last modified: 2019/08/06 16:39 by administrador