Postprocedural Complications of External Ventricular Drains: A Meta-Analysis Evaluating the Absolute Risk of Hemorrhages, Infections, and Revisions

Mahto, Neil; Owodunni, Oluwafemi P.; Okakpu, Uchenna; Kazim, Syed Faraz; Varela, Samantha; Varela, Yandry; Garcia, Josiel; Alunday, Robert; Schmidt, Meic H.; Bowers, Christian A.

doi:10.1016/j.wneu.2022.11.134

Cited by 6 publications

(4 citation statements)

References 160 publications

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“…Conducting similar multicentric studies could yield more comprehensive results and provide a clearer understanding of EVD placement dynamics (18)(19)(20). Such expanded research could potentially lead to improved EVD placement techniques and outcomes (21,22).…”

Section: Discussionmentioning

confidence: 99%

Determinants of Accuracy of Freehand, EVD Placement by Neurosurgical Trainees.

Farooqi,

Rehman,

Javeed

et al. 2024

JHRR

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Background: The insertion of an external ventricular drain (EVD) is a fundamental neurosurgical procedure predominantly performed by junior neurosurgical trainees. It is vital for managing conditions like hydrocephalus, intracranial hypertension, traumatic brain injury, and others. The procedure's success heavily relies on the precise identification of anatomical landmarks and the trainee's experience. Objective: This study aims to assess the precision and safety of EVD placement in patients treated by first-year (R1) and second-year (R2) neurosurgical residents, evaluating the impact of the residents' experience levels on the outcomes of the procedure. Methods: Conducted at the Neurosurgery Department of Jinnah Post Graduate Medical Center, Karachi, from February to July 2022, this prospective cohort study involved individuals aged 18 years or older undergoing EVD placement for hydrocephalus. Exclusion criteria included patients with more than 5mm midline shift on initial scans or those without a post-EVD placement scan. Procedures were performed under senior resident supervision, with postoperative CT scans assessing catheter tip placement and potential complications. Statistical analyses utilized IBM SPSS Statistics for Windows, Version 25.0, with Student’s t-test, Chi-square, and Fisher exact tests applied as appropriate. Results: The study comprised 152 patients (mean age: 39.4 ± 10.7 years; 52.6% male). The initial GCS scores varied, with 44.7% scoring above 8. Most EVD placements (60.5%) were by residents in their fourth or fifth year. The average procedure duration was 43 ± 8.7 minutes, with an average of 1.44 ± 0.12 passes. Optimal placement (Kakarla Grade 1) was achieved in 59.2% of cases, with significant differences in placement accuracy between R1 and R2 residents (p<0.05). Conclusion: The study highlights the significant role of experience and training in the successful placement of EVDs. The higher accuracy rates in more experienced residents underscore the need for enhanced training programs for junior neurosurgical trainees, focusing on anatomical landmark identification and procedural practice.

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Section: Discussionmentioning

confidence: 99%

Determinants of Accuracy of Freehand, EVD Placement by Neurosurgical Trainees.

Farooqi,

Rehman,

Javeed

et al. 2024

JHRR

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“…Intracranial bleeding is one of the most common and significant potential complications of EVD placement, and Wiesmann and Mayer were forerunners to investigate this adverse event while introducing an easy-to-handle grading system for EVD-related hemorrhages [20]. Since then, numerous studies from monocentric retrospective case series to meta-analyses have analyzed hemorrhage rates after EVD insertion [8,19,[40][41][42][43][44]. According to these, the incidence of hemorrhage (as calculated per inserted EVD) ranges between 0 [45] and 32.5% [43].…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly used right frontal approach through a twist-drill burr hole at Kocher's point is traditionally performed with a landmark-based technique and has several advantages such as easy patient positioning, a passage through the non-dominant hemisphere, a wide distance from the eloquent cortex, and-depending on patients' anatomy-a relatively large target region of the frontal horn of the ipsilateral lateral ventricle [2]. The most common immediate and delayed major complications of EVD placement include hemorrhage and infection, respectively, often requiring repositioning or replacement [8,9]. Although the precision of placement is critical with respect to avoiding bleeding complications and tissue damage [10], the above-mentioned landmark-based or even a freehand technique [11] is still widely preferred in spite of the availability of alternative technical solutions for imaging guidance [12] or stereotactic navigation [13], particularly in the acute setting.…”

Section: Introductionmentioning

confidence: 99%

Accuracy, Hemorrhagic Complications and CT Radiation Dose of Emergency External Ventricular Drain (EVD) Placement in Pediatric Patients: A 15-Year Retrospective Analysis

Stahl,

D’Anastasi,

Forbrig

et al. 2023

Diagnostics

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Purpose: To assess accuracy, the frequency of hemorrhagic complications and computed tomography (CT) radiation dose parameters in pediatric patients undergoing landmark-guided external ventricular drain (EVD) placement in an emergency setting. Methods: Retrospective analysis comprised 36 EVD placements with subsequent CT control scans in 29 patients (aged 0 to 17 years) in our university hospital from 2008 to 2022. The position of the EVD as well as the presence and extension of bleeding were classified according to previously established grading schemes. Dose length product (DLP), volume-weighted CT dose index (CTDIvol) and scan length were extracted from the radiation dose reports and compared to the diagnostic reference values (DRLs) issued by the German Federal Office for Radiation Protection. Results: After the initial EVD placement, optimal positioning of the catheter tip into the ipsilateral frontal horn or third ventricle (Grade I), or a functional positioning in the contralateral lateral ventricle or the non-eloquent cortex (Grade II), was achieved in 28 and 8 cases, respectively. In 32 of 36 procedures, no evidence of hemorrhage was present in the control CT scan. Grade 1 (<1 mL) and Grade 2 (≥1 to 15 mL) bleedings were detected after 3 and 1 placement(s), respectively. For control scans after EVD placements, CTDIvol (median [25%; 75% quartile]) was 39.92 [30.80; 45.55] mGy, DLP yielded 475.50 [375.00; 624.75] mGy*cm and the scan length result was 136 [120; 166] mm. Exceedances of the DRL values were observed in 14.5% for CTDIvol, 12.7% for DLP and 65.6% for the scan length. None of these values was in the range requiring a report to the national authorities. Conclusion: Landmark-based emergency EVD placement in pediatric patients yielded an optimal position in most cases already after the initial insertion. Complications in terms of secondary hemorrhages are rare. CT dose levels associated with the intervention are below the reportable threshold of the national DRLs in Germany.

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“…4 Two common complications of EVD placement are hemorrhage and infection. 5 We and others have previously shown that EVD-related infections independently increase the odds of poor outcome after sICH. 6 Catheter tract hemorrhages (CTH), on the other hand, are poorly studied.…”

mentioning

confidence: 81%

Catheter Tract Hemorrhages and Intracerebral Hemorrhage Outcomes in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Trial

Garton,

Oh,

Müller

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Factors associated with external ventricular catheter tract hemorrhage (CTH) are well studied; whether CTH adversely influence outcomes after intracerebral hemorrhage (sICH), however, is poorly understood. We therefore sought to evaluate the association between CTH and sICH outcomes. METHODS: We performed a post hoc analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage trial. The exposure was CTH and evaluated on serial computed tomography scans between admission and randomization (approximately 72 hours). The primary outcomes were a composite of death or major disability (modified Rankin Score >3) and mortality alone, both assessed at 6 months. Secondary outcomes were functional outcomes at 30 days, permanent cerebrospinal fluid (CSF) shunt placement, any infection, and ventriculitis. We performed logistic regression adjusted for demographics, comorbidities, sICH characteristics, and treatment assignment, for all analyses. RESULTS: Of the 500 patients included, the mean age was 59 (SD, ±11) years and 222 (44%) were female. CTH occurred in 112 (22.4%) patients and was more common in minority patients, those on prior antiplatelet therapy, and patients who had more than 1 external ventricular drain placed. The end of treatment intraventricular hemorrhage volume was higher among patients with CTH (11.7 vs 7.9 mL, P = .01), but there were no differences in other sICH characteristics or the total duration of external ventricular drain. In multivariable regression models, CTH was not associated with death or major disability (odds ratio, 0.7; 95% CI: 0.4-1.2) or death alone (odds ratio, 0.8; 95% CI, 0.5-1.4). There were no relationships between CTH and secondary outcomes including 30-day functional outcomes, permanent CSF shunt placement, any infection, or ventriculitis. CONCLUSION: Among patients with sICH and large intraventricular hemorrhage, CTH was not associated with poor sICH outcomes, permanent CSF shunt placement, or infections. A more detailed cognitive evaluation is needed to inform about the role of CTH in sICH prognosis.

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Postprocedural Complications of External Ventricular Drains: A Meta-Analysis Evaluating the Absolute Risk of Hemorrhages, Infections, and Revisions

Cited by 6 publications

References 160 publications

Determinants of Accuracy of Freehand, EVD Placement by Neurosurgical Trainees.

Determinants of Accuracy of Freehand, EVD Placement by Neurosurgical Trainees.

Accuracy, Hemorrhagic Complications and CT Radiation Dose of Emergency External Ventricular Drain (EVD) Placement in Pediatric Patients: A 15-Year Retrospective Analysis

Catheter Tract Hemorrhages and Intracerebral Hemorrhage Outcomes in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Trial

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