Object: The safety of reusing ventricular drain sites for shunting CSF in patients with no history of infection involving either the ventricular drain or the CSF was the focus of this investigation.
Methods: Prospectively accrued clinical data on all patients who, in an 8-year span ending in June 2008, underwent external ventricular drain placement and subsequently required CSF shunts were retrospectively evaluated for evidence of shunt infection and other complications.
Results: The infection rate for 50 consecutive operations in 50 patients who met the inclusion criteria was 2.0%.
Conclusions: Data from this study support the position that the reuse of ventriculostomy tracts when implanting first-time CSF shunts is, with regard to the risk of infection, a safe practice and avoids all risks associated with making a new ventricular entry.
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http://dx.doi.org/10.3171/2009.12.PEDS09406 | DOI Listing |
Neurotherapeutics
January 2025
Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address:
A wide range of acute brain injuries, including both traumatic and non-traumatic causes, can result in elevated intracranial pressure (ICP), which in turn can cause further secondary injury to the brain, initiating a vicious cascade of propagating injury. Elevated ICP is therefore a neurological injury that requires intensive monitoring and time-sensitive interventions. Patients at high risk for developing elevated ICP undergo placement of invasive ICP monitors including external ventricular drains, intraparenchymal ICP monitors, and lumbar drains.
View Article and Find Full Text PDFJ Neurosurg
January 2025
Departments of1Neurosurgery.
Objective: Intraventricular hemorrhage (IVH) is a serious condition with high mortality rates and poor functional outcome in survivors. Treatment includes external ventricular drains (EVDs), which are associated with several complications. This study reports the clinical outcome and complication rate in patients with primary IVH (pIVH) and secondary IVH treated with EVDs.
View Article and Find Full Text PDFJ Med Syst
January 2025
Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
This study aimed to develop and validate a cost-effective, customizable patient-specific phantom for simulating external ventricular drain placement, combining image segmentation, 3-D printing and molding techniques. Two variations of the phantom were created based on patient MRI data, integrating a realistic skin layer with anatomical landmarks, a 3-D printed skull, an agarose polysaccharide gel brain, and a ventricular cavity. To validate the phantom, 15 neurosurgeons, residents, and physician assistants performed 30 EVD placements.
View Article and Find Full Text PDFJ Neurosurg Anesthesiol
January 2025
Neurological Surgery.
Background: We implemented a quality improvement project to transition from routine cerebrospinal fluid (CSF) sampling to indication-based sampling in aneurysmal subarachnoid hemorrhage (aSAH) patients with an external ventricular drain (EVD).
Methods: Forty-seven patients were assessed across 2 epochs: routine (n=22) and indication-based (n=25) CSF sampling. The primary outcome was the number of CSF samples, and secondary outcomes included cost reductions and ventriculostomy-associated infections.
Cureus
November 2024
Anesthesiology and Pain Medicine, Harborview Medical Center, Seattle, USA.
Prompt emergence from general anesthesia is crucial after neurosurgical procedures, such as craniotomies, to facilitate timely neurological evaluation for identification of intraoperative complications. Delayed emergence can be caused by residual anesthetics, metabolic imbalances, and intracranial pathology, for which an eye examination can provide early diagnostic clues. The sunset sign (or setting sun sign), characterized by a downward deviation of the eyes, can be an early indicator of raised intracranial pressure (ICP) or midbrain compression, as is commonly observed in states of hydrocephalus or periaqueductal or tectal plate dysfunction.
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