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Externalized Ventriculostomy Drains

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https://www.readbyqxmd.com/read/29778601/diagnosis-classification-and-management-of-fourth-ventriculomegaly-in-adults-report-of-9-cases-and-literature-review
#1
Kaveh Barami, Indro Chakrabarti, James Silverthorn, Jeremy Ciporen, Paul T Akins
OBJECTIVE: An enlarged fourth ventricle otherwise known as fourth ventriculomegaly (4th VM) has been previously reported in the pediatric population yet literature on adults is scant. We report our experience with 4th VM in adults over an 11 year period and review the literature. MATERIAL/METHODS: retrospective chart review of adult patients with the diagnosis of 4th VM admitted to the ICU in a tertiary care center RESULTS: 9 patients were identified with 4th VM...
May 17, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29772359/bilateral-external-ventricular-drains-increase-ventriculostomy-associated-cerebrospinal-fluid-infection-in-low-modified-graeb-score-intraventricular-hemorrhage
#2
Zheng Wen-Jian, L I Liang-Ming, Hu Zi-Hui, Liao Wei, Lin Qi-Chang, Zhu Yong-Hua, Lin Shao-Hua
BACKGROUND: Ventriculostomy-associated cerebrospinal fluid infection (VAI) is a major complication limiting the use of an external ventricular drain (EVD) in intraventricular hemorrhage (IVH). Risk factors of VAI are still under wide discussion. METHODS: We performed a retrospective review of 84 IVH patients who underwent EVD at our center between January 2012 and January 2017. Preoperative clinical parameters, surgeon status, number of catheters and catheter-days, subgaleal tunneling distance, frequency of urokinase flush, and prophylactic antibiotics were compared between the infective and non-infective groups...
May 14, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29682017/the-organisms-and-factors-affecting-outcomes-of-external-ventricular-drainage-catheter-related-ventriculitis-a-penang-experience
#3
Jo Ee Sam, Chee Loon Lim, Priya Sharda, Nasser Abdul Wahab
Introduction: Ventriculostomy-related infection (VRI) from external ventricular drain (EVD) insertion is a common complication and carries a high mortality rate. Choice of empiric antibiotics depends on the institutions common causative organisms and their susceptibility. We determined risk factors for mortality in patients with VRI, the common organisms causing VRI, and the rate of EVD-related VRI at our institution. Methods: Medical records and operative data of patients with cerebrospinal fluid positive cultures with an EVD inserted from 2012 to 2015 were traced...
April 2018: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/29545219/creation-of-an-evd-registry-from-a-quality-improvement-project
#4
David P Darrow, Coridon Quinn, Truong H Do, Matthew Hunt, Stephen Haines
INTRODUCTION: External ventricular drains can pose a serious source of morbidity and mortality. Interventions proven to reduce the risk of infections are lacking. Single center studies limit the study of procedures that mitigate infection, but bundled protocols have demonstrated utility. A collaborative EVD registry was designed to facilitate local quality improvement projects to be implemented at any location using standardized data collection instruments through resident collaboration to reduce and study EVD infection and prevention...
March 12, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29541885/recurrent-sampling-and-ventriculostomy-associated-infections-a-case-control-study
#5
Daniel Roan Thompson, Savvas Vlachos, Sabina Patel, Simeon Innocent, Christos Tolias, Konstantinos Barkas
BACKGROUND: External ventricular drain (EVD) insertion is a common neurosurgical procedure with a significant risk of ventriculostomy-associated infections (VAIs), other morbidities and mortality. Several risk factors have been identified but their effect is unclear. OBJECTIVE: Our primary objective was to assess whether recurrent EVD sampling increased the risk of VAIs. The secondary objective was to explore the effect of sampling frequency, duration of EVD stay, presence of cerebrospinal fluid leak and concurrent infections...
May 2018: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29492575/icp-monitoring-by-open-extraventricular-drainage-common-practice-but-not-suitable-for-advanced-neuromonitoring-and-prone-to-false-negativity
#6
Konstantin Hockel, Martin U Schuhmann
OBJECTIVE: A drawback in the use of an external ventricular drain (EVD) originates in the fact that draining cerebrospinal fluid (CSF) (open system) and intracranial pressure (ICP) monitoring can be done at the same time but is considered to be unreliable regarding the ICP trace. Furthermore, with the more widespread use of autoregulation monitoring using blood pressure and ICP signals, the question arises of whether an ICP signal from an open EVD can be used for this purpose. Using an EVD system with an integrated parenchymal ICP probe we compared the different traces of an ICP signal and their derived parameters under opened and closed CSF drainage...
2018: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/29483013/endoscopic-third-ventriculostomy-for-shunt-malfunction-in-children-a-review
#7
REVIEW
Mueez Waqar, Jonathan R Ellenbogen, Conor Mallucci
Endoscopic third ventriculostomy (ETV) is increasingly used in place of shunt revision for shunt malfunction (secondary ETV). This review provides a comprehensive overview of preoperative, operative and postoperative considerations for patients undergoing a secondary ETV. Preoperatively, patient selection is vital and there is evidence that secondary ETV is more effective than primary ETV in certain hydrocephalic aetiologies. Operative considerations include use of neuronavigation and consideration of surgeon technical experience due to anatomical differences that are likely to accompany chronic shunting, management of existing shunt hardware and the use of temporary external ventricular drains or short/long-term ventricular access devices...
May 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29097331/infection-incidence-associated-with-external-ventriculostomy-placement-a-comparison-of-outcomes-in-the-emergency-department-intensive-care-unit-and-operating-room
#8
Gurkirat Kohli, Roshansa Singh, Yehuda Herschman, Antonios Mammis
BACKGROUND: External ventricular drain (EVD) placement is a common neurosurgical procedure used to control acute hydrocephalus and other neurosurgical complications. The infection and complication rates reported in the literature are highly variable, and iatrogenic factors determine the outcome of drain placement. We examined the impact of the setting of EVD placement (emergency department [ED] vs. intensive care unit [ICU] vs. operating room [OR]) and the experience of the operating surgeon on the infection rate, complication rate, EVD replacement, eventual placement of a ventriculoperitoneal shunt, and the need for further surgical intervention...
February 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29088955/real-time-ultrasound-guided-external-ventricular-drain-placement-technical-note
#9
James H Manfield, Kenny K H Yu
In the United Kingdom, ultrasound-guided external ventricular drain (EVD) insertion is becoming the standard of care to mitigate the morbidity associated with catheter malposition and multiple passes. Many neurosurgeons routinely use ultrasound to check the preinsertion trajectory, although real-time visualization of ventricular cannulation is preferable since minor deviations can be significant in patients with smaller ventricles, and live visualization further enables the catheter tip to be adjusted away from the choroid plexus...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28905331/antibiotic-distribution-into-cerebrospinal-fluid-can-dosing-safely-account-for-drug-and-disease-factors-in-the-treatment-of-ventriculostomy-associated-infections
#10
Nilesh Kumta, Jason A Roberts, Jeffrey Lipman, Menino Osbert Cotta
Ventriculostomy-associated infections, or ventriculitis, in critically ill patients are associated with considerable morbidity. Efficacious antibiotic dosing for the treatment of these infections may be complicated by altered antibiotic concentrations in the cerebrospinal fluid due to variable meningeal inflammation and antibiotic properties. Therefore, doses used to treat infections with a higher degree of meningeal inflammation (such as meningitis) may often fail to achieve equivalent exposures in patients with ventriculostomy-associated infections such as ventriculitis...
April 2018: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/28789958/diagnosis-of-ventriculostomy-related-infection-is-cerebrospinal-fluid-lactate-measurement-a-useful-tool
#11
Pedro Grille, Federico Verga, Alberto Biestro
OBJECTIVE: To evaluate the value of CSF lactate (LCSF ) for the diagnosis of ventriculostomy related infections (VRI), and compare it with other CSF markers. METHODS: Prospective study of neurocritical patients admitted to Maciel Hospital and Clinicas Hospital ICUs in which an external ventricular drain (EVD) was inserted. In patients with clinical suspicion of VRI, a CSF sample was obtained through the EVD for CSF culture and markers analysis (glucose, protein, lactate and leukocytes)...
November 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28716567/moving-the-goalposts-a-comparison-of-different-definitions-for-primary-external-ventricular-drain-infection-and-its-risk-factors-a-multi-center-study-of-2575-patients
#12
Peter Y M Woo, Hoi-Tung Wong, Jenny K S Pu, Wai-Kei Wong, Larry Y W Wong, Michael W Y Lee, Kwong-Yui Yam, Wai-Man Lui, Wai-Sang Poon
External ventricular drainage is the most common procedure performed in daily neurosurgical practice. One devastating complication is ventriculostomy-associated infection, but the establishment of evidence-based management guidelines has been hindered by the lack of an universal definition. There is also limited data with regard to the utility of comorbidity health indices and surgery-related factors in predicting infection. This study aims to compare the incidence of infection according to five commonly used definitions and to identify risk factors for this complication...
November 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28713628/outcomes-of-post-neurosurgical-ventriculostomy-associated-infections
#13
Muhammad E Bari, Ghani Haider, Komail Malik, Muhammad Waqas, Syed F Mahmood, Mubbashira Siddiqui
BACKGROUND: Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes. METHODS: This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28708018/endoscopic-third-ventriculostomy-and-repeat-endoscopic-third-ventriculostomy-in-pediatric-patients-the-dutch-experience
#14
MULTICENTER STUDY
Gerben E Breimer, Ruben Dammers, Peter A Woerdeman, Dennis R Buis, Hans Delye, Marjolein Brusse-Keizer, Eelco W Hoving
OBJECTIVE After endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV. METHODS Retrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998-2015)...
October 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28614970/effect-of-cerebrospinal-fluid-drainage-on-brain-tissue-oxygenation-in-traumatic-brain-injury
#15
Omar S Akbik, Mark Krasberg, Edwin M Nemoto, Howard Yonas
The effectiveness of cerebrospinal fluid (CSF) drainage in lowering high intracranial pressure (ICP) is well established in severe traumatic brain injury (TBI). Recently, however, the use of external ventricular drains (EVDs) and ICP monitors in TBI has come under question. The aim of this retrospective study was to investigate the effect of CSF drainage on brain tissue oxygenation (PbtO2). Using a multi-modality monitoring system, we continuously monitored PbtO2 and parenchymal ICP during CSF drainage events via a ventriculostomy in 40 patients with severe TBI...
November 15, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28612132/hemorrhage-rate-after-external-ventricular-drain-placement-in-subarachnoid-hemorrhage-time-to-heparin-administration
#16
Andrew P Gard, Brian D Sayles, J Will Robbins, William E Thorell, Daniel L Surdell
OBJECTIVE: The use of antiplatelet or anticoagulants has previously been shown to increase hemorrhagic complications of ventricular catheterization. Although heparin use 24 h after ventriculostomy appears safe, the safety of heparin immediately (within 4 h) after ventriculostomy is unknown. The objective of this study was to assess the safety of heparin immediately (within 4 h) after ventriculostomy in subarachnoid hemorrhage (SAH) patients undergoing endovascular treatment. PATIENTS AND METHODS: This is a retrospective cohort study of 46 patients with aneurysmal SAH secondary to aneurysm rupture who required ventriculostomy...
December 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28549914/timing-of-permanent-ventricular-shunt-placement-following-external-ventricular-drain-placement-in-primary-intracerebral-hemorrhage
#17
Steven Ray Peters, David Tirschwell
BACKGROUND: Intraventricular hemorrhage requiring ventriculostomy placement is a frequent complication of spontaneous intracerebral hemorrhage. Although a subset of patients will require permanent ventricular shunt placement, little is known about contemporary practices regarding the timing of ventriculostomy and ventricular shunt placement after intracerebral hemorrhage. METHODS: Using the 2010-2012 National Inpatient Sample, we identified patients with International Classification of Diseases, Ninth Revision codes for intracerebral hemorrhage, excluded secondary causes, and examined procedure dates...
October 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28405540/markedly-improved-success-rate-of-endoscopically-assisted-third-ventriculostomy-is-achieved-by-routine-placement-of-external-lumbar-drain
#18
Justen Watkins, Marc Cabanne, Dan Miulli
Hydrocephalus is a major cause of patient decreased quality of life and high health care financial burden in the United States and throughout the world. The placement of ventricular shunts (ventriculoperitoneal shunt) has proven to be a safe treatment for hydrocephalus, but it is associated with a high complication rate leading to a lower quality of life and continued financial burden for patients, their families, and society as a whole. The endoscopically assisted third ventriculostomy (ETV) has been practiced as an alternative to ventricular shunting since the 1990s...
April 2017: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/28219470/comparing-external-ventricular-drains-related-ventriculitis-surveillance-definitions
#19
COMPARATIVE STUDY
Maria M Reyes, Satish Munigala, Emily L Church, Tobias B Kulik, Salah G Keyrouz, Gregory J Zipfel, David K Warren
OBJECTIVE To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for ventriculitis and others found in the literature among patients with an external ventricular drain (EVD) DESIGN Retrospective cohort study from January 2009 to December 2014 SETTING Neurology and neurosurgery intensive care unit of a large tertiary-care center PATIENTS Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded...
May 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28180053/isolated-spontaneous-midbrain-hemorrhage-in-a-14-year-old-boy
#20
Kim-Long R Nguyen, Hyunyoung Kim, Laszlo Nagy
Isolated spontaneous midbrain hemorrhages are rare because they are usually secondary to hemorrhages from inferior structures such as the pons and cerebellum, or superior structures such as the thalamus and putamen. While the etiologies are largely unidentified, the most common ones are vascular malformations and bleeding diathesis with hypertension being relatively uncommon. We report midbrain hemorrhage in a 14-year-old boy with a long-standing history of frequent migraine headaches and attention deficit/hyperactivity disorder (ADHD)...
January 2017: Journal of Neurological Surgery Reports
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