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Externalized Ventriculostomy Drain

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
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...
February 21, 2017: Infection Control and Hospital Epidemiology
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
Ariane Lewis, Barry M Czeisler, Aaron S Lord
BACKGROUND AND PURPOSE: The ideal strategy to prevent infections in patients with external ventricular drains (EVDs) is unclear. METHODS: We conducted a cross-sectional survey of members of the Neurocritical Care Society on infection prevention practices for patients with EVDs between April and July 2015. RESULTS: The survey was completed by 52 individuals (5% response rate). Catheter selection, use of prolonged prophylactic systemic antibiotics (PPSAs), cerebrospinal fluid (CSF) collection policies, location of EVD placement, and performance of routine EVD exchanges varied...
January 2017: Neurohospitalist
Roy Poblete, Ling Zheng, Ranjita Raghavan, Steven Cen, Arun Amar, Nerses Sanossian, William Mack, May Kim-Tenser
BACKGROUND: Patients with aneurysmal subarachnoid hemorrhage (aSAH) are susceptible to various medical complications, including ventriculostomy-associated infections (VAIs) in those who undergo external ventricular drain (EVD) placement. Many preventative strategies for VAIs have been used during the last 20 years, but their overall effect is unknown. Using the Nationwide (National) Inpatient Sample, we examined trends in VAI rates and mortality during a recent 12-year period in the aSAH population...
March 2017: World Neurosurgery
Jack M Leschke, Andrew Lozen, Mayank Kaushal, Akinwunmi Oni-Orisan, Mazen Noufal, Osama Zaidat, Glen A Pollock, Wade M Mueller
BACKGROUND: Currently, a complete understanding of post-ventriculostomy hemorrhagic complications in subarachnoid hemorrhage due to ruptured aneurysms remains unknown. The present study evaluates the impact of periprocedural risk factors on rates of external ventricular drain (EVD)-associated hemorrhage in the setting of endovascular treatment of intracranial aneurysms. METHODS: A retrospective chart review of 107 patients who underwent EVD placement within 24 h of endovascular coiling was performed...
December 20, 2016: Neurocritical Care
Ahmed El Damaty, Soenke Langner, Henry W S Schroeder
BACKGROUND: We report a case of ruptured massa intermedia (MI) as a sequela of hydrocephalus. CASE DESCRIPTION: A single case report is presented describing the sequelae of tumor bed hematoma after a posterior fossa hemangioblastoma resection in which the patient bled 3 days after surgery, resulting in secondary hydrocephalus and subsequently dilatation of the third ventricle, which resulted in rupture of the MI. The patient was managed on emergency basis with an external ventricular drain then endoscopically with a third ventriculostomy and clot extraction...
January 2017: World Neurosurgery
Zachary D Levy, David E Ledoux, Martin L Lesser, Timothy White, Jaclyn M Rosenthal, Marguerite Johnson, Gunes A Aygok
Iatrogenic ventriculitis is a potential complication of ventriculostomy drain placement. In this study, an alcohol-impregnated external ventricular drain port cap was added to a standardized ventriculostomy placement bundle. Rates of ventriculitis were reduced postintervention, but this finding did not reach statistical significance.
October 14, 2016: American Journal of Infection Control
Vianney Gilard, Ben Ousmanou Djoubairou, Arnaud Lepetit, Thomas Metayer, Clement Gakuba, Charlotte Gourio, Stephane Derey, François Proust, Evelyne Emery, Thomas Gaberel
OBJECTIVE: Intraventricular hemorrhage (IVH) often requires the insertion of an external ventricular drain (EVD), but blood clots could occlude the catheters. Large EVD catheters may help to reduce the risk of catheter occlusion. Here, we compared small catheters with large catheters for ventriculostomy in patients suffering from IVH. METHODS: We conducted a retrospective cohort study. Patients were included if they had IVH requiring EVD insertion. We then compared baseline characteristics and outcomes of patients treated with large catheters with patients treated with small catheters...
January 2017: World Neurosurgery
Torben Slott Jensen, Jakob Gram Carlsen, Jens Christian Sørensen, Frantz Rom Poulsen
BACKGROUND: Ventriculostomy/external ventricular drain (EVD) is a common neurosurgical procedure. Various techniques are used to fixate the drain and the objective of this study was, in a retrospective setting, to compare the incidence of complications when using bolt-connected EVD (BC-EVD) versus tunneled EVD (T-EVD). METHODS: All patients subjected to an EVD performed through a new burr hole from 2009 through 2010 at two Depts. of Neurosurgery in Denmark (Odense and Aarhus) were retrospectively identified...
August 2016: Acta Neurochirurgica
Aydin Mohammadi, Nicholas Jufas
OBJECTIVE: To enhance understanding of the possible dangers of large vestibular schwannomas and their potential to cause sudden death through rare situations such as brain herniation precipitated by cerebrospinal fluid pressure shifts. PATIENT: An otherwise healthy 32-year-old woman with a magnetic resonance imaging demonstrating a cystic cerebellopontine angle mass, presumptive for vestibular schwannoma, experienced sudden onset of headaches, nausea, and vomiting...
June 2016: Otology & Neurotology
Luc Marechal, Shaohui Foong, Zhenglong Sun, Kristin L Wood
Motivated by the need for developing a neuronavigation system to improve efficacy of intracranial surgical procedures, a localization system using passive magnetic fields for real-time monitoring of the insertion process of an external ventricular drain (EVD) catheter is conceived and developed. This system operates on the principle of measuring the static magnetic field of a magnetic marker using an array of magnetic sensors. An artificial neural network (ANN) is directly used for solving the inverse problem of magnetic dipole localization for improved efficiency and precision...
August 2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Ahmad N Saad, Melissa Kanack, Joyce McIntyre, Michael Levy, Hal Meltzer, Steven R Cohen
Macrocephaly resulting from untreated hydrocephalus is a rare but difficult condition to treat. The patient presented is a 6-year-old boy who had progressively increasing head size since birth secondary to untreated hydrocephalus with associated developmental delay. His initial head circumference was 69 cm, and computed tomography scan showed evidence of obstructive hydrocephalus. For the first stage of the procedure, bicoronal and circumferential strip craniectomies were performed, 5 fully open 3.5 mm midface distractors were placed to facilitate vault reduction, and absorbable plates were placed in the frontoorbital region...
November 2015: Journal of Craniofacial Surgery
Wendy C Ziai, Paul A Nyquist, Daniel F Hanley
Intraventricular hemorrhage (IVH) frequently complicates intracranial hemorrhage (ICH) and is a significant independent contributor to morbidity and mortality, yet therapy directed at ameliorating intraventricular clotting has been limited and until recently, has not been subject to systematic evaluation. Thrombolytic therapy with placement of an external ventricular drain for management of severe IVH secondary to ICH has been investigated in multiple observational studies, small randomized controlled trials and several meta-analyses, soon to culminate with the completion of the 500 patient CLEAR IVH randomized controlled trial...
2015: Frontiers of Neurology and Neuroscience
Roman Mounier, David Lobo, Fabrice Cook, Mathieu Martin, Arie Attias, Bouziane Aït-Mamar, Inanna Gabriel, Olivier Bekaert, Jean Bardon, Biba Nebbad, Benoît Plaud, Gilles Dhonneur
Ventriculostomy-related infection (VRI) is a serious complication of external ventricular drain (EVD) but its natural history is poorly studied. We prospectively tracked the bacteria pathways from skin towards ventricles to identify the infectious process resulting in ventriculostomy-related colonization (VRC), and VRI. We systematically sampled cerebrospinal fluid (CSF) on a daily basis and collected swabs from both the skin and stopcock every 3.0 days for microbiological analysis including in 101 neurosurgical patient...
2015: PloS One
H Shekhar, P Kalsi, S Dambatta, R Strachan
OBJECTIVE: External ventriculostomy-related infection (VRI) of cerebrospinal fluid (CSF) is a source of significant morbidity and mortality. In previous trials, antibiotic-impregnated ventricular catheters have been associated with lower incidence of CSF infections. We undertook this retrospective observational study to evaluate whether the introduction of antibiotic-impregnated external ventricular drains (EVDs) in 2004 has decreased VRI in our neurosurgical unit. METHOD: One hundred and fifteen patients underwent insertion of EVDs from January 2000 to March 2008...
2016: British Journal of Neurosurgery
Brandon K Root, Benjamin G Barrena, Todd A Mackenzie, David F Bauer
OBJECTIVE: To determine whether antibiotic impregnated external ventricular drains (AI-EVDs) are effective in preventing ventriculostomy associated infection (VAI), and to examine their cost effectiveness. METHODS: A comprehensive literature search was performed for published data through May 2014, including randomized controlled trials and observational cohort studies comparing AI-EVDs with nonimpregnated controls. A meta-analysis of included studies was performed using a random effects model...
February 2016: World Neurosurgery
Roman Mounier, David Lobo, Fabrice Cook, Alexandre Fratani, Arie Attias, Mathieu Martin, Karin Chedevergne, Jean Bardon, Sanaa Tazi, Biba Nebbad, Sébastien Bloc, Benoît Plaud, Gilles Dhonneur
BACKGROUND: Our aim was to describe the pattern of ventriculostomy-related infection (VRI) development using a dynamic approach. STUDY DESIGN: Retrospective longitudinal study. METHODS: We analyzed the files of 449 neurosurgical patients who underwent placement of external ventricular drain (EVD). During the study period, CSF sampling was performed on a daily base setting. VRI was defined as a positive CSF culture resulting in antibiotic treatment...
December 2015: Acta Neurochirurgica
R Gondar, A Rogers, S Momjian
BACKGROUND: Endoscopic third ventriculostomy (ETV) is an ideal treatment for obstructive hydrocephalus. Although ETV is a safe procedure, several complications related to this procedure have been reported in the literature. We present a rare case of late onset symptomatic bilateral subdural hematoma after an uneventful ETV that proved particularly difficult to solve. CASE DESCRIPTION: A 61-year-old male patient presented in our neurosurgery department three months after ETV (aqueductal stenosis) with progressive headaches and anomic aphasia...
October 2015: Neuro-Chirurgie
Nathaniel K Coulson, Peter A Chiarelli, David K Su, Jason J Chang, Brian MacConaghy, Revathi Murthy, Peter Toms, Terrence L Robb, Richard G Ellenbogen, Samuel R Browd, Pierre D Mourad
OBJECT Urgent ventriculostomy placement can be a lifesaving procedure in the setting of hydrocephalus or elevated intracranial pressure. While external ventricular drain (EVD) insertion is common, there remains a high rate of suboptimal drain placement. Here, the authors seek to demonstrate the feasibility of an ultrasound-based guidance system that can be inserted into an existing EVD catheter to provide a linear ultrasound trace that guides the user toward the ventricle. METHODS The ultrasound stylet was constructed as a thin metal tube, with dimensions equivalent to standard catheter stylets, bearing a single-element, ceramic ultrasound transducer at the tip...
October 2015: Journal of Neurosurgery. Pediatrics
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