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Externalized Ventriculostomy Drain

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 to patients treated with small catheters...
October 8, 2016: 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
Bruce L Tai, Deborah Rooney, Francesca Stephenson, Peng-Siang Liao, Oren Sagher, Albert J Shih, Luis E Savastano
In this paper, the authors present a physical model developed to simulate accurate external ventricular drain (EVD) placement with realistic haptic and visual feedbacks to serve as a platform for complete procedural training. Insertion of an EVD via ventriculostomy is a common neurosurgical procedure used to monitor intracranial pressures and/or drain CSF. Currently, realistic training tools are scarce and mainly limited to virtual reality simulation systems. The use of 3D printing technology enables the development of realistic anatomical structures and customized design for physical simulators...
October 2015: Journal of Neurosurgery
Justin R Ryan, Tsinsue Chen, Peter Nakaji, David H Frakes, L Fernando Gonzalez
BACKGROUND: Educational simulators provide a means for students and experts to learn and refine surgical skills. Educators can leverage the strengths of medical simulators to effectively teach complex and high-risk surgical procedures, such as placement of an external ventricular drain. OBJECTIVE: Our objective was to develop a cost-effective, patient-derived medical simulacrum for cerebral lateral ventriculostomy. METHODS: A cost-effective, patient-derived medical simulacrum was developed for placement of an external lateral ventriculostomy...
November 2015: World Neurosurgery
Catherine A Mazzola, Asim F Choudhri, Kurtis I Auguste, David D Limbrick, Marta Rogido, Laura Mitchell, Ann Marie Flannery
OBJECT: The objective of this systematic review and analysis was to answer the following question: What are the optimal treatment strategies for posthemorrhagic hydrocephalus (PHH) in premature infants? METHODS: Both the US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to PHH. Two hundred thirteen abstracts were reviewed, after which 98 full-text publications that met inclusion criteria that had been determined a priori were selected and reviewed...
November 2014: Journal of Neurosurgery. Pediatrics
Gary E Stein, Fadi Yasin, Curtis Smith, Amy Scharmen, Daniel Havlichek, Charles Bill
BACKGROUND: Ceftaroline is a broad-spectrum cephalosporin antibiotic with activity against drug-resistant bacteria, including strains of methicillin-resistant Staphylococcus aureus (MRSA), and may be useful to prevent and treat ventriculostomy-related infections (VRIs). The purpose of this study was to analyze the pharmacokinetics and pharmacodynamics of prophylactic ceftaroline in neurosurgical patients with an external ventricular drain (EVD). METHODS: Adult patients in the neurosurgical intensive care unit with an EVD were given prolonged prophylaxis with ceftaroline...
April 2015: Surgical Infections
Vaibhav Patil, Rajiv Gupta, Raúl San José Estépar, Ronilda Lacson, Arnold Cheung, Judith M Wong, A John Popp, Alexandra Golby, Christopher Ogilvy, Kirby G Vosburgh
BACKGROUND: Placement accuracy of ventriculostomy catheters is reported in a wide and variable range. Development of an efficient image-guidance system may improve physician performance and patient safety. OBJECTIVE: We evaluate the prototype of Smart Stylet, a new electromagnetic image-guidance system for use during bedside ventriculostomy. METHODS: Accuracy of the Smart Stylet system was assessed. System operators were evaluated for their ability to successfully target the ipsilateral frontal horn in a phantom model...
2015: Stereotactic and Functional Neurosurgery
Paul M Foreman, Philipp Hendrix, Christoph J Griessenauer, Philip G R Schmalz, Mark R Harrigan
OBJECTIVE: External ventricular drain (EVD) placement is a common neurosurgical procedure performed in both the intensive care unit (ICU) and operating room (OR). The optimal setting for EVD placement in regard to safety and accuracy of placement is poorly defined. METHODS: A retrospective chart review was performed on 150 consecutive patients who underwent EVD placement at a tertiary care center from January of 2013 to February of 2014. Clinical and radiographic data were obtained and used to compare safety and accuracy of placement between EVDs placed in the ICU versus OR...
January 2015: Clinical Neurology and Neurosurgery
Faik C Meral, Michael A Persaud, Aaron E Silva, Abhishek Mundra, Greg T Clement, Kirby G Vosburgh, Phillip J White
A ventriculostomy is often performed to relieve symptoms of emergent hydrocephalus. This involves the placement of an external ventricular drain (EVD) into the cerebral ventricles to remove excess cerebrospinal fluid. Free-handed EVD cannulation results in high rates of misplacement (~50%), leading to an increased risk of iatrogenic complications. Extant technical approaches to improve ventriculostomy guidance are either too complex or inaccurate. We have investigated the possibility of a novel device to guide EVD placement using transcranial ultrasound...
April 2014: Journal of the Acoustical Society of America
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