Accuracy and Safety of Ventriculostomy Using Two Different Procedures of External Ventricular Drainage: A Single-Center Series.

BACKGROUND AND STUDY AIMS:  Patients with acute hydrocephalus are treated by either insertion of a conventional external ventricular drain (EVD) or percutaneous needle trephination (PNT) at our institution, depending on the acuteness of intervention and the severity of illness. We compared both procedures regarding accuracy and safety necessitating surgical revision of EVD or PNT.

METHODS:  Between January 2012 and January 2014, 451 ventriculostomies were performed in 301 patients at our institution. All patients underwent routine computed tomography after insertion of the ventricular drain during the treatment course. Patient characteristics, underlying pathology, ventriculostomy modality, radiologic features, catheter tip location, and treatment-related complications were analyzed.

RESULTS:  A total of 307 of 451 ventriculostomy procedures (68%) were performed as conventional EVD, and 144 (32%) were performed as PNT. Overall, 11% of patients with conventional EVD underwent surgical revision due to lacking accuracy, infection, or hemorrhage; 7% of patients with PNT underwent surgical revision ( p  = 0.2). However, multivariate analysis revealed that only "hospital stay > 21 days" as an independent variable was significantly associated with surgical revision after ventriculostomy.

CONCLUSION:  The present data indicate that PNT has a similar safety profile in emergency situations in critically ill patients who need immediate treatment for acute hydrocephalus when compared with the conventional EVD procedure.