Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Review Article Volume 3 Issue 7

External Ventricular Drains: An Overview of Indications, Technique, and Complications

Anudeep Yekula1, Aditya Mittal2, Varun Sagi3 and Mihir Gupta4*

1Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States of America
2School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
3School of Medicine, University of Minnesota Twin Cities, Minneapolis, MN, United States of America
4Department of Neurosurgery, University of California San Diego, La Jolla, CA, United States of America

*Corresponding Author: Mihir Gupta, Department of Neurosurgery, University of California San Diego, La Jolla, CA, United States of America.

Received: May 28, 2020; Published: June 30, 2020

×

Abstract

External ventricular drains (EVDs or ventriculostomies) are frequently required for acute management of intracranial hypertension and monitoring intracranial pressure. Patients with ventriculostomies are frequently co-managed by multiple specialists including neurologists, neuro-intensivists, trauma specialists, emergency department physicians and neurosurgeons. We provide background on the indications, placement technique, troubleshooting and complications related to this procedure. We also discuss emerging best practices for preventing complications such as ventriculostomy-related infection. We conclude with considerations regarding ventriculostomy removal and areas of ongoing study. This review serves as a primer that may facilitate collaborative care between diverse allied providers.

Keywords: External Ventricular Drain; EVD; Ventriculostomy; Kocher’s Point; Hydrocephalus; Cerebrospinal Fluid; Neurocritical Care; Intracranial Pressure; Ventriculitis; Intracranial Hemorrhage

×

References

  1. Abbott NJ. “Evidence for bulk flow of brain interstitial fluid: significance for physiology and pathology”. Neurochemistry International 45 (2004): 545-552.
  2. Arabi Y., et al. “Ventriculostomy-associated infections: incidence and risk factors”. American Journal of Infection Control 33 (2005): 137-143.
  3. Bauer DF., et al. “The relationship between INR and development of hemorrhage with placement of ventriculostomy”. The Journal of Trauma 70 (2011): 1112-1117.
  4. Binz DD., et al. “Hemorrhagic complications of ventriculostomy placement: a meta-analysis”. Neurocritical Care 10 (2009): 253-256.
  5. Blomstedt GC. “Results of trimethoprim-sulfamethoxazole prophylaxis in ventriculostomy and shunting procedures. A double-blind randomized trial”. Journal of Neurosurgery 62 (1985): 694-697.
  6. Carney N., et al. “Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition”. Neurosurgery 80 (2017): 6-15.
  7. Chan KH and Mann KS. “Prolonged therapeutic external ventricular drainage: a prospective study”. Neurosurgery 23 (1988): 436-438.
  8. Changa AR., et al. “Management of Elevated Intracranial Pressure: a Review”. Current Neurology and Neuroscience Reports 19 (2019): 99.
  9. Chau CYC., et al. “The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury”. Journal of Clinical Medicine Research 8 (2019).
  10. Dey M., et al. “Bleeding and infection with external ventricular drainage: a systematic review in comparison with adjudicated adverse events in the ongoing Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase III (CLEAR-III IHV) trial”. Neurosurgery 76 (2015): 291-300.
  11. Dorresteijn K., et al. “Factors and measures predicting external CSF drain-associated ventriculitis: A review and meta-analysis”. Neurology 93 (2019): 964-972.
  12. Fried HI., et al. “The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement: A Statement for Healthcare Professionals from the Neurocritical Care Society”. Neurocritical Care 24 (2016): 61-81.
  13. Hagel S., et al. “External ventricular drain infections: risk factors and outcome”. Interdisciplinary Perspectives on Infectious Diseases (2014): 708531.
  14. Harrop JS., et al. “Impact of a standardized protocol and antibiotic-impregnated catheters on ventriculostomy infection rates in cerebrovascular patients”. Neurosurgery 67 (2010): 187-191.
  15. Horan TC., et al. “CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting”. American Journal of Infection Control 36 (2008): 309-332.
  16. Kakarla UK., et al. “Safety and accuracy of bedside external ventricular drain placement”. Neurosurgery 63 (2008): 162-166.
  17. Klopfenstein JD., et al. “Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial”. Journal of Neurosurgery 100 (2004): 225-229.
  18. Korinek AM., et al. “Prevention of external ventricular drain--related ventriculitis”. Acta Neurochirurgica (Wien) 147 (2005): 39-45.
  19. Kubilay Z., et al. “Decreasing ventricular infections through the use of a ventriculostomy placement bundle: experience at a single institution”. Journal of Neurosurgery 118 (2013): 514-520.
  20. Lozier AP., et al. “Ventriculostomy-related infections: a critical review of the literature”. Neurosurgery2 (2008): 688-700.
  21. Mayhall CG., et al. “Ventriculostomy-related infections. A prospective epidemiologic study”. The New England Journal of Medicine 310 (1984): 553-559.
  22. Omar MA and Mohd Haspani MS. “The risk factors of external ventricular drainage-related infection at hospital kuala lumpur: an observational study”. Malaysian Journal of Medical Sciences 17 (2010): 48-54.
  23. Poon WS., et al. “CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy: a randomised study”. Acta Neurochirurgica 71 (1998): 146-148.
  24. Pople I., et al. “Comparison of infection rate with the use of antibiotic-impregnated vs standard extraventricular drainage devices: a prospective, randomized controlled trial”. Neurosurgery 71 (2012): 6-13.
  25. Rao SS., et al. “Intermittent CSF drainage and rapid EVD weaning approach after subarachnoid hemorrhage: association with fewer VP shunts and shorter length of stay”. Journal of Neurosurgery (2019): 1-6.
  26. Sussman ES., et al. “Hemorrhagic complications of ventriculostomy: incidence and predictors in patients with intracerebral hemorrhage”. Journal of Neurosurgery 120 (2014): 931-936.
  27. Talibi SS., et al. “The implementation of an external ventricular drain care bundle to reduce infection rates”. British Journal of Neurosurgery (2020): 1-6.
  28. Tubbs RS., et al. “The foramen of Monro: a review of its anatomy, history, pathology, and surgery”. Child's Nervous System 30 (2014): 1645-1649.
  29. Tunkel AR., et al. “Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis”. Clinical Infectious Diseases 64 (2017): e34-e65.
  30. Zabramski JM., et al. “Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial”. Journal of Neurosurgery 98 (2003): 725-730.
×

Citation

Citation: Mihir Gupta., et al. “External Ventricular Drains: An Overview of Indications, Technique, and Complications".Acta Scientific Neurology 3.7 (2020): 16-22.




Metrics

Acceptance rate32%
Acceptance to publication20-30 days

Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"

Contact US