The history of external ventricular drainage

2014 ◽  
Vol 120 (1) ◽  
pp. 228-236 ◽  
Author(s):  
Visish M. Srinivasan ◽  
Brent R. O'Neill ◽  
Diana Jho ◽  
Donald M. Whiting ◽  
Michael Y. Oh
Keyword(s):  
Traumatic Brain Injury ◽  
Virtual Reality ◽  
18Th Century ◽  
External Ventricular Drainage ◽  
Neurosurgical Procedures ◽  
Reye Syndrome ◽  
Ventricular Drainage ◽  
Icp Monitoring ◽  
History Of ◽  
Materials Used

External ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures. It was first performed as early as 1744 by Claude-Nicholas Le Cat. Since then, there have been numerous changes in technique, materials used, indications for the procedure, and safety. The history of EVD is best appreciated in 4 eras of progress: development of the technique (1850–1908), technological advancements (1927–1950), expansion of indications (1960–1995), and accuracy, training, and infection control (1995–present). While EVD was first attempted in the 18th century, it was not until 1890 that the first thorough report of EVD technique and outcomes was published by William Williams Keen. He was followed by H. Tillmanns, who described the technique that would be used for many years. Following this, many improvements were made to the EVD apparatus itself, including the addition of manometry by Adson and Lillie in 1927, and continued experimentation in cannulation/drainage materials. Technological advancements allowed a great expansion of indications for EVD, sparked by Nils Lundberg, who published a thorough analysis of the use of intracranial pressure (ICP) monitoring in patients with brain tumors in 1960. This led to the application of EVD and ICP monitoring in subarachnoid hemorrhage, Reye syndrome, and traumatic brain injury. Recent research in EVD has focused on improving the overall safety of the procedure, which has included the development of guidance-based systems, virtual reality simulators for trainees, and antibiotic-impregnated catheters.

scholarly journals Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jia-cheng Gu ◽  
Hong Wu ◽  
Xing-zhao Chen ◽  
Jun-feng Feng ◽  
Guo-yi Gao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
External Ventricular Drainage ◽  
Unfavorable Outcome ◽  
Ventricular Drainage ◽  
Outcome Group ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

External Ventricular Drainage

2018 ◽  
pp. 165-172
Author(s):  
Nitin Agarwal ◽  
Andrew F. Ducruet
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Neurological Disease ◽  
External Ventricular Drain ◽  
Management Strategies ◽  
External Ventricular Drainage ◽  
Postoperative Management ◽  
Ventricular Drainage ◽  
Cerebrospinal Fluid Diversion ◽  
Lumbar Drain

External ventricular drainage, or ventriculostomy, refers to surgical placement of a catheter into the ventricle to achieve temporary cerebrospinal fluid diversion and remains one of the most frequently performed neurosurgical interventions. External ventricular drainage is an essential therapeutic strategy for a myriad of neurological disease processes causing hydrocephalus or increased intracranial pressure including traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage with intraventricular extension. In select cases, lumbar drains may provide a suitable alterative to an external ventricular drain (EVD). Complications related to both EVD and lumbar drain placement include malfunction, infection, and hemorrhage. This chapter reviews the indications, surgical technique, postoperative management strategies, and potential complications associated with external ventricular drainage.

scholarly journals Optimal Timing of External Ventricular Drainage after Severe Traumatic Brain Injury: A Systematic Review

2020 ◽  
Vol 9 (6) ◽  
pp. 1996
Author(s):  
Charlene Y. C. Chau ◽  
Saniya Mediratta ◽  
Mikel A. McKie ◽  
Barbara Gregson ◽  
Selma Tulu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Patient Outcomes ◽  
External Ventricular Drainage ◽  
Small Sample ◽  
Optimal Timing ◽  
Intensity Level ◽  
Cochrane Central Register ◽  
Ventricular Drainage ◽  
Meta Analyses

External ventricular drainage (EVD) may be used for therapeutic cerebrospinal fluid (CSF) drainage to control intracranial pressure (ICP) after traumatic brain injury (TBI). However, there is currently uncertainty regarding the optimal timing for EVD insertion. This study aims to compare patient outcomes for patients with early and late EVD insertion. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, MEDLINE/EMBASE/Scopus/Web of Science/Cochrane Central Register of Controlled Trials were searched for published literature involving at least 10 severe TBI (sTBI) patients from their inception date to December 2019. Outcomes assessed were mortality, functional outcome, ICP control, length of stay, therapy intensity level, and complications. Twenty-one studies comprising 4542 sTBI patients with an EVD were included; 19 of the studies included patients with an early EVD, and two studies had late EVD placements. The limited number of studies, small sample sizes, imbalance in baseline characteristics between the groups and poor methodological quality have limited the scope of our analysis. We present the descriptive statistics highlighting the current conflicting data and the overall lack of reliable research into the optimal timing of EVD. There is a clear need for high quality comparisons of early vs. late EVD insertion on patient outcomes in sTBI.

Telemetric ICP monitoring after surgery for posterior fossa and third ventricular tumors

1984 ◽  
Vol 60 (3) ◽  
pp. 649-651 ◽  
Author(s):  
Paul H. Chapman ◽  
Eric Cosman ◽  
Michael Arnold
Keyword(s):  
Posterior Fossa ◽  
External Ventricular Drainage ◽  
Ventricular Catheter ◽  
Ventricular Drainage ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Content Type ◽  
Clinical Observations ◽  
Ventricular Tumors ◽  
Fine Print

✓ After surgery for posterior fossa or third ventricular tumors, hydrocephalus may persist or evolve. Proper management of this complication requires timely detection. Temporary external ventricular drainage has been suggested by some authors as an adjunct to clinical observations and radiographic studies for unshunted patients. As an alternative, the authors have used a telemetric method of pressure monitoring in association with a ventricular catheter and subcutaneous reservoir. This has been found useful in eight patients without the disadvantages inherent in other methods of management.

scholarly journals Anestesi Scalp Block dan Occipital Block pada Tindakan External Ventricular Drainage (EVD) pada Kehamilan 32 Minggu

2020 ◽  
Vol 9 (2) ◽  
pp. 102-107
Author(s):  
Muhammad Arshad ◽  
Dewi Yulianti Bisri ◽  
Sri Rahardjo
Keyword(s):  
Ct Scan ◽  
First Trimester ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Third Trimester ◽  
Intrauterine Pregnancy ◽  
High Care ◽  
History Of ◽  
Scalp Block ◽  
Obstetric Surgery

Hidrosefalus adalah pembesaran ventrikel otak sebagai akibat peningkatan jumlah cairan serebrospinal (CSS) yang disebabkan oleh ketidakseimbangan antara produksi, sirkulasi dan absorbsinya. Perkiraan wanita hamil yang dilakukan operasi non obstetric sekitar 1–2%. Pasien obstetri dengan penyakit bedah saraf selalu dirawat di ICU. Insidensi operasi selama kehamilan dilaporkan 42% prosedur pembedahan terjadi pada trimester pertama, 35% pada trimester kedua, dan 23% pada trimester ketiga. Seorang wanita 35 tahun dengan usia kehamilan 32–33 minggu datang ke IGD dengan penurunan kesadaran tanpa riwayat trauma, tidak dijumpai tekanan darah tinggi. Dari pemeriksaan CT-Scan ditemukan adanya hidrosefalus, sehingga dilakukan tindakan external ventricular drainage (EVD). Anestesi untuk pasien dalam keadaan hamil harus mempertimbangkan bayi dalam kandungan sehingga dilakukan pembiusan scalp block dan occipital block. Obat yang digunakan ropivakain HCl 0,375 % (sebanyak 10cc). Setelah operasi pasien dirawat di ruang pemulihan, 2 jam kemudian dirawat di ruang high care unit (HCU). Pencegahan terhadap hipoksia dan hipotensi adalah keharusan, walaupun periode hipoksemia yang pendek masih bisa ditoleransi. Hipoksemia maternal yang berkepanjangan akan menyebabkan vasokonstriksi sirkulasi uteroplasental yang pada akhirnya menurunkan perfusi sehingga menyebabkan hipoksemia, asidosis dan kematian janin. Scalp Block and Occipital Block Anesthesia for External Ventricular Drainage (EVD) in 32-Week PregnancyAbstractHydrocephalus is enlargement of the brain ventricles as a result of an increase in the amount of cerebrospinal fluid (CSS) caused by an imbalance between production, circulation and absorption. Estimates of pregnant women in non-obstetric surgery are around 1–2%. Obstetric patients with neurosurgery disorders are always treated in the ICU. The incidence of surgery during pregnancy was reported in 42% of surgical procedures occurred in the first trimester, 35% in the second trimester, and 23% in the third trimester. A 35-year-old woman with 32-33 weeks' gestation came to the emergency room with decreased consciousness yet no history of trauma and high blood pressure. Hydrocephalus were found in CT scan, and the external ventricular drainage (EVD) is taken. The patient has intrauterine pregnancy so the anesthesia choice is scalp block and occipital block. Ropivacaine HCl 0.375% (as much 10cc) was used. After surgery the patient was treated in the recovery room for 2 hours, and discharged to the high care unit (HCU) afterwards. Hypoxia and hypotension is a challenge in short periods of hypoxemia that can still be tolerated. Prolonged maternal hypoxemia prevention will cause uteroplacental circulation vasoconstriction which ultimately reduces perfusion, causing foetal hypoxemia, acidosis and death.

scholarly journals The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury

2019 ◽  
Vol 8 (9) ◽  
pp. 1422 ◽  
Author(s):  
Charlene Y. C. Chau ◽  
Claudia L. Craven ◽  
Andres M. Rubiano ◽  
Hadie Adams ◽  
Selma Tülü ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Brain Injury ◽  
Clinical Effectiveness ◽  
External Ventricular Drainage ◽  
Optimal Timing ◽  
Ventricular Drainage ◽  
Contemporary Practice ◽  
Economic Considerations

External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations.

scholarly journals External ventricular drainage for intraventricular hemorrhage

2018 ◽  
Vol 32 (2) ◽  
pp. 347-354
Author(s):  
V.A. Kiran Kumar ◽  
N.A. Sai Kiran ◽  
V. Anil Kumar ◽  
Luis Rafael Moscote-Salazar ◽  
Amrita Ghosh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intraventricular Hemorrhage ◽  
Alcohol Intake ◽  
Past History ◽  
External Ventricular Drain ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Poor Outcome ◽  
History Of ◽  
Time Of Admission

Abstract Background: Intervention to reduce intracranial pressure using External Ventricular Drain (EVD) is a common life saving measure in a neurosurgery intensive care unit(ICU). Objective: The present study was undertaken to assess the outcome of patients who underwent external ventricular drainage for intraventricular hemorrhage(IVH). Methods: The available data of the patients who underwent placement of external ventricular drain from February 2012 to May 2016 for intraventricular hemorrhage (IVH) at Narayana Medical College and Hospital, Nellore, was retrieved from the hospital case records and analyzed. Results: Total of 69 patients were included in this study. Mean age was 53.7 ±11.6 years. Clinical presentation included altered sensorium in 66 patients (96%), hemiparesis in 62 patients (90%) , vomiting in 40 patients (58%) and seizures in 9 patients (13%). Fifty two patients (75%) were known hypertensives and 10 patients (15%) were diabetic. Past history of smoking was recorded in 16(23%) patients and alcohol intake in 17 patients (25%). GCS at the time of admission was 3-8 (low) in 39 patients (57%), 9-12 in 23 patients(33%) and 13-15 in 7 patients (10%). At the time of admission, 60 patients ( 87%) had diastolic blood pressure more than 90 mmHg, 63 patients (91%) had systolic blood pressure more than 140 mmHg. Major site of hemorrhage was basal ganglia in 24 (35%), thalamus in 13 (19%), cerebellum in 5 (7%), brain stem in 3, frontal/temporal in 2 patients. SAH with IVH was noted in 12 patients (17%) and only IVH was noted in 10 patients (14%). Mean duration of external ventricular drainage was 4.6+1.7 days (Range 1-9 days). Mean hospital stay was 11.3±7.5 days and mean ICU stay was 8+5.4 days. Thirty eight patients (55%) died during hospital stay. At the time of discharge, poor out come (Glagow out come score 1-3) was noted in 52 patients (75%) and good out come (Glagow out come score-4,5) was noted in 17 patients. Among various parameters analyzed , poor GCS (3-8) at admission, history of smoking and alcohol intake were found to correlate significantly with poor outcome. None of the other factors like old age, site of bleed, pupillary asymmetry at admission, high blood pressure at admission, past history of hypertension and diabetes were found to correlate with poor outcome. Conclusions: Majority of the patients with intracranial hematomas with intraventricular extension presented in poor neurological condition (GCS= 3-8). Poor neurological condition at the time of admission, past history of smoking and alcohol intake were associated with poor outcome.

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