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.

Acute hydrocephalus in posterior fossa injury

1997 ◽  
Vol 86 (4) ◽  
pp. 629-632 ◽  
Author(s):  
Hideharu Karasawa ◽  
Hajime Furuya ◽  
Hiromichi Naito ◽  
Ken Sugiyama ◽  
Junji Ueno ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Ct Scanning ◽  
Mortality Rates ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Content Type ◽  
Acute Hydrocephalus ◽  
Significant Difference ◽  
Fine Print

✓ This is the first known report of the use of computerized tomography (CT) scanning to examine acute hydrocephalus in posterior fossa injury. Of the 1802 patients with acute head trauma treated at Funabashi Municipal Medical Center, 53 (2.9%) had suffered injury to the posterior fossa. Of these, 12 patients (22.6%) had associated acute hydrocephalus: nine patients with acute epidural hematoma (AEH) and three with intracerebellar hematoma and contusion (IH/C). There was a significant relationship between cases of AEH with hydrocephalus and supratentorial extension, hematoma thickness of 15 mm or more, and abnormal mesencephalic cisterns. In cases of IH/C, bilateral lesions and no visible fourth ventricle were significant causes of hydrocephalus. According to these results, possible mechanisms of acute hydrocephalus in posterior fossa injury may be as follows: in cases of AEH, hematoma that extends to the supratentorial area compresses the aqueduct posteriorly and causes hydrocephalus; in cases of IH/C, hematoma and contusional lesions may directly occlude the fourth ventricle and cause acute hydrocephalus. Seven patients suffering from AEH with acute hydrocephalus underwent evacuation of their hematoma without external ventricular drainage. In these cases, CT scanning showed that the hydrocephalus improved immediately after evacuation of the hematoma. Two patients suffering from IH/C with hydrocephalus underwent a procedure for evacuation of the hematoma and external ventricular drainage. The authors do not believe that ventricular drainage is necessary in treating posterior fossa AEH. However, both evacuation of the hematoma and ventricular drainage are necessary in cases of IH/C with hydrocephalus to provide the patient with every chance for survival. There was no significant difference in mortality rates when cases of AEH with acute hydrocephalus (0%) were compared with cases of AEH without hydrocephalus (7.7%). The observed mortality rates in cases of IH/C with hydrocephalus and those without hydrocephalus were 100% and 15.4%, respectively; this is statistically significant.

Percutaneous tunnel ventriculostomy

1980 ◽  
Vol 53 (5) ◽  
pp. 662-665 ◽  
Author(s):  
William A. Friedman ◽  
John K. Vries
Keyword(s):  
Bacterial Contamination ◽  
Average Duration ◽  
External Ventricular Drainage ◽  
Ventricular Catheter ◽  
Ventricular Drainage ◽  
Content Type ◽  
Significant Incidence ◽  
Fine Print

✓ External ventricular drainage is an important therapeutic adjunct in neurosurgical practice. Unfortunately, this procedure has been associated with a significant incidence of ventriculitis. A major source for many of these infections has been bacterial contamination of the tract of the ventricular catheter, at the site where it enters the scalp. To prevent this problem, the authors have devised a new ventriculostomy technique that involves tunneling the ventricular catheter through the scalp, between the dermis and the galea. One hundred consecutive procedures in 66 patients are analyzed in this paper. The average duration of drainage was 6.2 days. There were no infections subsequent to the insertion of the ventricular catheter in this group of patients.

Management of obstructive hydrocephalus secondary to posterior fossa tumors by steroids and subcutaneous ventricular catheter reservoir

1986 ◽  
Vol 65 (5) ◽  
pp. 649-653 ◽  
Author(s):  
Urs D. Schmid ◽  
Rolf W. Seiler
Keyword(s):  
Intracranial Pressure ◽  
Posterior Fossa ◽  
Obstructive Hydrocephalus ◽  
Drainage System ◽  
External Ventricular Drainage ◽  
High Dose ◽  
Ventricular Catheter ◽  
Content Type ◽  
Wide Range ◽  
Fine Print

✓ In 61 patients (38 adults and 23 children) with surgically treatable tumors of the posterior fossa and obstructive hydrocephalus the following treatment for hydrocephalus was employed: 1) a high dose of steroids was given after diagnosis; 2) a frontal ventricular catheter with a subcutaneous fluid reservoir (Rickham) was inserted within 2 to 5 days; 3) a temporary external ventricular drainage system was attached to the reservoir if, despite the steroids, intracranial pressure was over 30 cm H2O; and 4) tumor excision was performed within 5 days to reopen the cerebrospinal fluid (CSF) pathways. In view of the wide range of potential complications, it was decided not to use a shunt before craniotomy. A shunt was inserted only if the CSF pathways remained obstructed after tumor removal. With this regimen, 93% of all patients (100% of the adults and 83% of the children) were shunt-free after the operation, without fatal complications. The infection rate was 4.9%. It was concluded that the severity of symptoms of raised intracranial pressure from hydrocephalus, the intraventricular pressure, and the size or location of the tumor prior to surgery do not have prognostic value as to which patients will require a shunt after surgery.

Cerebrospinal fluid antibiotic levels during treatment of shunt infections

1980 ◽  
Vol 52 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Steven L. Wald ◽  
Robert L. McLaurin
Keyword(s):  
Cerebrospinal Fluid ◽  
Inhibitory Concentration ◽  
External Ventricular Drainage ◽  
Cerebrospinal Fluid Shunt ◽  
Ventricular Drainage ◽  
Antibiotic Concentration ◽  
Content Type ◽  
Intraventricular Injections ◽  
Shunt Infections ◽  
Fine Print

✓ Twenty patients with documented cerebrospinal fluid shunt infections were treated with daily intraventricular injections of methicillin, cephalothin, or gentamicin without removal of the shunt or external ventricular drainage. Periodic determinations of intraventricular antibiotic concentration revealed significant levels in relation to the established minimum inhibitory concentration in all cases.

Intracranial pressure monitoring in the posterior fossa: a preliminary report

1989 ◽  
Vol 71 (4) ◽  
pp. 503-505 ◽  
Author(s):  
Robert H. Rosenwasser ◽  
Laurence I. Kleiner ◽  
Joseph P. Krzeminski ◽  
William A. Buchheit
Keyword(s):  
Intracranial Pressure ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Early Postoperative Period ◽  
Intracranial Pressure Monitoring ◽  
Posterior Fossa Surgery ◽  
Pressure Monitoring ◽  
Content Type ◽  
Cranial Nerve Palsies ◽  
Fine Print

✓ Direct therapeutic drainage and intracranial pressure monitoring from the posterior fossa has never been accepted in neurosurgical practice. Potential complications including cerebrospinal fluid leak, cranial nerve palsies, and brain-stem irritation have been a major deterrent. The authors placed a catheter for pressure monitoring in the posterior fossa of 20 patients in the course of posterior fossa surgery: 14 patients with acoustic schwannomas, four with posterior fossa meningiomas, one with cerebellar hemangioblastoma, and one with a solitary cerebellar metastatic lesion. A Richmond bolt was also placed in the frontal area. Continuous monitoring of the supratentorial and infratentorial compartments was performed for 48 hours. During the first 12 hours the posterior fossa pressure was 50% greater than that of the supratentorial space in all patients (p < 0.01). Over the next 12 hours the supratentorial pressure was 10% to 15% higher than the posterior fossa pressures in all patients, and by 48 hours of monitoring the pressures had equilibrated. There was no mortality or morbidity referable to insertion of the posterior fossa catheter. The conclusions drawn from this study are that: 1) direct monitoring and drainage of the posterior fossa is safe and effective; and 2) within the early postoperative period, the supratentorial pressures failed to reflect what is taking place within the posterior fossa. The implications and advantages of direct posterior fossa monitoring in the postoperative patient are discussed.

Temporary ventricular drainage and emergency radiotherapy in the management of hydrocephalus associated with germinoma

2002 ◽  
Vol 96 (6) ◽  
pp. 1020-1022 ◽  
Author(s):  
John M. Buatti ◽  
William A. Friedman
Keyword(s):  
Obstructive Hydrocephalus ◽  
External Ventricular Drainage ◽  
Tumor Control ◽  
Ventricular Drainage ◽  
Content Type ◽  
Fractionated Radiotherapy ◽  
Novel Strategy ◽  
Emergency Radiotherapy ◽  
Fine Print

Object. The authors used an alternative strategy to avoid shunt placement for hydrocephalus associated with germinoma, and the ensuing complications. Methods. Between 1998 and 2000, five patients presenting with germinomas of the pineal area and symptomatic obstructive hydrocephalus were treated with a novel strategy. On arrival, they underwent ventriculostomy placement and one of several surgical procedures to obtain tissue for diagnosis. Within several days of the initial diagnosis, stereotactically guided fractionated radiotherapy was started. All patients experienced rapid tumor shrinkage and resolution of hydrocephalus, allowing discontinuation of external ventricular drainage without the need for permanent shunting of cerebrospinal fluid. To date, follow up reveals 100% radiographically and clinically confirmed tumor control. Conclusions. Prompt resolution of hydrocephalus and absence of complications make this a potentially valuable therapy for control of germinomas and their symptoms.

Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial

2003 ◽  
Vol 98 (4) ◽  
pp. 725-730 ◽  
Author(s):  
Joseph M. Zabramski ◽  
Donald Whiting ◽  
Rabih O. Darouiche ◽  
Terry G. Horner ◽  
Jeffrey Olson ◽  
...  
Keyword(s):  
Controlled Trial ◽  
External Ventricular Drain ◽  
Final Analysis ◽  
External Ventricular Drainage ◽  
Study Data ◽  
Catheter Insertion ◽  
Control Group ◽  
Ventricular Catheter ◽  
Content Type ◽  
Fine Print

Object. Catheter-related infection of the cerebrospinal fluid (CSF) pathways is a potentially life-threatening complication of external ventricular drainage. A major source of infection is bacterial contamination along the external ventricular drain (EVD) catheter track. The authors examined the efficacy of EVD catheters impregnated with minocycline and rifampin in preventing these catheter-related infections. Methods. The authors conducted a prospective, randomized clinical trial at six academic medical centers. All hospitalized patients 18 years or older who required placement of an EVD catheter were eligible for inclusion in the study. Patients were randomly assigned to undergo placement of an EVD with a catheter impregnated with minocycline and rifampin or a standard untreated catheter (control group). To assess primary outcome, CSF samples were collected using a sterile technique at the time of catheter insertion, at least every 72 hours while the catheter remained in place, and at the time of catheter removal. At the time of removal, CSF cultures were obtained from the tip and tunneled segments of each catheter by performing semiquantitative roll-plate and quantitative sonication techniques. Of the 306 patients enrolled in the study, data from 288 were included in the final analysis. Eighteen patients were excluded from analysis: 14 because the ventricular catheter was in place less than 24 hours, and four because CSF cultures obtained at the time of catheter insertion were positive for infection. Of these 288 patients, 139 were assigned to the control group and 149 to the treatment group. The two groups were well matched with respect to all clinical characteristics, including patient sex and mean age, indication for catheter placement, and length of time the catheter remained in place. The antibiotic-impregnated catheters were one half as likely to become colonized as the control catheters (17.9 compared with 36.7%, respectively, p < 0.0012). Positive CSF cultures were seven times less frequent in patients with antibiotic-impregnated catheters compared with those in the control group (1.3 compared with 9.4%, respectively, p = 0.002). Conclusions. The use of EVD catheters impregnated with minocycline and rifampin can significantly reduce the risk of catheter-related infections.

Intratumoral hemorrhage in posterior fossa tumors after ventricular drainage

1981 ◽  
Vol 54 (3) ◽  
pp. 406-408 ◽  
Author(s):  
Jesús Vaquero ◽  
José M. Cabezudo ◽  
Rafael G. de Sola ◽  
Luis Nombela
Keyword(s):  
Posterior Fossa ◽  
Obstructive Hydrocephalus ◽  
The Other ◽  
Ventricular Drainage ◽  
Preoperative Management ◽  
Posterior Fossa Tumors ◽  
Content Type ◽  
Intratumoral Hemorrhage ◽  
Fatal Bleeding ◽  
Fine Print

✓ Severe intratumoral hemorrhage in posterior fossa tumors is reported in two children, one with a Grade I astrocytoma, and the other with a medulloblastoma. Fatal bleeding occurred a few hours after insertion of ventricular drainage for preoperative management of obstructive hydrocephalus.

Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies

1995 ◽  
Vol 83 (5) ◽  
pp. 791-794 ◽  
Author(s):  
Rohit K. Khanna ◽  
Mark L. Rosenblum ◽  
Jack P. Rock ◽  
Ghaus M. Malik
Keyword(s):  
Prophylactic Antibiotic ◽  
External Ventricular Drainage ◽  
Ventricular Catheter ◽  
Ventricular Drainage ◽  
Risk Of Infection ◽  
Content Type ◽  
Gram Staining ◽  
Short Tunnel ◽  
Upper Abdomen

✓ External ventricular drainage has been used extensively for management of several neurosurgical disorders. The main limitation of this procedure has been the high risk of infection, especially with prolonged drainage. In an effort to minimize the risk of infection, the authors have used a new ventriculostomy technique that involves tunneling the ventricular catheter subcutaneously to an exit site in the lower chest or upper abdomen. This report describes the results of this procedure on 100 consecutive cases. Patients requiring emergency ventriculostomies had short-tunnel ventriculostomies placed at the bedside that were converted to long-tunnel ventriculostomies in the operating room within 5 days. The average duration of drainage was 18.3 days (range 5–40 days). Cerebrospinal fluid was routinely sent for Gram staining and culture to monitor for infection. Prophylactic antibiotic medications were administered only perioperatively. No infection was observed during the first 16 days of drainage in any patient. The overall incidence of infection was 4% and blockage occurred in 6% of the cases. In this series the incidence of ventricular infection was 2.37 per 1000 ventricular drainage days, one of the lowest reported incidences of infection in the literature. This procedure provides a simple and effective method of maintaining long-term ventricular drainage with a very low risk of infection or blockage.

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