Relative risks of ventriculostomy infection and morbidity. The risk of non-infectious complications was 5.6%, including hemorrhagic occurrences and misplacement severe enough to require a new catheter insertion. The daily hazard of infection approximately equalled the non-infectious risk of routine catheter replacement by day 5.
What is the most common complication associated with ventriculostomy catheters?
Ventriculitis (20%)Infection is the most common complication of external ventricular drainage (EVD), with rates ranging from 0 to 45%.
What is a ventriculostomy procedure?
An alternative procedure to shunt surgery is an endoscopic third ventriculostomy (ETV). Instead of inserting a shunt, the surgeon makes a hole in the floor of your brain to allow the trapped cerebrospinal fluid (CSF) to escape to the brain's surface, where it can be absorbed.
What causes ventriculostomy?
Predisposing factors that cause ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, second membrane relics within the stoma, CSF absorption failure, CSF infection/high protein, and improper selection of patients.
Is a ventriculostomy brain surgery?
About Your Surgery ETV is a surgery to drain extra cerebrospinal fluid (CSF) from your brain.
Where does a ventriculostomy go?
Definition and Overview. Ventriculostomy or ventricular drain is a quick surgical procedure performed in the head to attach a device to drain cerebrospinal fluid (CSF) buildup in the brain. This device may be placed externally, and it can be either temporary or permanent.
What is the complication of external ventricular drain insertion?
Common complications following EVD insertion include haemorrhage, misplacement, dislodgement, blockage and infection, which could be further complicated by ventriculitis, meningitis, brain abscess or subdural empyema. These are associated with increased length of hospital stay, morbidity and mortality.
What are the possible complications for ETV?
The most frequent intraoperative complications of ETV are hemorrhage (the most severe being due to basilar rupture) and injury of neural structures. In the immediate postoperative period, hematomas, infections, and cerebrospinal fluid leaks may present. Morbidity can be neurological and/or hormonal.
Who needs a ventriculostomy?
Ventriculostomy is a neurosurgical procedure that involves creating a hole (stoma) within a cerebral ventricle for drainage. It is most commonly performed on those with hydrocephalus. It is done by surgically penetrating the skull, dura mater, and brain such that the ventricle of the brain is accessed.
What are the three causes of hydrocephalus?
Possible causes of acquired hydrocephalus include: bleeding inside the brain – for example, if blood leaks over the surface of the brain (subarachnoid haemorrhage) blood clots in the brain (venous thrombosis) meningitis – an infection of the membranes surrounding the brain and spinal cord.
Can a person with hydrocephalus drive?
For the most part, hydrocephalus does not limit your ability to drive. However, it's not uncommon for individuals with hydrocephalus to experience challenges with depth perception, processing speed, reaction timing, coordination, short-term memory, vision, orientation, and/or navigational issues.
How long do people with hydrocephalus live?
What is the life expectancy of a child who has hydrocephalus? Children often have a full life span if hydrocephalus is caught early and treated. Infants who undergo surgical treatment to reduce the excess fluid in the brain and survive to age 1 will not have a shortened life expectancy due to hydrocephalus.
What is the best treatment for hydrocephalus?
The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate. One end of the tubing is usually placed in one of the brain's ventricles.
Is an EVD the same as a ventriculostomy?
An external ventricular drain (EVD), also known as a ventriculostomy or extraventricular drain, is a device used in neurosurgery to treat hydrocephalus and relieve elevated intracranial pressure when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed.
Is hydrocephalus a surgery?
Hydrocephalus is treated with one of two surgical options: A shunt (tube) is surgically inserted into the brain and connected to a flexible tube placed under the skin to drain the excess fluid into either the chest cavity or the abdomen so it can be absorbed by the body.
What are the possible complications for ETV?
The most frequent intraoperative complications of ETV are hemorrhage (the most severe being due to basilar rupture) and injury of neural structures. In the immediate postoperative period, hematomas, infections, and cerebrospinal fluid leaks may present. Morbidity can be neurological and/or hormonal.
What is the purpose of intracranial pressure monitoring?
Intracranial pressure (ICP) monitoring is a diagnostic test that helps your doctors determine if high or low cerebrospinal fluid (CSF) pressure is causing your symptoms. The test measures the pressure in your head directly using a small pressure-sensitive probe that is inserted through the skull.
Who first proposed the ventriculostomy?
Ventriculostomy is one of the most common emergency based neurosurgical procedures practitioners undertake globally.[1] The first attempt was by Claude-Nicolas Le Cat , a French anatomist.[2] Ingraham later advocated the application of a closed draining system to minimize the infective complications.[3]
Who was the first to describe the ventricular system?
Herophilus and Erasistratus were the first to provide the anatomical depiction of the ventricular system inside the brain. Later, Domenico Felice Antonio Cotugno described the presence of cerebrospinal fluid (CSF) within this interconnecting system. [3]
What was the first guide for ventricular catheters?
Ghajar first introduced a ventricular catheter guide for optimizing trajectory during ventriculostomy. He advocated a perpendicular trajectory relative to the skull surface. [9]
Why are patient safety checklists mandatory?
To ensure better clinical outcome and to prioritize patient safety by minimizing complications, there need to be mandatory patient safety checklists to be implemented by the interprofessional team involved in the process. Following guidelines has to be adhered to [6]:
Where does the ventricular system develop?
The ventricular system develops from the cavities within the developing brain vesicles. The cavity of the rhombencephalon later forms the fourth ventricle, whereas the cavity of the diencephalon forms the third ventricle, and those of the telencephalon develop into the lateral ventricles. The cavity within the mesencephalon forms the aqueduct connecting third to the fourth ventricles. [3]
Who should receive a thorough explanation regarding the indication for the procedure and the risks involved before the procedure?
The patient and next of kin/relatives should receive a thorough explanation regarding the indication for the procedure and the risks involved before the procedure, and written consent obtained. [6]
Can hydrocephalus cause aneurysmal rebleed?
Over-drainage can lead to aneurysmal rebleed and in cases of hydrocephalus complicate the upward transtentorial herniation.
How is ventriculostomy done?
Once you reach the hospital, you will be asked to change into a hospital gown and wear non-skid socks. The surgery will be performed in the operation theatre. You will lie on the operating bed, and compression boots will be put on to help blood flow to your legs. You will be given general anaesthesia to make you fall asleep during the procedure. Then, your hair will be shaved on the area where the cut is to be made.
What is ventriculostomy?
Ventriculostomy is a surgery performed in both children and adults to reduce the excess cerebrospinal fluid (CSF) in ventricles of the brain. Ventricles are interconnected cavities in the brain, filled with CSF. There are four ventricles in the brain. Two lateral ventricles in either hemisphere of brain, a third ventricle that is connected to both these ventricles and the fourth ventricle that lies in the brain stem and is connected to the third ventricle via a channel called the cerebral aqueduct.
When to follow up with your doctor after a ventriculostomy?
A follow-up appointment will generally be scheduled for seven to 10 days after the surgery to remove the stitches or staples in your incision.
Where does the CSF flow in endoscopic third ventriculostomy?
Endoscopic third ventriculostomy. Most blockages in CSF flow occur in the slender pathway between the third and fourth ventricle. In endoscopic third ventriculostomy, the CSF is diverted from the third ventricle to the chambers beneath the base of the brain.
What is a ventriculoperitoneal shunt?
Additional management of infected or malfunctioning ventriculoperitoneal shunts (a medical device that is used to control pressure on the brain caused by fluid accumulation)
Why do you put a mask on after a third ventriculostomy?
On waking up, you may feel tired. Next day after the endoscopic third ventriculostomy, the doctor will remove the bandage covering your incision, and it will be left uncovered.
Can you smoke before a ventriculostomy?
You may need some diagnostic and radiological tests before the surgery. If you drink or smoke, you will need to stop both a few days before the surgery. Ventriculostomy is performed either by endoscopy or by inserting an external drain in the ventricle (brain cavity).
Introduction
Traumatic brain injury (TBI) is a major cause of death and disability in the world harboring significant public health and socio-economic importance. TBI is estimated to be the primary cause of mortality and disability among young individuals.
Methods
We performed a systematic search on PubMed and Google Scholar databases (from 1966 to August 2017) for relevant studies related to ventricular drain infections. Keywords used in the search strategy include:
Results
Table 1 summarizes the factors that proved to be significant or non-significant in the univariate analyses of the studies included in this review. Out of the 20 articles selected for analysis, three studies reported no significant association between the risk factors evaluated and EVD infection ( 6, 15, 17) after multivariate analysis.
Discussion
The keywords and references used in our review were similar to the keywords and references in other reviews ( 8, 9, 28 ). Despite the sparse amount of articles on this topic, we were able to identify a total of 15 risk factors.
Conclusion
Studies published on risk factors of EVD infection till 2017 have serious limitations and can be considered only as preliminary investigations which yielded a set of variables (patients and EVD related factors) that should be covered by future observational epidemiological investigations.
Author Contributions
AS was responsible for the search of articles. JS was responsible for the structure of the content in the manuscript. AS, JS, and AB were responsible for the writing of the manuscript. AB, JS, and EC were responsible for the editing, proof-reading and finalization of the manuscript
Conflict of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.