Artikel
Analysis of efficacy and safety of over 200 external ventricular drainages placed over mini burr hole (3.5 mm) trephinations in subarachnoid haemorrhage
Suche in Medline nach
Autoren
Veröffentlicht: | 4. Juni 2012 |
---|
Gliederung
Text
Objective: Burr hole trephinations are most frequently used for external ventricular drainage (EVD). Most centres perform 10–30 mm burr hole trephinations in complete operating theatre settings. Implanted drainages are usually tunnelled before diverted out of the skin. In contrast to this procedure, we present a bedside technique, using 3.5 mm burr hole trephinations and percutaneous implantation.
Methods: In a two years period, 212 patients (mean age 54 years) were treated with mini burr hole trephinations. We analysed each procedure in terms of efficacy and complications. All patient charts, pre- and postoperative CCTs, CSF-, blood- and microbiology results, were evaluated.
Results: The mean duration of EVD amounted to 8.2 days (standard deviation 7 days). Catheter-related infection occurred in 17 patients (8.1%). In nine of these 17 patients (53%) no germ was found, the identified germs were Staphylococcus epidermidis (18%), other koagulase-negative Staph. (17%), Staph. aureus (6%) and Enterococcus species (6%). There was an increase of white blood cells (WBC) in the cerebrospinal fluid (CSF) from average 130 WBC/µL baseline in subarachnoid haemorrhage to 2672 WBC/µL in an evident infection. Seven patients (3%) sustained an EVD related haemorrhage, six of them had a marginal bleeding around the catheter, one had a haematoma of 3 cm diameter, none of them required an operative evacuation or revision. A revision of the catheter was done in 22 patients (10%), in 17 patients (8%) due to infection, in 5 patients (2%) due to misplacement. Forty-nine patients (23%) required a ventriculo-peritoneal shunt.
Conclusions: Compared with the literature, mini burr hole trephinations for EVDs are efficient and do not have a higher complication rate despite the percutaneous implantation technique. Because of its fast availability at bedside this procedure is of advantage especially in emergencies.