gms | German Medical Science

Objective: Placement of ventricular drains (VD) is one of the most common procedures in neurosurgery. Priority should be given to avoidance of complications like infections, malposition and procedure associated haemorrhages. Furthermore, the technique should be cost-efficient, feasible and quickly available. We compared two techniques of VD placement in respect of those factors.

Methods: In this oberservative-descriptive study patients with acute hydrocephalus and the necessity of a VD insertion are compared concerning complications rate by their placement technique: twist drillbore (tdb) hole versus trepan bore (tb)hole trepanation. The further comparisons include the location of surgery: operating theatre versus ICU versus emergency room. Statistical criterias include malpositioning (definition: VD outside the ipsilateral ventricle), infection rate and bleeding complications. Significance was put up to p≤0.05.

Results: 147 (42%) patients receive the VD via twist drill bore (Tdb) hole and 201 (57,4%) patients via trepan bore (tb) hole trepanation. There were no differences between infection rate N_tdb= 14 (9,5%) versus N_tb= 8 (4%), (p=0,154) and the frequency procedure associated bleedings N_tdb= 8 (5,4%) versus N_tb= 12 (6%), (p=0,167) in both groups. Patients, getting their VD via trepan bore hole, had a significant lower risk for malposition N_tdb= 36 (24,5%) versus N_tb= 42 (20,9%) (p=0,05). However, there was no significant difference at all for intraparenchymal malposition (p=0,06). Furthermore there was no significant difference between the location of surgery and the infections rate (p=0,339).

Conclusion: Placement of VD via twist drill bore hole is an adequate procedure to trepan bore hole related to infection- and bleeding rate. Frequency of malposition in twist drill bore hole is higher. However, the incidence of relevant malpositions (intraparenchymal malposition) does not differ significantly from both techniques. Advantages of tdb are the independence of the location of the surgery and therefor the quick practicability.