Article
Ventriculostomy for acute hydrocepahlus in critically ill patients on the ICU – Outcome analysis of two different procedures
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Authors
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P. Schödel
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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M. Proescholdt
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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A. Brawanski
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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K.M. Schebesch
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
| Published: | April 28, 2011 |
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Outline
Text
Objective: The burr-hole trepanation at Kocher's Point and insertion of an external ventricular drainage is one of the most fundamental procedures in neurosurgery. This procedure is usually performed in the operating room (OR) but especially in critically ill patients the transport to the OR represents a major risk. Thus, the burr-hole trepanation and implantation of an external ventricular drainage (EVD) is frequently performed on the ICU. Since 2004, we have performed two different procedures for this intervention: the conventional method with a mechanical compressed-air or electric drill and an alternative method with manual twist drill including fixation of the EVD in a skull-screw (Bolt Kit, Rehau, Germany). This study was designed to evaluate the outcome of both surgical procedures.
Methods: In this retrospective analysis we included 166 patients with acute haemorrhage-related hydrocephalus that had been operated at our neurosurgical ICU in a six years interval. We reviewed the charts for demographics, kind of surgical procedure, rate of relevant CSF-infections, frequency of insertions, wound infection, radiological misplacement rates, postoperative haemorrhages, revision rates and shunt-dependency.
Results: In 122 patients we used the manual Bolt Kit System (BKS Group), in 44 patients the conventional method was performed (MD Group). We found a statistical significant lesser rate of relevant CSF-infections and insertions needed in the BKS Group (p=0.002 and p=0.001 resp.). The rate of wound infections, radiological misplacement, surgical revisions, shunt-dependency and the postoperative haemorrhages did not differ statistically significant.
Conclusions: Our data show that the use of the manual drill and implantation of a skull screw is superior to the conventional method with a mechanical drill. Presumably the reason for the differences in the CSF-infection rate is the two skin incisions, subcutaneous tunneling and fixation of the EVD directly to the skin when the conventional method is applied. The skull screw directs the EVD into the ventricle without skin contact. The lesser frequency of insertions needed may be due to the fact that the skull screw allows just one trajectory for the insertion of the EVD.
