gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Influence of surgeon's experience and placement modality on accuracy of external ventricular drains

Meeting Abstract

  • Konstantin Brawanski - A.ö. Landeskrankenhaus - Universitätskliniken Innsbruck, Tirol Kliniken GmbH, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Christian F. Freyschlag - Innsbruck, Austria
  • Martina Obermoser - Innsbruck, Austria
  • Claudius Thomé - A.ö. Landeskrankenhaus - Universitätskliniken Innsbruck, Tirol Kliniken GmbH, Universitätsklinik für Neurochirurgie, Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.14.02

doi: 10.3205/17dgnc254, urn:nbn:de:0183-17dgnc2548

Published: June 9, 2017

© 2017 Brawanski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Placement of an external ventricular drain (EVD) for managing acute hydrocephalus and/or intracranial hypertension is a standard procedure, carried out mostly by neurosurgical trainees. The most common complications associated with EVDs are catheter misplacement, infection, hemorrhage and dislocation. The objective of the present single center analysis was to determine relationships between incidence of complications and the surgeons’ level of experience/training and the modality used (bedside/OR).

Methods: A retrospective analysis of 219 patients with adequate imaging and follow-up data that had received a total of 232 EVDs between January 2010 and May 2015 was conducted. The position of the catheter tip (malposition was defined as: catheter tip outside ispilateral lateral ventricle, third ventricle), hemorrhage and catheter dislocations and related infections were evaluated. Imaging parameters were obtained on the first CT scan after insertion. The complications were analysed in correlation to different levels of neurosurgical training and the circumstances of placement – whether the EVDs were inserted bedside or in the OR. Data were analysed with Chi-square and Fisher´s exact test.

Results: 127 patients (54.7%) were female and 105 (45.3%) were male. The median age was 63 years (range 11 – 92 years). A total of 199 (85.8%) EVDs were inserted in the OR, whereas 33 (14.2%) were placed bedside. We found 32 (13.8%) malpositions and 200 (86.2 %) correctly placed catheters. The majority of EVDs (182, 78.4%) was placed by residents, only 50 (21.6%) were inserted by fully trained neurosurgeons. EVDs placed by residents were misplaced in 15.4% of cases (28 of 182) in comparison to 8.0% (4 of 50) by board-certified neurosurgeons (p=0.247). 13.1% (26 of 199) of all placed EVDs in the OR and 18.2% (6 of 33) of all placed EVDs bedside, showed a malposition (p=0.419). CSF infections occurred in 15.4% (28 of 182) of all EVDs placed by residents and 12.0% (6 of 50) of all EVDs placed by consultants (p=0.656). EVDs placed in the OR showed a CSF infection in 13.6% (27 of 199) and bedside placed EVDs in 21.2% (7 of 33) (p=0.286).

Conclusion: The level of resident’s training showed no influence on the accuracy of EVD placement. Our analysis supported the equipoise of insertion modalities (bedside/OR) in terms of infections and misplacement.