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

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Complications and Shunt-Dependency following Placement of an External Ventricular Drainage – a Single-Center Experience

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  • Marit Herbolzheimer - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
  • Kerim Hakan Sitoci-Ficici - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
  • Markus Dengl - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
  • Amir Zolal - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
  • Dino Podlesek - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
  • Matthias Kirsch - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
  • Gabriele Schackert - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland

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. DocMi.19.05

doi: 10.3205/17dgnc496, urn:nbn:de:0183-17dgnc4961

Published: June 9, 2017

© 2017 Herbolzheimer 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 and postoperative management of external ventricular drainage differs significantly in different neurosurgical units due to lacking of nationwide or international guidelines. We examined the management and complications in our institution for the years 2009 till 2015 to identify problems and possibilities for improvement.

Methods: We conducted a retrospective analysis of external ventricular drainages performed between 2009 and 2015 on adult patients in our institution. Points of interest were, among others, the underlying disease, patient demographics, duration of external drainage, measured liquor dynamics and chemistry, usage of prophylactic antibiotics (which was changed in our institution in 2014).

Results: 573 patients were treated with an external ventricular drainage receiving 961 interventions. The far most prominent underlying diseases were aneurysmal subarachnoid hemorrhage (29.7 %) and intracerebral hemorrhage (27.2 %). 51.5 % of the patients received a permanent drainage system (shunt). There was a high dependence on the underlying disease for shunt placement, e.g. patients with subarachnoid hemorrhage received in 67.3 % of the cases a permanent liquor shunt after an external drainage. The over-all infection rate in our institution was 8.52 % per patient. Since we changed our management and abandoned prophylactic antibiotic usage in 2014, we could correlate historically the infection rates with or without prophylactic antibiotics, which were similar (8.54 % vs. 8.46 % for patients receiving prophylaxis vs. no prophylaxis).

Conclusion: Although external ventricular drainage is a frequent neurosurgical intervention, it is still haunted by a high complication rate, infection being the most prominent. The infection rates in our institution were consistent within the range of various reports from other institutions. Antibiotic prophylaxis could not provide a significant lower infection rate and was thus rightfully abandoned and should be one recommendation in a future guideline for external ventricular drainages. We had a high rate for shunt placement compared to other reports, especially in patients with subarachnoid hemorrhage; the reasons for this will be discussed.