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BACKGROUND: The management of ventriculitis remains controversial, with no single management strategy that can provide a good outcome. There are few articles describing the brainwashing technique, and most for neonatal intraventricular hemorrhage. This technical note is important because it describes a practical way to perform brainwashing in case of ventriculitis, and it is more feasible compared to endoscopic lavage in developing countries. METHOD: We describe in a stepwise fashion the surgical technique of ventricular lavage. CONCLUSION: Ventricular lavage is a neglected technique that can help to improve ventricular infection and hemorrhage prognosis.
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Ventriculite Cerebral , Recém-Nascido , Humanos , Comunicação Persuasiva , Endoscopia/efeitos adversos , Hemorragia Cerebral/complicações , Resultado do Tratamento , Drenagem/efeitos adversosRESUMO
Introduction Weaning from external ventricular drainage (EVD) of cerebrospinal fluid (CSF) in hydrocephalus induced by aneurismal subarachnoid hemorrhage (SAH) had been proposed either through the rapid, gradual or intermittent approaches. There are no uniform guidelines for it. Given this, we planned to study the comparative outcome between EVD drainage with intermittent clamping versus EDV followed by Ommaya reservoir. Material and Methods The present retrograde observational study was conducted from July 2018 to March 2021 in the department of neurosurgery with 67 patients who developed hydrocephalus following SAH after aneurysm rupture. We divided the patients into two groups. Group 1 had only EVD placed for CSF drainage with intermittent clamping before the placement of the ventriculoperitoneal (VP) shunt, and, in group 2, an Ommaya reservoir was placed after EVD before the shunt. Result There were 38 patients in group 1 and 29 in group 2. They were age-matched, with a mild male predominance in group 1. Shunt dependency was significantly reduced in group 2 patients (p » 0.011), along with reduced length of stay in ICU (p » 0,001) and length of stay in Hospital (p » 0.019). We found improved Glasgow outcome score in group 2 patients (p » 0.006) together with reduced incidence of infarct (p » 0.0095). Conclusion We may infer from the present study that continuous drainage through EVD, initially, in hydrocephalus induced by SAH following aneurysm rupture, increases cerebral perfusion pressure (CPP) and decreases intracranial pressure (ICP) leading to decreased infarct rate and intermittent drainage through Ommaya following EVD reservoir, decreases shunt dependency, reduces ICU and hospital stay, with improved Glasgow outcome score on follow-up, but these findings need to be validated in a prospective randomized control trial.
Introdução O desmame da drenagem ventricular externa (DVE) do líquido cefalorraquidiano (LCR) na hidrocefalia induzida por hemorragia subaracnóidea aneurismática (HSA) foi proposto pelas abordagens rápida, gradual ou intermitente. Não há diretrizes uniformes para isso. Diante disso, planejamos estudar o resultado comparativo entre drenagem DVE com pinçamento intermitente versus DVE seguido de reservatório de Ommaya. Materiais e métodos O presente estudo observacional retrógrado foi realizado de julho de 2018 a março de 2021 no departamento de neurocirurgia com 67 pacientes que desenvolveram hidrocefalia após HSA consequente de ruptura de aneurisma. Dividimos os pacientes em dois grupos. O grupo 1 teve apenas DVE colocado para drenagem do líquor com pinçamento intermitente antes da colocação da derivação ventrículo-peritoneal (VP) e, no grupo 2, um reservatório de Ommaya foi colocado após a DVE antes da derivação. Resultado Havia 38 pacientes no grupo 1 e 29 no grupo 2. Eles eram pareados por idade, com leve predominância do sexo masculino no grupo 1. A dependência de shunt foi significativamente reduzida nos pacientes do grupo 2 (p » 0,011), juntamente com menor tempo de internação na UTI (p » 0,001) e tempo de permanência no Hospital (p » 0,019). Encontramos melhora no escore de Glasgow nos pacientes do grupo 2 (p » 0,006) juntamente com redução da incidência de infarto (p » 0,0095). Conclusão Podemos inferir do presente estudo que a drenagem contínua por DVE, inicialmente, na hidrocefalia induzida por HSA após ruptura de aneurisma, aumenta a pressão de perfusão cerebral (PPC) e diminui a pressão intracraniana (PIC) levando à diminuição da taxa de infarto e drenagem intermitente por Ommaya após DVE reservatório, diminui a dependência do shunt, reduz a permanência na UTI e no hospital, com melhora do escore de Glasgow no acompanhamento, mas esses achados precisam ser validados em um estudo prospectivo randomizado de controle.
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Introducción: La utilización de drenajes ventriculares al exterior (DVE) es uno de los procedimientos más frecuentes dentro de la neurocirugía. Los DVE presentan una elevada tasa de infección, con valores que van desde 3-22 %. Las publicaciones que hablan acerca de los factores de riesgo asociados a IAD son limitadas al hemisferio norte, por lo tanto, los resultados no son tan fácilmente trasladables a nuestro medio. Creemos que es importante conocer los factores de riesgo que predisponen a las IAD en nuestra comunidad, para poder prevenirlas y evitarlas. Materiales y métodos: Estudio analítico retrospectivo de una cohorte de 66 pacientes pediátricos que recibieron 137 DVE. Se analizaron los factores considerados de riesgo para infección asociada al drenaje (IAD). Resultados: De los 66 pacientes analizados con DVE, 15 (22.7%; IC 95%: 14-34,5) presentaron una IAD. Los pacientes que presentaron fístula de LCR (65,2% vs 0%; p <0,0001), desconexión del sistema (60% vs 16% p<0,007), obstrucción (75% vs 19% p=0,03), menor edad (2 vs 9 p=0,03), internación prolongada (68 vs 42; p=<0.000), mayor tiempo en quirófano (462 vs 113; p=<0,000), y mayor número de recambios (4 vs 1; p=<0,000) mostraron una incidencia de IAD significativamente superior. Conclusión: La incidencia anual de IAD en nuestra población fue del 22,7%.La fístula de LCR junto con la desconexión y la obstrucción del sistema parecerían ser factores de riesgo para IAD. La edad, el tiempo de internación, la duración de la cirugía y el número de recambios parecerían ser también factores de riesgo para las IAD.
Introduction: The use of external ventricular drainage (EVD) is one of the most frequent procedures within neurosurgery. EVDs present a high infection rate, with values ranging from 3-22%.Information about risk factors associated with EVD are limited to the northern hemisphere, therefore, the results are not so easily transferable to our environment. We believe that it is important to know the risk factors that predispose EVD Ìs infections in our community, in order to prevent and avoid them. Materials and methods: We performed a retrospective analytical study of a cohort of 66 pediatric patients who received 137 EVD. Risk factors for EVD infections were analyzed. Results: Of the 66 patients analyzed with EVD, 15 (22.7%; 95% CI: 14-34.5) presented an EVD infection. CSF fistula (65.2% vs 0%; p <0.0001), disconnection (60% vs 16% p <0.007), obstruction (75% vs 19% p = 0.03) , younger age (2 vs 9 p = 0.03), prolonged hospitalization (68 vs 42; p = <0.000), longer time in the operating room (462 vs 113; p = <0.000), and greater number of replacements (4 vs 1; p = <0.000) showed a significantly higher incidence of EVD infections. Conclusion: The annual incidence of ADI in our population was 22.7%. CSF fistula along with system disconnection and obstruction, younger age, length of stay, surgery duration, and number of replacements appear to be risk factors for EVD infections.
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Criança , Infecções , Pediatria , Drenagem , Fatores de Risco , NeurocirurgiaRESUMO
Objectives External ventricular drainage (EVD) is extensively used in the neurosurgical practice with the purpose of monitoring the intracranial pressure and draining the cerebrospinal fluid (CSF). Despite its remarkable benefits, the technique is not devoid of risks, notably infections, which have been reported in up to 45% of the cases. Methods A retrospective analysis of the main risk factors for CSF infection in neurosurgical patients submitted to EVD at a single institution. We recorded and submitted to statistical comparison every risk factor for CSF infection present or absent in each of the 110 EVD patients enrolled, 53 males and 57 females, with an average age of 52.9 years, with different underlying neurosurgical conditions. Results Infection of the CSF occurred in 32 patients (29%). The rate of mortality related to CSF infection was of 18.7% (6 of 32). The risk factors that showed statistical significance for CSF infection in this series were: emergency surgery; length of stay at the intensive care unit (UCI); duration of the EVD; parenchymal and/or intraventricular hemorrhage; simultaneous infections; time of bladder catheterization; and the use of non-disposable adhesive drapes as part of the preparation of the wound area. Conclusions Infection of the CSF in patients submitted to EVD is multifactorial and a challenge in terms of prevention. Further studies proposing scores with blended risk factors may be useful to prevent and reduce the morbidity and mortality associated with CSF infection.