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External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates

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Title: External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates
Authors: Atallah, Oday, Krauss, Joachim K., Hermann, Elvis J.
Source: Childs Nerv Syst
Publisher Information: Springer Science and Business Media LLC, 2024.
Publication Year: 2024
Subject Terms: Male, Adolescent, Research, Infant, Newborn, Infant, Infant, Newborn [MeSH], Adolescent [MeSH], Female [MeSH], Intracranial hemorrhage, Humans [MeSH], External ventricular drainage, Postoperative Complications/epidemiology [MeSH], Retrospective Studies [MeSH], Drainage/methods [MeSH], Infection, Infant [MeSH], Male [MeSH], Children, Cerebrospinal Fluid Shunts/methods [MeSH], Brain tumors, Postoperative Complications/etiology [MeSH], Child [MeSH], Hydrocephalus/surgery [MeSH], Child, Preschool [MeSH], Cerebrospinal Fluid Shunts, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Child, Preschool, Humans, Drainage, Female, Child, Retrospective Studies, Hydrocephalus
Description: Purpose Placement of an external ventricular drainage (EVD) is one of the most frequent procedures in neurosurgery, but it has specific challenges and risks in the pediatric population. We here investigate the indications, management, and shunt conversion rates of an EVD. Methods We retrospectively analyzed the data of a consecutive series of pediatric patients who had an EVD placement in the Department of Neurosurgery at Hannover Medical School over a 12-year period. A bundle approach was introduced to reduce infections. Patients were categorized according to the underlying pathology in three groups: tumor, hemorrhage, and infection. Results A total of 126 patients were included in this study. Seventy-two were male, and 54 were female. The mean age at the time of EVD placement was 5.2 ± 5.0 years (range 0–17 years). The largest subgroup was the tumor group (n = 54, 42.9%), followed by the infection group (n = 47, 37.3%), including shunt infection (n = 36), infected Rickham reservoir (n = 4), and bacterial or viral cerebral infection (n = 7), and the hemorrhage group (n = 25, 19.8%). The overall complication rate was 19.8% (n = 25/126), and the total number of complications was 30. Complications during EVD placement were noted in 5/126 (4%) instances. Complications during drainage time were infection in 9.5% (12 patients), dysfunction in 7.1% (9 patients), and EVD dislocation in 3.2% (4 patients). The highest rate of complications was seen in the hemorrhage group. There were no long-term complications. Conversion rates into a permanent shunt system were 100% in previously shunt-dependent patients. Conversion rates were comparable in the tumor group (27.7%) and in the hemorrhage group (32.0%). Conclusion EVD placement in children is an overall safe and effective option in children. In order to make further progress, carefully planned prospective and if possible randomized studies are needed controlling for multivariable aspects.
Document Type: Article
Other literature type
Language: English
ISSN: 1433-0350
0256-7040
DOI: 10.1007/s00381-024-06367-y
Access URL: https://pubmed.ncbi.nlm.nih.gov/38557894
https://repository.publisso.de/resource/frl:6495517
Rights: CC BY
Accession Number: edsair.doi.dedup.....c919a8d5f87f68fd71b71d41520ba40e
Database: OpenAIRE
Description
Abstract:Purpose Placement of an external ventricular drainage (EVD) is one of the most frequent procedures in neurosurgery, but it has specific challenges and risks in the pediatric population. We here investigate the indications, management, and shunt conversion rates of an EVD. Methods We retrospectively analyzed the data of a consecutive series of pediatric patients who had an EVD placement in the Department of Neurosurgery at Hannover Medical School over a 12-year period. A bundle approach was introduced to reduce infections. Patients were categorized according to the underlying pathology in three groups: tumor, hemorrhage, and infection. Results A total of 126 patients were included in this study. Seventy-two were male, and 54 were female. The mean age at the time of EVD placement was 5.2 ± 5.0 years (range 0–17 years). The largest subgroup was the tumor group (n = 54, 42.9%), followed by the infection group (n = 47, 37.3%), including shunt infection (n = 36), infected Rickham reservoir (n = 4), and bacterial or viral cerebral infection (n = 7), and the hemorrhage group (n = 25, 19.8%). The overall complication rate was 19.8% (n = 25/126), and the total number of complications was 30. Complications during EVD placement were noted in 5/126 (4%) instances. Complications during drainage time were infection in 9.5% (12 patients), dysfunction in 7.1% (9 patients), and EVD dislocation in 3.2% (4 patients). The highest rate of complications was seen in the hemorrhage group. There were no long-term complications. Conversion rates into a permanent shunt system were 100% in previously shunt-dependent patients. Conversion rates were comparable in the tumor group (27.7%) and in the hemorrhage group (32.0%). Conclusion EVD placement in children is an overall safe and effective option in children. In order to make further progress, carefully planned prospective and if possible randomized studies are needed controlling for multivariable aspects.
ISSN:14330350
02567040
DOI:10.1007/s00381-024-06367-y