Abstract
Background and Study Aims Patients with acute hydrocephalus are treated by either insertion of a conventional
external ventricular drain (EVD) or percutaneous needle trephination (PNT) at our
institution, depending on the acuteness of intervention and the severity of illness.
We compared both procedures regarding accuracy and safety necessitating surgical revision
of EVD or PNT.
Methods Between January 2012 and January 2014, 451 ventriculostomies were performed in 301
patients at our institution. All patients underwent routine computed tomography after
insertion of the ventricular drain during the treatment course. Patient characteristics,
underlying pathology, ventriculostomy modality, radiologic features, catheter tip
location, and treatment-related complications were analyzed.
Results A total of 307 of 451 ventriculostomy procedures (68%) were performed as conventional
EVD, and 144 (32%) were performed as PNT. Overall, 11% of patients with conventional
EVD underwent surgical revision due to lacking accuracy, infection, or hemorrhage;
7% of patients with PNT underwent surgical revision (p = 0.2). However, multivariate analysis revealed that only “hospital stay > 21 days”
as an independent variable was significantly associated with surgical revision after
ventriculostomy.
Conclusion The present data indicate that PNT has a similar safety profile in emergency situations
in critically ill patients who need immediate treatment for acute hydrocephalus when
compared with the conventional EVD procedure.
Keywords
external ventricular drain - acute hydrocephalus - ventriculostomy - percutaneous
needle trephination
