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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(04): e297-e302
DOI: 10.1055/s-0041-1730332
Original Article | Artigo Original

Simultaneous Cranioplasty and External Ventricular Drain Implantation in Patients with Hydrocephalus: Case Series and Literature Review

Implante de derivação ventricular externa e cranioplastia simultânea em pacientes com hidrocefalia: Série de casos e revisão de literatura
Lívio Pereira de Macêdo 
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Arlindo Ugulino Netto
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Kauê Franke
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Pierre Vansant Oliveira Eugenio
2   Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
,
John Anderson da Silva Rocha
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Glaudir Donato Pinto Júnior
2   Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
,
João Pedro Maia Medeiros
2   Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
,
Juan Pablo Borges Rodrigues Maricevich 
3   Department of Plastic Surgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Nivaldo S. Almeida
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Hildo Rocha Cirne Azevedo-Filho 
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
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Abstract

Introduction The increase in intracranial pressure (ICP) is a neurological complication resulting from numerous pathologies that affect the brain and its compartments. Therefore, decompressive craniectomy (DC) is an alternative adopted to reduce ICP in emergencies, especially in cases refractory to clinical therapies, in favor of patient survival. However, DC is associated with several complications, including hydrocephalus (HC). The present study presents the results of an unusual intervention to this complication: the implantation of an external ventricular drain (EVD) in the intraoperative period of cranioplasty (CP).

Methods Patients of both genders who presented with HC and externalization of the brain through the cranial vault after decompressive hemicraniectomy and underwent EVD implantation, to allow the CP procedure, in the same surgical procedure, were included.

Results Five patients underwent DC due to a refractory increase in ICP, due to automobile accidents, firearm projectiles, falls from stairs, and ischemic strokes. All evolved with HC. There was no uniform time interval between DC and CP. The cerebrospinal fluid (CSF) was drained according to the need for correction of cerebral herniation in each patient, before undergoing cranioplasty. All patients progressed well, without neurological deficits in the immediate postoperative period.

Conclusion There are still several uncertainties about the management of HC resulting from DC. In this context, other CP strategies simultaneous to the drainage of CSF, not necessarily related to ventriculoperitoneal shunt (VPS), should be considered and evaluated more deeply, in view of the verification of efficacy in procedures of this scope, such as the EVD addressed in this study.

Resumo

Introdução O aumento da pressão intracraniana (PIC) decorre de inúmeras patologias que acometem o encéfalo e seus envoltórios. Diante disso, a craniectomia descompressiva (CD) é uma alternativa adotada para redução da PIC nas emergências, especialmente em casos refratários a terapias clínicas, em prol da sobrevida dos pacientes. Entretanto, existem diversas complicações associadas à CD, entre as quais está a hidrocefalia (HC). O presente estudo apresenta resultados de uma intervenção incomum para essa complicação: o implante de derivação ventricular externa (DVE) no intraoperatório de cranioplastia (CP).

Métodos Foram incluídos pacientes de ambos os gêneros que apresentaram HC e exteriorização encefálica da abóbada craniana após hemicraniectomia descompressiva e foram submetidos a implante de DVE, para possibilitar a CP, no mesmo ato operatório.

Resultados Cinco pacientes foram submetidos a CD pelo aumento refratário da PIC, decorrente de acidentes automobilísticos, projéteis de arma de fogo, quedas de escada e acidentes vasculares cerebrais isquêmicos. Todos evoluíram com HC. Não houve uniformidade de intervalo de tempo entre a CD e a CP. O líquido cerebroespinal (LCE) foi drenado de acordo com a necessidade de correção da herniação cerebral em cada paciente, antes da CP. Todos os pacientes evoluíram bem, sem déficits neurológicos no pós-operatório imediato.

Conclusão Ainda existem inúmeras incertezas sobre o manejo da HC consequente de CD. Assim, outras estratégias de CP simultânea à drenagem de LCE, não necessariamente relacionadas à derivação ventriculoperitoneal, devem ser consideradas e avaliadas mais profundamente, tendo em vista a constatação de eficácia em procedimentos desse âmbito, como a DVE abordada no presente estudo.

Keywords

cranioplasty - external ventricular drain - post-traumatic hydrocephalus - neurosurgery

Palavras-chave

cranioplastia - dreno ventricular externo - hidrocefalia pós-traumática - neurocirurgia


Publikationsverlauf

Eingereicht: 18. Oktober 2020

Angenommen: 00. Januar 2021

Artikel online veröffentlicht:
29. Juli 2021

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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