Ramayya Ashwin G, Glauser Gregory, Mcshane Brendan, Branche Marc, Sinha Saurabh, Kvint Svetlana, Buch Vivek, Abdullah Kalil G, Kung David, Chen H Isaac, Malhotra Neil R, Ozturk Ali
Department of Neurosurgery, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2019 Mar;123:e509-e514. doi: 10.1016/j.wneu.2018.11.196. Epub 2018 Nov 29.
Freehand bedside ventriculostomy placement can result in catheter malfunction requiring a revision procedure and cause significant patient morbidity. We performed a single-center retrospective review to assess factors related to this complication.
Using an administrative database and chart review, we identified 101 first-time external ventricular drain placements performed at the bedside. We collected data regarding demographics, medical comorbidities, complications, and catheter tip location. We performed univariate and multivariate statistical analyses using MATLAB. We corrected for multiple comparisons using the false discovery rate (FDR) procedure.
Multivariate regression analyses revealed that revision procedures were more likely to occur after drain blockage (odds ratio [OR] 17.9) and hemorrhage (OR 10.3, FDR-corrected P values < 0.01, 0.05, respectively). Drain blockage was less frequent after placement in an "optimal location" (ipsilateral ventricle or near foramen of Monroe; OR 0.09, P = 0.009, FDR-corrected P < 0.03) but was more likely to occur after placement in third ventricle (post-hoc P values < 0.015). Primary diagnoses included subarachnoid hemorrhage (n = 30, 29.7%), intraparenchymal hemorrhage with intraventricular extravasation (n = 24, 23.7%), tumor (n = 20, 19.8%), and trauma (n = 17, 16.8%). Most common complications included drain blockage (n = 12, 11.8%) and hemorrhage (n = 8, 7.9%). In total, 16 patients underwent at least 1 revision procedure (15.8%).
Bedside external ventricular drain placement is associated with a 15% rate of revision, that typically occurred after drain blockage and postprocedure hemorrhage. Optimal placement within the ipsilateral frontal horn or foramen of Monroe was associated with a reduced rate of drain blockage.
徒手床边脑室造瘘术置管可能导致导管故障，需要进行修正手术，并会给患者带来严重的发病率。我们进行了一项单中心回顾性研究，以评估与该并发症相关的因素。
通过行政数据库和病历审查，我们确定了101例在床边进行的首次体外脑室引流置管。我们收集了有关人口统计学、内科合并症、并发症和导管尖端位置的数据。我们使用MATLAB进行单变量和多变量统计分析。我们使用错误发现率（FDR）程序对多重比较进行校正。
多变量回归分析显示，在引流管堵塞（比值比[OR]17.9）和出血（OR 10.3，FDR校正P值分别<0.01、0.05）后更有可能进行修正手术。在“最佳位置”（同侧脑室或靠近Monro孔）置管后引流管堵塞的频率较低（OR 0.09，P = 0.009，FDR校正P < 0.03），但在第三脑室置管后更有可能发生（事后P值<0.015）。主要诊断包括蛛网膜下腔出血（n = 30，29.7%）、脑实质内出血伴脑室内渗血（n = 24，23.7%）、肿瘤（n = 20，19.8%）和创伤（n = 17，16.8%）。最常见的并发症包括引流管堵塞（n = 12，11.8%）和出血（n = 8，7.9%）。总共有16例患者接受了至少1次修正手术（15.8%）。
床边体外脑室引流置管与15%的修正率相关，修正通常发生在引流管堵塞和术后出血之后。在同侧额角或Monro孔内的最佳置管与引流管堵塞率降低相关。
