Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Yale University, New Haven, CT, USA.
Clin Neurol Neurosurg. 2021 Aug;207:106761. doi: 10.1016/j.clineuro.2021.106761. Epub 2021 Jun 16.
Sutures are conventionally used for external ventricular drain (EVD) catheter fixation, but staples are an appealing alternative as they are quicker and easier to learn. We report our institutional experience with EVD fixation techniques and the patterns of catheter fixation.
We conducted a retrospective review of all aneurysmal subarachnoid hemorrhage (aSAH) patients treated in a single US center between 2007 and 2017.
Out of 307 patients, 217 patients (62.2% female, mean age 59.5 years) met inclusion criteria harboring 268 EVDs. Two main configurations were used for EVD catheter fixation; spiral-shaped EVDs in 139 (51.9%) cases and arciform (C-shaped) EVDs in 129 (48.1%) of the cases. 220 (82.1%) were secured with staples and 48 (17.9%) with sutures. The most common complication was obstruction (n = 43, 16.2%), followed by infections (n = 18, 6.8%). Catheter dislodgements occurred in 16 (5.9%) catheters and 61 (22.8%) required repositioning/replacement. EVD dislodgement rates did not differ between the staples and sutures group, or between the spiral and C-shaped EVDs (p = 0.5 and 0.93, respectively). No cases of catheter perforation by the staples were encountered in our cohort.
Staples and sutures are equally valid and acceptable methods for EVD fixation with similar dislodgement rates. Scarce data exist in the literature regarding dislodgements, and further studies are needed to address its incidence and the best preventive strategies.
缝线传统上用于外部脑室引流 (EVD) 导管固定，但由于其固定速度更快且更容易掌握，因此订书钉是一种很有吸引力的替代方法。我们报告了我们机构在 EVD 固定技术方面的经验以及导管固定方式。
我们对 2007 年至 2017 年期间在单一美国中心治疗的所有蛛网膜下腔出血（aSAH）患者进行了回顾性研究。
在 307 例患者中，217 例（62.2%为女性，平均年龄 59.5 岁）符合纳入标准，共植入 268 根 EVD 导管。EVD 导管固定采用两种主要的固定方式；139 例（51.9%）采用螺旋形 EVD，129 例（48.1%）采用弧形（C 形）EVD。220 例（82.1%）用订书钉固定，48 例（17.9%）用缝线固定。最常见的并发症是阻塞（n=43，16.2%），其次是感染（n=18，6.8%）。16 根（5.9%）导管发生导管移位，61 根（22.8%）需要重新定位/更换。在我们的队列中，订书钉组和缝线组之间以及螺旋形 EVD 和 C 形 EVD 之间的 EVD 移位率没有差异（p=0.5 和 0.93）。我们的队列中没有遇到因订书钉导致导管穿孔的病例。
订书钉和缝线是固定 EVD 同样有效和可接受的方法，且移位率相似。关于移位的文献数据很少，需要进一步研究以确定其发生率和最佳预防策略。
