Elzain Mohammed Awad, Ahmed Moayad Moawia, Salim Abubakr Darrag
Department of Neurosurgery, King Abdullah Hospital, Bisha, Saudi Arabia.
Department of Neurosurgery, Mawada Hospital, Khartoum, Sudan.
Sudan J Paediatr. 2022;22(1):36-46. doi: 10.24911/SJP.106-1642444214.
This study reflects our experience in managing Sudanese children with different cranial conditions through external ventricular drainage (EVD): indications for EVD, pathologies faced, and early outcome. A prospective review of cases operated at the National Center for Neurological Sciences was carried out during the period from February 2014 to February 2016. The patients were closely followed up till EVD removal and discharge. Thirty-five Sudanese children were included in the study (age range between 6 days and 7 years). Majority of the cases had posterior fossa tumor with obstructive hydrocephalus ( = 19, 54.3%). Twenty (57.1%) patients presented with a decreased level of consciousness, while 28 (80%) patients presented with symptoms and signs of raised intracranial pressure (ICP). The decision for EVD was made preoperatively based on positive cranial computed tomography/magnetic resonance imaging findings in 10 (28.6%) patients. Additionally, 28 (80%) patients responded to single injectable antibiotic therapy with an average duration of 22 days. Subsequently, 25 (71.4%) patients improved or got cured, 5 deteriorated, and 11 died. We conclude that EVD can be used for many indications, including obstructive, postinfectious, and postmeningitic hydrocephalus as well as intraventricular hemorrhage. Most patients may present with either deteriorating levels of consciousness or symptoms and signs of raised ICP, but few of them may have positive brain imaging findings and therefore the decision for EVD was made intraoperatively. The average duration for EVD use was 3 weeks with single antibiotic therapy use, which was found as effective as when combined with intraventricular therapy.
本研究反映了我们通过外部脑室引流（EVD）管理患有不同颅脑疾病的苏丹儿童的经验：EVD的适应证、面临的病理情况以及早期结果。对2014年2月至2016年2月期间在国家神经科学中心接受手术的病例进行了前瞻性回顾。对患者进行密切随访直至EVD拔除及出院。35名苏丹儿童纳入研究（年龄范围为6天至7岁）。大多数病例患有后颅窝肿瘤伴梗阻性脑积水（n = 19，54.3%）。20名（57.1%）患者出现意识水平下降，28名（80%）患者出现颅内压（ICP）升高的症状和体征。10名（28.6%）患者术前根据头颅计算机断层扫描/磁共振成像阳性结果决定行EVD。此外，28名（80%）患者对单一注射用抗生素治疗有反应，平均疗程为22天。随后，25名（71.4%）患者病情改善或治愈，5名病情恶化，11名死亡。我们得出结论，EVD可用于多种适应证，包括梗阻性、感染后和脑膜炎后脑积水以及脑室内出血。大多数患者可能表现为意识水平下降或ICP升高的症状和体征，但其中少数患者脑成像结果可能为阳性，因此EVD的决定是在术中做出的。EVD使用的平均疗程为3周，采用单一抗生素治疗，发现其与联合脑室内治疗一样有效。
