gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Analysis of efficacy and safety of over 200 external ventricular drainages placed over mini burr hole (3.5 mm) trephinations in subarachnoid haemorrhage

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  • T.M. Freiman - Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum der Albert-Ludwigs-Universität, Freiburg
  • H. Tischer - Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum der Albert-Ludwigs-Universität, Freiburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.08.05

doi: 10.3205/12dgnc230, urn:nbn:de:0183-12dgnc2307

Published: June 4, 2012

© 2012 Freiman et al.
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Outline

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Objective: Burr hole trephinations are most frequently used for external ventricular drainage (EVD). Most centres perform 10–30 mm burr hole trephinations in complete operating theatre settings. Implanted drainages are usually tunnelled before diverted out of the skin. In contrast to this procedure, we present a bedside technique, using 3.5 mm burr hole trephinations and percutaneous implantation.

Methods: In a two years period, 212 patients (mean age 54 years) were treated with mini burr hole trephinations. We analysed each procedure in terms of efficacy and complications. All patient charts, pre- and postoperative CCTs, CSF-, blood- and microbiology results, were evaluated.

Results: The mean duration of EVD amounted to 8.2 days (standard deviation 7 days). Catheter-related infection occurred in 17 patients (8.1%). In nine of these 17 patients (53%) no germ was found, the identified germs were Staphylococcus epidermidis (18%), other koagulase-negative Staph. (17%), Staph. aureus (6%) and Enterococcus species (6%). There was an increase of white blood cells (WBC) in the cerebrospinal fluid (CSF) from average 130 WBC/µL baseline in subarachnoid haemorrhage to 2672 WBC/µL in an evident infection. Seven patients (3%) sustained an EVD related haemorrhage, six of them had a marginal bleeding around the catheter, one had a haematoma of 3 cm diameter, none of them required an operative evacuation or revision. A revision of the catheter was done in 22 patients (10%), in 17 patients (8%) due to infection, in 5 patients (2%) due to misplacement. Forty-nine patients (23%) required a ventriculo-peritoneal shunt.

Conclusions: Compared with the literature, mini burr hole trephinations for EVDs are efficient and do not have a higher complication rate despite the percutaneous implantation technique. Because of its fast availability at bedside this procedure is of advantage especially in emergencies.