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2014 ; 54
(7
): 545-51
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Hemorrhage rates associated with two methods of ventriculostomy: external
ventricular drainage vs ventriculoperitoneal shunt procedure
#MMPMID24522005
Ko JK
; Cha SH
; Choi BK
; Lee JI
; Yun EY
; Choi CH
Neurol Med Chir (Tokyo)
2014[]; 54
(7
): 545-51
PMID24522005
show ga
Cerebrospinal fluid (CSF) diversion is an essential component of neurosurgical
care, but the rates and significance of hemorrhage associated with external
ventricular drainage (EVD) and ventriculoperitoneal (VP) shunt procedures have
not been well quantified. In this retrospective study, the authors examined the
frequencies of hemorrhagic complications associated with EVD and VP shunt
procedures, and attempted to identify associated risk factors. The treatment
records of 370 EVDs in 276 patients and 102 VP shunts in 96 patients performed
between 2008 and 2010 were retrospectively reviewed. Post-insertion computed
tomographic (CT) scans were analyzed for any new hemorrhage related to the
ventricular catheter. The effects of diagnosis at admission, endovascular
treatment, anti-platelet medication, and a concurrent craniotomy operation were
included in the analysis conducted to identify risk factors of ventricular
catheter-related hemorrhage. Hemorrhage following EVD was detected on CT scans in
76 (20.5%) of the 370 cases. However, symptomatic hemorrhage occurred in only 5
cases (1.4% of all EVDs). VP shunt was associated with a higher incidence of
ventricular catheter-related hemorrhage than EVD (hemorrhage rate: 43.1%) and the
rate of detectable neurological change was 2.9%. Multivariate logistic-regression
analysis of risk factors of EVD-related hemorrhage identified preoperative
anti-platelet medication as the only significant factor (odds ratio, 3.583 [95%
confidence interval, 1.353 to 9.486]; p = 0.010). Ventriculostomy-related
hemorrhagic complications were more common than anticipated, especially for the
VP shunt procedure. However, such hemorrhages are rarely large, rarely the cause
of neurological deterioration, and rarely require surgical removal. Preoperative
anti-platelet medication appears to affect EVD-related hemorrhage development.