Safety, accuracy, and cost effectiveness of bedside bolt external ventricular drains (EVDs) in comparison to tunnelled EVDs inserted in theatres.
World Neurosurg. 2019 Feb 05;:
Authors: Roach J, Gaastra B, Bulters D, Shtaya A
OBJECTIVE: External ventricular drain (EVD) placement is frequently required in neurosurgical patients to divert CSF and monitor intracranial pressure. The usual practise is the tunnelled EVD technique performed in operating theatres. EVD insertion through a bolt in intensive care is also described. We employ both practices in our institute. Herein, we compare the indications, accuracy, safety and costs of the two techniques.
METHODS: Retrospective cohort study of a prospectively maintained EVD data-base of all patients undergoing first frontal EVD placement between Jan 2010-Dec 2015. Those with preceding CSF infection were excluded. We compared bolt EVD with tunnelled EVD techniques in terms of accuracy of EVD tip location by analysing CT scans to grade catheter tip location as optimal (ipsilateral frontal horn) or otherwise suboptimal, and complications that include infection and revision rates.
RESULTS: 579 eligible patients aged 3 months to 84 years were identified. 430 had tunnelled EVDs and 149 bolt EVDs. The most frequent diagnosis was intracranial haemorrhage (73% bolt vs 50.4% tunnelled group (p<0.001)). Other diagnoses included tumour (4.7% bolt vs 19.1% tunnelled (p<0.001)), traumatic brain injury (17.5% bolt vs 17.4% tunnelled). In the bolt EVD group 66.4% of EVD tips were optimal, compared to 61.0% in the tunnelled group (p=0.33). Infection was confirmed in 15 (10.0%) bolt EVDs compared to 61 (14.2%) tunnelled EVDs (p=0.2). Each bolt EVD kit costs £260 while placing a tunnelled one in theatre costs £1316.
CONCLUSIONS: Bedside bolt EVD placement is safe, accurate and cost effective in selective patients with haemorrhage related hydrocephalus.
PMID: 30735879 [PubMed – as supplied by publisher]