Safety and accuracy of bedside external ventricular drain placement.

• DOI: 10.1227/01.neu.0000335031.23521.d0
• Publication Date: 2008-07-01
• Authors: U. Kumar Kakarla; Louis J. Kim; Steven W. Chang; Nicholas Theodore; Robert F. Spetzler
• Keywords: Ventriculostomy; External ventricular drain

To study the safety and accuracy of ventriculostomy by neurosurgical trainees.Initial computed tomographic studies 346 consecutive patients who underwent bedside were reviewed retrospectively. Diagnosis, catheter tip location, midline shift, procedural complications tabulated. analyze placement, we used a new grading system: Grade 1, optimal placement in ipsilateral frontal horn or third ventricle; 2, functional contralateral lateral ventricle noneloquent cortex; 3, suboptimal eloquent cortex nontarget cerebrospinal fluid space, with without drainage. Statistical analysis was performed using Fisher's exact test weighted kappa coefficient.Diagnoses included following: subarachnoid hemorrhage, n = 153 (44%); trauma, 64 (18%); intracerebral hemorrhage/intraventricular 63 other, 66 (20%). There 266 (77%) 34 (10%) 46 (13%) 3 placements. Hemorrhagic occurred 17 (5%). Four (1.2%) symptomatic, two (0.6%) requiring surgery. Inter- intraobserver agreement almost perfect (kappa 0.846 0.922, respectively) as applied to our system. Rates highest shift (P 0.059) trauma 0.0001). hemorrhage 0.003) when placed side 0.063). Neither resident's training experience nor seemed affect accuracy.Bedside is safe accurate procedure for intracranial pressure monitoring