Objective: Aim of the study was to assess the duration of preoperative external ventricular drain (EVD) as a predictor for permanent cerebrospinal fluid (CSF) diversion in pediatric posterior fossa tumors. Methods: Th...Objective: Aim of the study was to assess the duration of preoperative external ventricular drain (EVD) as a predictor for permanent cerebrospinal fluid (CSF) diversion in pediatric posterior fossa tumors. Methods: The study was conducted in the Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia from January 2010 to December 2013. The data were collected retrospectively. The patients who had emergency insertion of external ventricular drain (EVD) due to hydrocephalus before the definitive posterior fossa tumor surgery were included in the study. Results: The preoperative emergency insertion of EVD was done in 38 patients with pediatric posterior fossa tumors. The patients were divided into two groups. Group A consists of those patients who had duration of preoperative EVD equal or less than 7 days. Group B includes those patients who had duration of preoperative EVD more than 7 days. Group A has 16 patients while Group B has 22 patients. The predominant clinical feature was symptoms and signs of raised intracranial pressure (ICP) only. Infection related to EVD was seen in seven patients. Ventriculoperitoneal (VP) shunt was required in 31.25% of Group A patients and 18.18% of Group B patients (p value = 0.35). Overall shunt rate was 23.68%. Conclusion: There are well known number of factors that can determine the need of permanent CSF diversion in patients with posterior fossa tumors. However, there is no effect of preoperative duration of EVD in determining the requirement of postoperative VP shunt.展开更多
In this study, we aimed to evaluate patients who develop ventriculostomy requirements and to evaluate the external ventricular drainage infection rates retrospectively at our clinic. In the study, dates between Januar...In this study, we aimed to evaluate patients who develop ventriculostomy requirements and to evaluate the external ventricular drainage infection rates retrospectively at our clinic. In the study, dates between January 2012 and 2014, patients who were inserted external ventricular drainage with different indications were examined retrospectively. By using the medical record system, patients’ demographics (age, sex), diagnostic, ventriculostomy indications and ventriculostomy time had been reached. By accessing laboratory data, the patients’ cultures of cerebrospinal fluids biochemical tests were analyzed retrospectively. Within the period of the study, 20 in 117 patients with external ventricular drainage were not included the study because of shunt infection and shunt occlusion of extracted patients. During the treatment period 148 EVD were inserted to 97 patients. The number of male patients was 53;the number of female patients was 44. When the reason of the examined patients’ using external ventricular drainage was analyzed, 55% hemorrhagic cerebrovascular diseases, (subarachnoid hemorrhage, intraventricular hemorrhage, intracerebral hemorrhage, cerebellar hemorrhage, traumatic intracranial injury), 24.7% tumor induced use, 7.4% central nervous system infections (menengitis, apse), and 12.4% occlusive cerebrovascular diseases (hydrocephalus or brain edema that were developed after the infarct) were seen. During the course of our study, 23% of the surveyed 97 patients had leukocytosis. CFT culture of 12 patients found positive. In CFT cultures mostly coagulase-negative staphylococcus growth took place. Eventually, when we compare our infection proportions to the international literature, very large differences were not observed. Except for revisioned patients, no other criteria were found that increased the rate of infection. We think that a rigorous pre-operative preparation and a regular maintenance of external ventricular drainage may reduce the rate of infection.展开更多
Background: The treatment of cerebellar hemorrhage (CH) may be different surgery or conservative according to the hematoma volume, compression of vital structures or hydrocephalus existence. In the present study, the ...Background: The treatment of cerebellar hemorrhage (CH) may be different surgery or conservative according to the hematoma volume, compression of vital structures or hydrocephalus existence. In the present study, the authors investigated the risk factors, the indications and the situation of external ventricular drainage (EVD) on the treatment line. Methods: 63 pure cerebellar hemorrhage patients were enrolled in the study. 36 cases underwent surgery;the other 27 were received conservative treatment. 15 and 13 cases received EVD in both groups. Hospital stay and mortality rates were investigated. Results: 4 cases in the conservative group underwent surgery secondary to treatment failure. Both of the groups had equal rates of morbidity and mortality. On the other hand, the group that received surgical intervention had shorter median hospital stay. The EVD does not seem to be life-saving at first but it gives time for preparing for surgery. Conclusions: We found that CH was strongly associated with early hydrocephalus and mortality. The early diagnosis and surgical evacuation of the mass are mandatory and life-saving if hematoma is larger than 10 ml. The EVD may not being a life-saving instrument but majorly it may be a time earning device if acute hydrocephalus present.展开更多
文摘Objective: Aim of the study was to assess the duration of preoperative external ventricular drain (EVD) as a predictor for permanent cerebrospinal fluid (CSF) diversion in pediatric posterior fossa tumors. Methods: The study was conducted in the Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia from January 2010 to December 2013. The data were collected retrospectively. The patients who had emergency insertion of external ventricular drain (EVD) due to hydrocephalus before the definitive posterior fossa tumor surgery were included in the study. Results: The preoperative emergency insertion of EVD was done in 38 patients with pediatric posterior fossa tumors. The patients were divided into two groups. Group A consists of those patients who had duration of preoperative EVD equal or less than 7 days. Group B includes those patients who had duration of preoperative EVD more than 7 days. Group A has 16 patients while Group B has 22 patients. The predominant clinical feature was symptoms and signs of raised intracranial pressure (ICP) only. Infection related to EVD was seen in seven patients. Ventriculoperitoneal (VP) shunt was required in 31.25% of Group A patients and 18.18% of Group B patients (p value = 0.35). Overall shunt rate was 23.68%. Conclusion: There are well known number of factors that can determine the need of permanent CSF diversion in patients with posterior fossa tumors. However, there is no effect of preoperative duration of EVD in determining the requirement of postoperative VP shunt.
文摘In this study, we aimed to evaluate patients who develop ventriculostomy requirements and to evaluate the external ventricular drainage infection rates retrospectively at our clinic. In the study, dates between January 2012 and 2014, patients who were inserted external ventricular drainage with different indications were examined retrospectively. By using the medical record system, patients’ demographics (age, sex), diagnostic, ventriculostomy indications and ventriculostomy time had been reached. By accessing laboratory data, the patients’ cultures of cerebrospinal fluids biochemical tests were analyzed retrospectively. Within the period of the study, 20 in 117 patients with external ventricular drainage were not included the study because of shunt infection and shunt occlusion of extracted patients. During the treatment period 148 EVD were inserted to 97 patients. The number of male patients was 53;the number of female patients was 44. When the reason of the examined patients’ using external ventricular drainage was analyzed, 55% hemorrhagic cerebrovascular diseases, (subarachnoid hemorrhage, intraventricular hemorrhage, intracerebral hemorrhage, cerebellar hemorrhage, traumatic intracranial injury), 24.7% tumor induced use, 7.4% central nervous system infections (menengitis, apse), and 12.4% occlusive cerebrovascular diseases (hydrocephalus or brain edema that were developed after the infarct) were seen. During the course of our study, 23% of the surveyed 97 patients had leukocytosis. CFT culture of 12 patients found positive. In CFT cultures mostly coagulase-negative staphylococcus growth took place. Eventually, when we compare our infection proportions to the international literature, very large differences were not observed. Except for revisioned patients, no other criteria were found that increased the rate of infection. We think that a rigorous pre-operative preparation and a regular maintenance of external ventricular drainage may reduce the rate of infection.
文摘Background: The treatment of cerebellar hemorrhage (CH) may be different surgery or conservative according to the hematoma volume, compression of vital structures or hydrocephalus existence. In the present study, the authors investigated the risk factors, the indications and the situation of external ventricular drainage (EVD) on the treatment line. Methods: 63 pure cerebellar hemorrhage patients were enrolled in the study. 36 cases underwent surgery;the other 27 were received conservative treatment. 15 and 13 cases received EVD in both groups. Hospital stay and mortality rates were investigated. Results: 4 cases in the conservative group underwent surgery secondary to treatment failure. Both of the groups had equal rates of morbidity and mortality. On the other hand, the group that received surgical intervention had shorter median hospital stay. The EVD does not seem to be life-saving at first but it gives time for preparing for surgery. Conclusions: We found that CH was strongly associated with early hydrocephalus and mortality. The early diagnosis and surgical evacuation of the mass are mandatory and life-saving if hematoma is larger than 10 ml. The EVD may not being a life-saving instrument but majorly it may be a time earning device if acute hydrocephalus present.
