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External ventricular drain causes brain tissue damage: an imaging study

  • Original Article - Neurosurgical Techniques
  • Published:
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Abstract

Background

An external ventricular drain (EVD) is used to measure intracranial pressure (ICP) and to drain cerebrospinal fluid (CSF). The procedure is generally safe, but parenchymal sequelae are reported as a possible side effect, with variable incidence. We investigated the mechanical sequelae of EVD insertion and their clinical significance in acute brain-injured patients, with a special focus on hemorrhagic lesions.

Methods

Mechanical sequelae of EVD insertion were detected in patients by computed tomography (CT) and magnetic resonance imaging (MRI), performed for clinical purposes.

Results

In 155 patients we studied the brain tissue surrounding the EVD by CT scan (all patients) and MRI (16 patients); 53 patients were studied at three time points (day 1–2, day 3–10, >10 days after EVD placement) to document the lesion time course. Small hemorrhages, with a hyperdense core surrounded by a hypodense area, were identified by CT scan in 33 patients. The initial average (hyper- + hypodense) lesion volume was 8.16 ml, increasing up to 15 ml by >10 days after EVD insertion. These lesions were not accompanied by neurologic deterioration or ICP elevation. History of arterial hypertension, coagulation abnormalities and multiple EVD insertions were significantly associated with hemorrhages. In 122 non-hemorrhagic patients, we detected very small hypodense areas (average volume 0.38 ml) surrounding the catheter. At later times these hypodensities slightly increased. MRI studies in 16 patients identified both intra- and extracellular edema around the catheters. The extracellular component increased with time.

Conclusion

EVD insertion, even when there are no clinically important complications, causes a tissue reaction with minimal bleedings and small areas of brain edema.

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Authors and Affiliations

  1. Neuroscience Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy

    Fabrizio Ortolano, Marco Carbonara, Tommaso Zoerle & Nino Stocchetti

  2. Department of Physiopathology and Transplant, University of Milan, Milan, Italy

    Antonella Stanco & Nino Stocchetti

  3. Neuroradiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Vittorio Civelli

  4. Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Giorgio Carrabba

Authors
  1. Fabrizio Ortolano
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  2. Marco Carbonara
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  3. Antonella Stanco
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  4. Vittorio Civelli
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  5. Giorgio Carrabba
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  6. Tommaso Zoerle
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  7. Nino Stocchetti
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Corresponding author

Correspondence to Fabrizio Ortolano.

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Funding

Technical support was provided by funds from Ricerca Corrente of Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico of Milan.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Our hospital institutional ethics committee (Comitato Etico of Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico) was notified of this retrospective study and approved it, waiving the need for consent.

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Ortolano, F., Carbonara, M., Stanco, A. et al. External ventricular drain causes brain tissue damage: an imaging study. Acta Neurochir 159, 1981–1989 (2017). https://doi.org/10.1007/s00701-017-3291-0

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  • DOI: https://doi.org/10.1007/s00701-017-3291-0

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