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Erschienen in: Acta Neurochirurgica 10/2017

08.08.2017 | Original Article - Neurosurgical Techniques

External ventricular drain causes brain tissue damage: an imaging study

verfasst von: Fabrizio Ortolano, Marco Carbonara, Antonella Stanco, Vittorio Civelli, Giorgio Carrabba, Tommaso Zoerle, Nino Stocchetti

Erschienen in: Acta Neurochirurgica | Ausgabe 10/2017

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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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Metadaten
Titel
External ventricular drain causes brain tissue damage: an imaging study
verfasst von
Fabrizio Ortolano
Marco Carbonara
Antonella Stanco
Vittorio Civelli
Giorgio Carrabba
Tommaso Zoerle
Nino Stocchetti
Publikationsdatum
08.08.2017
Verlag
Springer Vienna
Erschienen in
Acta Neurochirurgica / Ausgabe 10/2017
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-017-3291-0

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