Incidence of hemorrhage in the pediatric population with placement and removal of external ventricular drains

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OBJECT

External ventricular drains (EVDs) are regularly used in pediatric neurosurgery for diagnostic and therapeutic purposes. Hemorrhage caused by placing an EVD is a common complication noted in the adult literature. In the pediatric literature, on the other hand, only a few articles have assessed the risk of hemorrhage with placement, and none have reported the occurrence of hemorrhage with removal of an EVD. The authors investigated the incidence of hemorrhage with both placement and removal of the EVD in a pediatric population.

METHODS

After obtaining institutional review board approval, a comprehensive database was created to include all pediatric patients who required EVD placement between March 2008 and June 2014 at the authors’ institution. A retrospective chart review was completed, and all imaging was reviewed for evidence of hemorrhage with placement and removal of the EVD.

RESULTS

During the designated time period, 73 EVDs were placed in 63 patients (ages 2 weeks–17 years). Indications for EVD placement were as follows: shunt infection/malfunction (21), tumor (12), hydrocephalus (18), hemorrhage (12), edema (4), trauma (1), and other (5). Hemorrhage with placement was noted in 5 of the 50 patients who underwent imaging, with a volume ranging from 0.48 cm3 to 7.7 cm3. Thirty-two patients had imaging after EVD removal, and 7 of these patients were noted to have hemorrhage (volume range 0.012 cm3 to 81.5 cm3).

CONCLUSIONS

The authors found the incidence of hemorrhage at EVD placement to be 10%, and the incidence of hemorrhage on EVD removal to be 21.9% in those patients who underwent imaging after each event. Although none of the hemorrhages were of obvious clinical significance, these data can be useful in decision making, and in discussing the risks of EVDs with the patient’s family.

ABBREVIATIONEVD = external ventricular drain.

OBJECT

External ventricular drains (EVDs) are regularly used in pediatric neurosurgery for diagnostic and therapeutic purposes. Hemorrhage caused by placing an EVD is a common complication noted in the adult literature. In the pediatric literature, on the other hand, only a few articles have assessed the risk of hemorrhage with placement, and none have reported the occurrence of hemorrhage with removal of an EVD. The authors investigated the incidence of hemorrhage with both placement and removal of the EVD in a pediatric population.

METHODS

After obtaining institutional review board approval, a comprehensive database was created to include all pediatric patients who required EVD placement between March 2008 and June 2014 at the authors’ institution. A retrospective chart review was completed, and all imaging was reviewed for evidence of hemorrhage with placement and removal of the EVD.

RESULTS

During the designated time period, 73 EVDs were placed in 63 patients (ages 2 weeks–17 years). Indications for EVD placement were as follows: shunt infection/malfunction (21), tumor (12), hydrocephalus (18), hemorrhage (12), edema (4), trauma (1), and other (5). Hemorrhage with placement was noted in 5 of the 50 patients who underwent imaging, with a volume ranging from 0.48 cm3 to 7.7 cm3. Thirty-two patients had imaging after EVD removal, and 7 of these patients were noted to have hemorrhage (volume range 0.012 cm3 to 81.5 cm3).

CONCLUSIONS

The authors found the incidence of hemorrhage at EVD placement to be 10%, and the incidence of hemorrhage on EVD removal to be 21.9% in those patients who underwent imaging after each event. Although none of the hemorrhages were of obvious clinical significance, these data can be useful in decision making, and in discussing the risks of EVDs with the patient’s family.

External ventricular drains (EVDs) are regularly used in pediatric neurosurgery for diagnostic and therapeutic purposes. There are several indications for EVD placement, including hydrocephalus, infection, trauma, and tumors.24 The majority of articles regarding EVDs in the pediatric population discuss their use in the setting of posthemorrhagic hydrocephalus.2,3,5,9,10,13,15

Complications of EVDs are well recognized, with infection and hemorrhage being the most common ones related to these procedures.11,21–23 Hemorrhage with EVD placement has been found to occur more often than originally believed in adults. This may be related to more sensitive imaging modalities, which allow detection of smaller hemorrhages, or to standard imaging protocols becoming routine practice. In the pediatric literature, there are only a few articles that have assessed the risk of hemorrhage with EVD placement, and this is often as a secondary end point while investigating infection. Published rates from 0% to 17.6% have been reported,1,8,16,18,25,26 and these are similar to the hemorrhage rates attributed to placement of intracranial pressure monitors in children.4,17,20

There are currently no articles in the literature that have reported the occurrence of hemorrhage with removal of an EVD. Although this is often considered a benign procedure, it does hold risks for the patient. We investigated the incidence of hemorrhage with both EVD placement and removal in our pediatric population.

Methods

Patient Population

After obtaining approval by the institutional review board at the University of Minnesota Medical Center, a comprehensive database was created to include all pediatric patients (ages 0–17 years) who required EVD placement between March 2008 and June 2014. A retrospective chart review was completed, and all imaging studies were reviewed for evidence of hemorrhage with placement and removal of the EVD. The Health Insurance Portability and Accountability Act standards for privacy of personal health information were followed.

Placement Procedure for EVDs

The majority of EVDs in our series were placed in the operating room with the patient in a supine position. The entry point was identified as a point just anterior to the coronal suture in the midpupillary line, usually 2.5 cm to the right of midline. The scalp was clipped, prepared, and draped in a sterile fashion, and the planned incision was infiltrated with local anesthetic. An incision (typically curvilinear in case shunting would be required in the future) was made down to the bone, and a manual twist drill was used to make a small bur hole. A durotomy was made with an 18-gauge spinal needle. When image guidance was not used, the trajectory was in the midpupillary line and halfway between the tragus and lateral canthus (typically perpendicular to the calvaria). A Bactoseal catheter (DePuy Synthes) with stylet was inserted to a depth of 3–4 cm. The stylet was removed and the catheter passed to an appropriate depth based on the size of the child’s head or to 5–7 cm in those with adult-sized heads, and to a measured point approximately to the foramen of Monro based on preoperative imaging studies. The proximal catheter was then tunneled subcutaneously through a separate posterior stab incision and secured to the scalp with 3–0 nylon sutures. All EVDs were removed when the patient was able to tolerate at least 24 hours of drain clamping with stable intracranial pressure, stable ventricular size, and without clinical symptoms of intracranial hypertension.

Determination of EVD-Related Hemorrhage

For each patient, all head CT and/or MRI scans performed during the index hospitalization were evaluated for evidence of hemorrhage and were compared with the official radiology reports. The images were reviewed independently by one author (C.M.), who was blinded to the clinical outcomes. Hemorrhage related to EVD placement was defined as any new hemorrhage along the ventricular catheter tract noted on postprocedural imaging that was not present on preprocedural imaging. Any new hemorrhage noted along the prior catheter tract or within the ventricles after removal was considered hemorrhage related to EVD removal. The size of the hemorrhage was determined by measuring the maximum dimensions in x (A), y (B), and z (C) axes on axial, sagittal, and coronal head CT or MR images, and volume was calculated using the formula (A × B × C/2).12 All records were reviewed to determine if the hemorrhage was clinically significant or asymptomatic. A hemorrhage was clinically significant if the patient had a temporally related deterioration in neurological examination findings or clinical symptoms.

Statistical Analysis

A t-test was performed using Prism software (GraphPad Software, Inc.) to test for differences in volume between the hemorrhages noted on EVD placement and those on removal.

Results

Details regarding EVD placement are shown in Table 1. During the designated time period, 73 EVDs were placed in 63 patients (ages 2 weeks–17 years). Indications for EVD placement included shunt infection/malfunction (21 cases), tumor (12), hydrocephalus (18), hemorrhage (12), edema (4), trauma (1), and other (5). All but 4 EVDs were placed in the frontal location. The majority (85%) of EVDs were inserted in the operating room, and navigation was used for placement in 29 patients. One catheter had to be replaced because of accidental dislocation that occurred during transportation. No catheters in this group required replacement because of blockage.

TABLE 1.

Details regarding EVD placement in pediatric patients

VariableNo. of Cases
Total EVDs73 (63 patients)
Sex
 Female24
 Male39
Location
 Frontal69
 Occipital2
 Parietal1
 Temporal1
Placement location
 Bedside11
 Intraop62
Navigation
 Stealth18
 Ultrasound5
 Endoscopic6
 None44

Imaging studies were performed in 50 patients after EVD placement, and hemorrhage was noted in 5 patients (10%); 3 intraparenchymal hemorrhages and 2 epidural hematomas, 1 of which was remote from the EVD insertion site. The hemorrhage volume ranged from 0.48 cm3 to 7.7 cm3. None of these patients experienced symptoms related to their hemorrhage. No seizure activity was attributed to the hemorrhages, although one patient had a preexisting seizure disorder for which they were receiving daily maintenance antiepileptics, and another patient had been started on a prophylactic antiepileptic at the time of admission.

Postremoval imaging was obtained in 32 patients. Of these, 7 patients (21.9%) had hemorrhage following EVD removal that was not present on their postplacement scan, with volumes ranging from 0.012 cm3 to 81.5 cm3. Three hemorrhages were completely intraventricular, 3 were intraparenchymal, and 1 patient had both an intraparenchymal and an intraventricular hemorrhage. One patient had hemorrhage after both placement and removal: a remote epidural hematoma after placement and a small intraparenchymal hemorrhage after EVD removal. Four of the hemorrhages were not clinically significant, and 3 occurred in patients who were deeply sedated. An EVD was replaced in 1 patient (2 hemorrhages), whereas no additional intervention was required in the third patient. Again, no seizures were recorded in any of these patients—near the time of removal, 4 of them were receiving antiepileptics for known seizure disorders or surgical prophylaxis.

On comparison of the average hemorrhage volume noted on EVD placement and removal, we found that the volume was significantly larger in the group with hemorrhage after removal (31.1 ± 38.3 cm3 vs 2.67 ± 3.36 cm3). However, this was not statistically significant (p = 0.1337) given the small number of events.

Table 2 shows a comparison between the total study population, those with hemorrhage on placement, and those with hemorrhage on removal. Thrombocytopenia was recorded in 2 patients with platelet counts of 55 and 80 × 109/L (range 55–998 × 109/L), and platelet drips were administered during these EVD procedures. There was no history of anticoagulation use or coagulopathy in the 5 patients with hemorrhage on placement, although 1 patient had an international normalized ratio of 2.02 prior to placement. Of the 7 patients with hemorrhage noted on removal, 1 was started on a heparin drip prior to the removal and 1 patient had been on heparin prior to EVD placement. Two hemorrhages occurred in patients who had undergone bone marrow transplants. A similar comparison between those who underwent imaging after placement and/or removal is displayed in Table 3.

TABLE 2.

Analysis of demographic, medical history, and pre- and postprocedural data in patients with and without hemorrhage on EVD placement and removal

CharacteristicAll (73)PlacementRemoval
No Hemorrhage (68)Hemorrhage (5)No Hemorrhage (66)Hemorrhage (7)
Age range2 wks–17yrs6 wks–16yrs2 wks–17 yrs5 wks–17 yrs2 wks–5 yrs
Medical comorbidities
 Cardiac3 (4%)2 (3%)1 (20%)1 (2%)2 (29%)
 Heme/onc16 (22%)16 (24%)0 (0%)16 (24%)2 (29%)
 Vascular2 (3%)1 (2%)1 (20%)2 (3%)0 (0%)
 Hepatic1 (1%)1 (2%)0 (0%)1 (2%)0 (0%)
 Renal1 (1%)1 (2%)0 (0%)1 (2%)0 (0%)
 None17 (23%)15 (22%)2 (40%)16 (24%)1 (14%)
Coagulopathy6 (8%)6 (9%)0 (0%)4 (6%)2 (29%)
Prior anticoagulant or antiplatelet2 (3%)2 (3%)0 (0%)1 (2%)1 (14%)
Tumor12 (16%)12 (18%)0 (0%)10 (15%)2 (29%)
Hemorrhage12 (16%)10 (15%)2 (40%)9 (14%)3 (43%)
Shunt infection/malfunction21 (29%)20 (29%)1 (20%)20 (30%)1 (14%)
Hydrocephalus18 (25%)16 (24%)2 (40%)17 (26%)1 (14%)
Stroke/edema4 (5%)4 (6%)0 (0%)4 (6%)0 (0%)
Trauma1 (1%)1 (2%)0 (0%)1 (2%)0 (0%)
Other5 (7%)5 (7%)0 (0%)5 (7%)0 (0%)
Pre-EVD INR range0.62–2.020.62–1.580.98–2.020.86–2.020.62–1.27
Pre-EVD platelets range (×109/L)55–99855–998155–33255–99880–511
Intraop placement62 (85%)59 (87%)3 (60%)57 (86%)5 (71%)
Image guidance29 (40%)28 (41%)1 (20%)26 (39%)3 (43%)
Average attempts1 (1%)1111
DVT prophylaxis2 (3%)2 (3%)0 (0%)1 (2%)1 (14%)
Pre-removal INR range0.86–2.390.86–2.390.91–1.090.86–2.390.97–1.3
Pre-removal platelets range (×109/L)69–78869–788167–42269–788123–467
Days w/ EVD range1–371–373–191–372–13
Intraop removal28 (38%)28 (41%)0 (0%)27 (41%)1 (14%)

DVT = deep venous thrombosis; heme = hematological; INR = international normalized ratio; onc = oncological.

TABLE 3.

Comparison of cohort who had imaging after EVD placement and removal and cohort in whom no imaging was obtained

CharacteristicAll (73)PlacementRemoval
Imaging (50)No Imaging (23)Imaging (32)No Imaging (41)
Age range2 wks–17 yrs2 wks–17 yrs5 wks–14 yrs2wks–16yrs5 wks–17 yrs
Medical comorbidities
 Cardiac3 (4%)2 (4%)1 (4%)2 (6%)1 (2%)
 Heme/onc16 (22%)11 (22%)5 (22%)5 (16%)11 (27%)
 Vascular2 (3%)2 (4%)0 (0%)0 (0%)2 (5%)
 Hepatic1 (1%)0 (0%)1 (4%)1 (3%)0 (0%)
 Renal1 (1%)0 (0%)1 (4%)0 (0%)1 (2%)
 None17 (23%)16 (32%)1 (4%)6 (19%)11 (27%)
Coagulopathy6 (8%)5 (10%)3 (13%)5 (16%)5 (12%)
Prior anticoagulant or antiplatelet2 (3%)1 (2%)1 (4%)1 (3%)1 (2%)
Tumor12 (16%)9 (18%)3 (13%)5 (16%)7 (17%)
Hemorrhage12 (16%)9 (18%)3 (13%)1 (3%)3 (7%)
Shunt infection/malfunction21 (29%)10 (20%)11 (48%)9 (28%)12 (29%)
Hydrocephalus18 (25%)14 (28%)4 (18%)11 (34%)7 (17%)
Stroke/edema4 (5%)3 (6%)1 (4%)5 (16%)7 (17%)
Trauma1 (1%)1 (2%)0 (0%)0 (0%)1 (2%)
Other5 (7%)4 (8%)1 (4%)1 (3%)4 (10%)
Pre-EVDINR range0.62–2.020.62–2.020.86–1.220.62–1.580.93–2.02
Pre-EVD platelets range (×109/L)55–99855–695158–99880–99855–910
Intraop placement62 (85%)40 (80%)23 (100%)28 (88%)35 (85%)
Image guidance29 (40%)23 (46%)11 (48%)15 (47%)19 (46%)
Average attempts1 (1%)1111
Placement hemorrhageNANA1 (3%)4 (10%)
DVT prophylaxis2 (3%)1 (2%)1 (4%)1 (3%)1 (2%)
Pre-removal INR range0.86–2.390.86–2.390.86–1.120.86–1.30.9–2.39
Pre-removal platelets range (×109/L)69–78869–717158–788123–78869–623
Days w/ EVD range1–372–301–372–371–30
Intraop removal28 (38%)14 (28%)14 (61%)14 (44%)15 (37%)

NA = not applicable.

Discussion

We determined the incidence of hemorrhage with EVD placement and removal in the pediatric population at our institution. We report a 10% hemorrhage rate with EVD placement and a hemorrhage rate of 21.9% on EVD removal in those patients who underwent imaging (Fig. 1). Of the identified hemorrhages, the majority were asymptomatic. To our knowledge, this is the first article published that has investigated hemorrhage with EVD removal.

FIG. 1.
FIG. 1.

Axial and coronal head CT scans showing examples of hemorrhage (circles) with EVD placement (A and B) and removal (C and D). Figure is available in color online only.

Although many of the hemorrhages noted after both placement and removal were small and probably not clinically significant, it is still important to recognize the risk associated with these procedures. The fact that the hemorrhages identified were probably asymptomatic is largely due to their location. Our 2 patients with the largest hemorrhages had the entire volume contained within the ventricular system. Had the location been intraparenchymal, these hemorrhages would probably have been symptomatic. Several articles have shown that premature infants with intraventricular hemorrhage and a parenchymal lesion have worse neurological outcomes compared with those without parenchymal lesions.13,25,26 One must consider that similar outcomes may be associated with hemorrhages caused by EVD placement or removal, although this has not been studied. Additionally, the effect of a small hematoma may extend beyond the border of the hemorrhage itself. Forbes et al. used diffusion-weighted imaging to identify regions of perihematoma abnormalities representing areas of secondary neuronal damage.6 In the pediatric population, it is also important to remember that these patients may require the placement and removal of multiple EVDs over their lifetime. With each procedure there is the risk of hemorrhage, and there can be an additive effect of many small hemorrhages.

In the literature reporting findings in adults, only 3 articles report hemorrhage after removal of EVDs, with the incidence ranging from 1.1% to 6.9%.7,14,19 It is important to note that these articles were not investigating hemorrhage on removal and may have been less stringent in detecting such hemorrhages. As previously mentioned, there are no published rates for hemorrhage after EVD removal in the pediatric population. Of those who had imaging performed after removal, we found the incidence of hemorrhage to be 21.9%. This is similar to the incidence we found for all patients who received EVDs at our institution, which included both adult and pediatric patients.

The average hemorrhage volume on EVD removal was larger than that of the hemorrhages found after placement; however, this was not statistically significant given the small number of events. This may be due to the fact that 3 of the hemorrhages were large, with volumes greater than 50 cm3; however, they were entirely confined to the intraventricular space. Coincidentally, these 3 hemorrhages occurred in patients who were heavily sedated and who were difficult to assess for any neurological decline.

There are several limitations of this study, including its retrospective nature and small number of patients. Because we were specifically investigating hemorrhage with EVD placement and/or removal, it is possible that we may have identified small hemorrhages, which may not have been recognized on routine examinations. Determining whether a hemorrhage is clinically significant can also be challenging because many of our patients are heavily sedated and/or have significant preexisting neurological deficits so that identifying a change temporally related to the EVD placement or removal may be difficult.

At our institution we do not have a protocol for routine imaging after EVD placement or removal; it is often based on the attending neurosurgeon’s preference. Our reported incidences are in those patients in whom imaging was performed after EVD placement or removal. We are unable to account for any small hemorrhages that may have occurred in the patients who did not have imaging after placement or removal. We can assume that imaging would have been performed for any clinically significant hemorrhage, because serious adverse events will present themselves without scheduled imaging.

Conclusions

There is sparse literature regarding EVD complications in the pediatric population. Hemorrhage caused by placing an EVD is a common complication noted in the literature on adults, but it is only discussed in a few pediatric articles. Removing an EVD is also associated with hemorrhage and has not been previously studied in pediatric patients. We found an incidence of 10% hemorrhage at EVD placement and a 21.9% incidence of hemorrhage on EVD removal in our study in patients who underwent subsequent imaging. Although none of the hemorrhages were of clinical significance, these data can be useful in decision making, and in discussing the risks of EVDs with a patient’s family.

Author Contributions

Conception and design: Miller. Acquisition of data: Miller. Analysis and interpretation of data: Miller. Drafting the article: Miller. Critically revising the article: both authors. Reviewed submitted version of manuscript: both authors. Statistical analysis: Miller. Study supervision: Guillaume.

Supplemental Information

Previous Presentation

This work was previously presented at the AANS/CNS Section on Pediatric Neurological Surgery Annual Meeting, December 2014, as a digital poster with abstract.

References

  • 1

    Anderson RCKan PKlimo PBrockmeyer DLWalker MLKestle JR: Complications of intracranial pressure monitoring in children with head trauma. J Neurosurg 101:1 Suppl53582004

    • Search Google Scholar
    • Export Citation
  • 2

    Bassan HEshel RGolan IKohelet DBen Sira LMandel D: Timing of external ventricular drainage and neuro-developmental outcome in preterm infants with posthemorrhagic hydrocephalus. Eur J Paediatr Neurol 16:6626702012

    • Search Google Scholar
    • Export Citation
  • 3

    Berger AWeninger MReinprecht AHaschke NKohlhauser CPollak A: Long-term experience with subcutaneously tunneled external ventricular drainage in preterm infants. Childs Nerv Syst 16:1031102000

    • Search Google Scholar
    • Export Citation
  • 4

    Blaha MLazar DWinn RHGhatan S: Hemorrhagic complications of intracranial pressure monitors in children. Pediatr Neurosurg 39:27312003

    • Search Google Scholar
    • Export Citation
  • 5

    Cornips EVan Calenbergh FPlets CDevlieger HCasaer P: Use of external drainage for posthemorrhagic hydrocephalus in very low birth weight premature infants. Childs Nerv Syst 13:3693741997

    • Search Google Scholar
    • Export Citation
  • 6

    Forbes KPPipe JGHeiserman JE: Diffusion-weighted imaging provides support for secondary neuronal damage from intraparenchymal hematoma. Neuroradiology 45:3633672003

    • Search Google Scholar
    • Export Citation
  • 7

    Gardner PAEngh JAtteberry DMoossy JJ: Hemorrhage rates after external ventricular drain placement. J Neurosurg 110:102110252009

    • Search Google Scholar
    • Export Citation
  • 8

    Harbaugh RESaunders RLEdwards WH: External ventricular drainage for control of posthemorrhagic hydrocephalus in premature infants. J Neurosurg 55:7667701981

    • Search Google Scholar
    • Export Citation
  • 9

    Heep AEngelskirchen RHolschneider AGroneck P: Primary intervention for posthemorrhagic hydrocephalus in very low birthweight infants by ventriculostomy. Childs Nerv Syst 17:47512001

    • Search Google Scholar
    • Export Citation
  • 10

    Januschek EMachado LSSteinthal BUlrich PT: Posthemorrhagic hydrocephalus in very low birth weight infants—-a new gentle surgical technique for external ventricular drainage. Childs Nerv Syst 27:9919942011

    • Search Google Scholar
    • Export Citation
  • 11

    Khalil BASarsam ZBuxton N: External ventricular drains: is there a time limit in children?. Childs Nerv Syst 21:3553572005

  • 12

    Kothari RUBrott TBroderick JPBarsan WGSauerbeck LRZuccarello M: The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:130413051996

    • Search Google Scholar
    • Export Citation
  • 13

    Kreusser KLTarby TJTaylor DKovnar EHill AConry JA: Rapidly progressive posthemorrhagic hydrocephalus. Treatment with external ventricular drainage. Am J Dis Child 138:6336371984

    • Search Google Scholar
    • Export Citation
  • 14

    Kung DKPoliceni BACapuano AWRossen JDJabbour PMTorner JC: Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg 114:102110272011

    • Search Google Scholar
    • Export Citation
  • 15

    Massone MLCama ALeone DPellas EVallarino RCarini S: Results of early external ventricular diversion in posthemorrhagic ventricular dilatation in the newborn. Minerva Anestesiol 60:6636681994. (Italian)

    • Search Google Scholar
    • Export Citation
  • 16

    Ngo QNRanger ASingh RNKornecki ASeabrook JAFraser DD: External ventricular drains in pediatric patients. Pediatr Crit Care Med 10:3463512009

    • Search Google Scholar
    • Export Citation
  • 17

    Pople IKMuhlbauer MSSanford RAKirk E: Results and complications of intracranial pressure monitoring in 303 children. Pediatr Neurosurg 23:64671995

    • Search Google Scholar
    • Export Citation
  • 18

    Rhodes TTEdwards WHSaunders RLHarbaugh RELittle CLMorgan LJ: External ventricular drainage for initial treatment of neonatal posthemorrhagic hydrocephalus: surgical and neurodevelopmental outcome. Pediatr Neurosci 13:2552621987

    • Search Google Scholar
    • Export Citation
  • 19

    Ross IBDhillon GS: Ventriculostomy-related cerebral hemorrhages after endovascular aneurysm treatment. A JNR Am J Neuroradiol 24:152815312003

    • Search Google Scholar
    • Export Citation
  • 20

    Rossi SBuzzi FPaparella AMainini PStocchetti N: Complications and safety associated with ICP monitoring: a study of 542 patients. Acta Neurochir Suppl 7191931998

    • Search Google Scholar
    • Export Citation
  • 21

    Simpson SYung MSlater A: Severe dehydration and acute renal failure associated with external ventricular drainage of cerebrospinal fluid in children. Anaesth Intensive Care 34:6596632006

    • Search Google Scholar
    • Export Citation
  • 22

    Tobias JD: Cerebrospinal fluid losses through ventricular catheters leading to hyponatremia in two children. South Med J 84:2792801991

    • Search Google Scholar
    • Export Citation
  • 23

    Topjian AAStuart APabalan AAClair AKilbaugh TJAbend NS: Risk factors associated with infections and need for permanent cerebrospinal fluid diversion in pediatric intensive care patients with externalized ventricular drains. Neurocrit Care 21:2942992014

    • Search Google Scholar
    • Export Citation
  • 24

    Walker CTStone JJJacobson MPhillips VSilberstein HJ: Indications for pediatric external ventricular drain placement and risk factors for conversion to a ventriculoperitoneal shunt. Pediatr Neurosurg 48:3423472012

    • Search Google Scholar
    • Export Citation
  • 25

    Weninger MSalzer HRPollak ARosenkranz MVorkapic PKorn A: External ventricular drainage for treatment of rapidly progressive posthemorrhagic hydrocephalus. Neurosurgery 31:52581992

    • Search Google Scholar
    • Export Citation
  • 26

    Whitelaw APople ICherian SEvans DThoresen M: Phase 1 trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by drainage, irrigation, and flbrinolytic therapy. Pediatrics 111:7597652003

    • Search Google Scholar
    • Export Citation

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Article Information

Correspondence Catherine Miller, Department of Neurosurgery, University of Minnesota, MMC 96, Rm. D429, Mayo Building, 420 Delaware St. SE, Minneapolis, MN 55455. email: mill5459@umn.edu.

INCLUDE WHEN CITING Published online September 18, 2015; DOI: 10.3171/2015.5.PEDS1563.

Disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Axial and coronal head CT scans showing examples of hemorrhage (circles) with EVD placement (A and B) and removal (C and D). Figure is available in color online only.

References

  • 1

    Anderson RCKan PKlimo PBrockmeyer DLWalker MLKestle JR: Complications of intracranial pressure monitoring in children with head trauma. J Neurosurg 101:1 Suppl53582004

    • Search Google Scholar
    • Export Citation
  • 2

    Bassan HEshel RGolan IKohelet DBen Sira LMandel D: Timing of external ventricular drainage and neuro-developmental outcome in preterm infants with posthemorrhagic hydrocephalus. Eur J Paediatr Neurol 16:6626702012

    • Search Google Scholar
    • Export Citation
  • 3

    Berger AWeninger MReinprecht AHaschke NKohlhauser CPollak A: Long-term experience with subcutaneously tunneled external ventricular drainage in preterm infants. Childs Nerv Syst 16:1031102000

    • Search Google Scholar
    • Export Citation
  • 4

    Blaha MLazar DWinn RHGhatan S: Hemorrhagic complications of intracranial pressure monitors in children. Pediatr Neurosurg 39:27312003

    • Search Google Scholar
    • Export Citation
  • 5

    Cornips EVan Calenbergh FPlets CDevlieger HCasaer P: Use of external drainage for posthemorrhagic hydrocephalus in very low birth weight premature infants. Childs Nerv Syst 13:3693741997

    • Search Google Scholar
    • Export Citation
  • 6

    Forbes KPPipe JGHeiserman JE: Diffusion-weighted imaging provides support for secondary neuronal damage from intraparenchymal hematoma. Neuroradiology 45:3633672003

    • Search Google Scholar
    • Export Citation
  • 7

    Gardner PAEngh JAtteberry DMoossy JJ: Hemorrhage rates after external ventricular drain placement. J Neurosurg 110:102110252009

    • Search Google Scholar
    • Export Citation
  • 8

    Harbaugh RESaunders RLEdwards WH: External ventricular drainage for control of posthemorrhagic hydrocephalus in premature infants. J Neurosurg 55:7667701981

    • Search Google Scholar
    • Export Citation
  • 9

    Heep AEngelskirchen RHolschneider AGroneck P: Primary intervention for posthemorrhagic hydrocephalus in very low birthweight infants by ventriculostomy. Childs Nerv Syst 17:47512001

    • Search Google Scholar
    • Export Citation
  • 10

    Januschek EMachado LSSteinthal BUlrich PT: Posthemorrhagic hydrocephalus in very low birth weight infants—-a new gentle surgical technique for external ventricular drainage. Childs Nerv Syst 27:9919942011

    • Search Google Scholar
    • Export Citation
  • 11

    Khalil BASarsam ZBuxton N: External ventricular drains: is there a time limit in children?. Childs Nerv Syst 21:3553572005

  • 12

    Kothari RUBrott TBroderick JPBarsan WGSauerbeck LRZuccarello M: The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:130413051996

    • Search Google Scholar
    • Export Citation
  • 13

    Kreusser KLTarby TJTaylor DKovnar EHill AConry JA: Rapidly progressive posthemorrhagic hydrocephalus. Treatment with external ventricular drainage. Am J Dis Child 138:6336371984

    • Search Google Scholar
    • Export Citation
  • 14

    Kung DKPoliceni BACapuano AWRossen JDJabbour PMTorner JC: Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg 114:102110272011

    • Search Google Scholar
    • Export Citation
  • 15

    Massone MLCama ALeone DPellas EVallarino RCarini S: Results of early external ventricular diversion in posthemorrhagic ventricular dilatation in the newborn. Minerva Anestesiol 60:6636681994. (Italian)

    • Search Google Scholar
    • Export Citation
  • 16

    Ngo QNRanger ASingh RNKornecki ASeabrook JAFraser DD: External ventricular drains in pediatric patients. Pediatr Crit Care Med 10:3463512009

    • Search Google Scholar
    • Export Citation
  • 17

    Pople IKMuhlbauer MSSanford RAKirk E: Results and complications of intracranial pressure monitoring in 303 children. Pediatr Neurosurg 23:64671995

    • Search Google Scholar
    • Export Citation
  • 18

    Rhodes TTEdwards WHSaunders RLHarbaugh RELittle CLMorgan LJ: External ventricular drainage for initial treatment of neonatal posthemorrhagic hydrocephalus: surgical and neurodevelopmental outcome. Pediatr Neurosci 13:2552621987

    • Search Google Scholar
    • Export Citation
  • 19

    Ross IBDhillon GS: Ventriculostomy-related cerebral hemorrhages after endovascular aneurysm treatment. A JNR Am J Neuroradiol 24:152815312003

    • Search Google Scholar
    • Export Citation
  • 20

    Rossi SBuzzi FPaparella AMainini PStocchetti N: Complications and safety associated with ICP monitoring: a study of 542 patients. Acta Neurochir Suppl 7191931998

    • Search Google Scholar
    • Export Citation
  • 21

    Simpson SYung MSlater A: Severe dehydration and acute renal failure associated with external ventricular drainage of cerebrospinal fluid in children. Anaesth Intensive Care 34:6596632006

    • Search Google Scholar
    • Export Citation
  • 22

    Tobias JD: Cerebrospinal fluid losses through ventricular catheters leading to hyponatremia in two children. South Med J 84:2792801991

    • Search Google Scholar
    • Export Citation
  • 23

    Topjian AAStuart APabalan AAClair AKilbaugh TJAbend NS: Risk factors associated with infections and need for permanent cerebrospinal fluid diversion in pediatric intensive care patients with externalized ventricular drains. Neurocrit Care 21:2942992014

    • Search Google Scholar
    • Export Citation
  • 24

    Walker CTStone JJJacobson MPhillips VSilberstein HJ: Indications for pediatric external ventricular drain placement and risk factors for conversion to a ventriculoperitoneal shunt. Pediatr Neurosurg 48:3423472012

    • Search Google Scholar
    • Export Citation
  • 25

    Weninger MSalzer HRPollak ARosenkranz MVorkapic PKorn A: External ventricular drainage for treatment of rapidly progressive posthemorrhagic hydrocephalus. Neurosurgery 31:52581992

    • Search Google Scholar
    • Export Citation
  • 26

    Whitelaw APople ICherian SEvans DThoresen M: Phase 1 trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by drainage, irrigation, and flbrinolytic therapy. Pediatrics 111:7597652003

    • Search Google Scholar
    • Export Citation

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