This report describes a reliable and simple technique for securing external ventricular drains (EVDs) to the scalp and avoiding pullout complications. The operative technique consists of fixing the drain between 2 hydrocolloid dressings and securing it with staples. A 10-year retrospective analysis of EVD pullout complications was performed in a series of 435 consecutive patients who were treated at a single institution. The EVD pullout complication rate was 0.4%. No complications related to the fixation technique were found. The median operative time required to fix the drain was 60 seconds. The technique presented here is a simple and reliable procedure to fix the EVD to the scalp, preventing pullout complications and thus reducing the morbidity of EVD reimplantation.
Carlos Velásquez, Mónica Rivero-Garvía, Maria Jose Mayorga-Buiza, María de los Ángeles Cañizares-Méndez, Manuel E. Jiménez-Mejías and Javier Márquez-Rivas
José D. Carrillo-Ruiz, Pablo Andrade, Nora Godínez-Cubillos, María L. Montes-Castillo, Fiacro Jiménez, Ana L. Velasco, Guillermo Castro and Francisco Velasco
Spastic diplegia is present in three-fourths of children with cerebral palsy, interfering with gait and frequently accompanied by severe pain. The authors report the case of a 28-year-old woman with history of perinatal hypoxia, who presented with cerebral palsy and severe spastic diplegia (Ashworth Scale Score 4, Tardieu Scale Score 5) and was confined to a wheelchair. She complained of pain in the left hip and knee with mixed neuropathic and somatic components. She consistently rated pain intensity as 10 of 10 on a visual analog scale, and her symptoms were resistant to multiple treatments. The patient underwent selective bilateral adductor myotomies and the implantation of an infusion pump for intrathecal lidocaine application. Postoperative control of pain and spasticity was dramatic (scores of 0 on the Ashworth, Tardieu, and visual analog scales) and persisted throughout a follow-up period of 36 months. This is the first report in the literature of combined selective neurotomies for the treatment of spasticity and chronic lidocaine subarachnoid infusion to treat associated pain. This therapy could represent an alternative to treat spasticity associated with neuropathic and somatic pain.