Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein/red blood cell counts on shunt infection and malfunction

Clinical article

Restricted access


The purpose of this study was to determine the incidence of shunt infection in patients with subarachnoid hemorrhage (SAH) after converting an external ventricular drain (EVD) to a ventriculoperitoneal (VP) shunt using the existing EVD site. The second purpose was to assess the risk of shunt malfunction after converting the EVD to a permanent shunt irrespective of the cerebrospinal fluid (CSF) protein and red blood cell (RBC) counts.


Data obtained in 80 consecutive adult patients (18 men and 62 women, mean age 60.8 years, range 33–85 years) who underwent direct conversion of an EVD to a VP shunt for post-SAH hydrocephalus between August 2002 and March 2007 were retrospectively reviewed. In each patient, the existing EVD site was used to pass the proximal shunt catheter. In no patient was VP shunt insertion delayed based on preoperative RBC or protein counts.


The mean period of external ventricular drainage before VP shunt placement was 14.1 days (range 3–45 days). No patient suffered ventriculitis. The mean perioperative CSF protein level was 124 mg/dl (range 17–516 mg/dl). The mean and median perioperative RBC values in CSF were 14,203 RBCs/mm3 and 4600 RBCs/mm3 (range 119–290,000/mm3), respectively. No patient was lost to follow-up. The mean follow-up duration was 24 months (range 2–53 months). Three patients (3.8%) had shunt malfunction related to obstruction of the shunt system after 15 days, 2 months, and 18 months, respectively. There were no shunt-related infections. No patient suffered a clinically significant hemorrhage from ventricular catheter placement after VP shunt insertion.


In adult patients with aneurysmal SAH, conversion of an EVD to a VP shunt can be safely done using the same EVD site. In this defined patient population, protein and RBC counts in the CSF do not seem to affect shunt survival adversely. Thus, conversion of an EVD to VP shunt should not be delayed because of an elevated protein or RBC count.

Abbreviations used in this paper: CSF = cerebrospinal fluid; EVD = external ventricular drain; RBC = red blood cell; SAH = subarachnoid hemorrhage; VP = ventriculoperitoneal.

Article Information

Address correspondence to: Giuseppe Lanzino, M.D., Department of Neurosurgery, Mayo Clinic, 200 First Street, Rochester, Minnesota 55901. email:

© AANS, except where prohibited by US copyright law.




Brydon HLBayston RHayward RHarkness W: The effect of protein and blood cells on the flow-pressure characteristics of shunts. Neurosurgery 38:4985051996


Dehdashti ARRilliet BRufenacht DAde Tribolet N: Shuntdependent hydrocephalus after rupture of intracranial aneurysms: a prospective study of the influence of treatment modality. J Neurosurg 101:4024072004


Renier DLacombe JPierre-Kahn ASainte-Rose C: Hirsch: Factors causing acute shunt infection. Computer analysis of 1174 operations. J Neurosurg 61:107210781984


Sloffer CAAugspurger LWagenbach ALanzino G: Antimicrobial-impregnated external ventricular catheters: does the very low infection rate observed in clinical trials apply to daily clinical practice?. Neurosurgery 56:104110442005


Zabramski JMWhiting DDarouiche ROHorner TGOlson JRobertson C: Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial. J Neurosurg 98:7257302003


Cited By



All Time Past Year Past 30 Days
Abstract Views 251 251 88
Full Text Views 332 332 24
PDF Downloads 169 169 12
EPUB Downloads 0 0 0


Google Scholar