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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
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Daily drained CSF volume is a predictor for shunt dependence - A retrospective study
Amir Zolal1, Tareq Juratli1, Markus Dengl1
1Department of Neurosurgery, University Hospital Carl Gustav Carus, Dresden University of Technology, Germany.
Clinical Neurology and Neurosurgery
|September 6, 2015
Summary
The average daily cerebrospinal fluid (CSF) drained volume over three days can predict the outcome of an external ventricular drainage (EVD) clamp trial. A threshold of 130 ml daily indicates a higher likelihood of trial failure.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Acute hydrocephalus requires external ventricular drainage (EVD) for management.
- Following acute treatment, EVD clamp trials assess the need for permanent CSF shunting.
- Predicting EVD clamp trial outcomes aids in clinical decision-making.
Purpose of the Study:
- To identify simple, clinically accessible factors predicting external ventricular drainage (EVD) clamp trial success or failure.
- To determine if daily cerebrospinal fluid (CSF) drained volume is a reliable predictor.
Main Methods:
- Retrospective analysis of 86 patients undergoing EVD.
- Comparison of average daily CSF drained volume (at 15 cm H2O) with EVD clamp trial results.
- Statistical analysis including univariate and multivariate logistic regression, and hierarchical clustering.
Main Results:
- Mean daily CSF drained volume over three days significantly differed between patients who passed and failed the EVD clamp trial (p<0.01).
- Average daily CSF output remained a significant predictor in multivariate analysis (p=0.02).
- A threshold of 130 ml/day demonstrated 64.5% sensitivity and 83.6% specificity for predicting clamp trial failure.
Conclusions:
- Average daily CSF drained volume is a simple and clinically useful predictor of EVD clamp trial outcome.
- This factor can assist clinicians in identifying patients likely to fail the trial and require permanent shunting.
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