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External ventricular drain causes brain tissue damage: an imaging study.

Fabrizio Ortolano1, Marco Carbonara2, Antonella Stanco3

  • 1Neuroscience Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy. fabrizio.ortolano@policlinico.mi.it.

Acta Neurochirurgica
|August 10, 2017
PubMed
Summary
This summary is machine-generated.

External ventricular drain (EVD) insertion can cause minor bleeding and brain edema, even without major complications. These tissue reactions, including hemorrhages, are common but typically do not lead to neurological decline or increased intracranial pressure.

Keywords:
Brain damageBrain edemaBrain hemorrhageExternal ventricular drainIntracranial pressure monitoring

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Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Background:

  • External ventricular drains (EVDs) are crucial for measuring intracranial pressure (ICP) and draining cerebrospinal fluid (CSF).
  • While generally safe, EVD placement can lead to parenchymal sequelae, such as hemorrhagic lesions, with varying incidence.

Purpose of the Study:

  • To investigate the mechanical sequelae of EVD insertion in acute brain-injured patients.
  • To assess the clinical significance of these sequelae, with a focus on hemorrhagic lesions.

Main Methods:

  • Computed tomography (CT) and magnetic resonance imaging (MRI) were used to detect mechanical sequelae in 155 patients.
  • 33 patients with hemorrhages and 122 without were analyzed; 53 patients underwent imaging at multiple time points.

Main Results:

  • Small hemorrhages (average initial volume 8.16 ml, increasing over time) were observed in 33 patients, associated with hypertension, coagulation issues, and multiple EVD insertions.
  • These hemorrhages did not correlate with neurological deterioration or ICP elevation.
  • Non-hemorrhagic patients showed minimal hypodensities (0.38 ml) around the catheter, with MRI revealing intra- and extracellular edema that increased over time.

Conclusions:

  • EVD insertion induces a tissue reaction, including minimal bleeding and brain edema, even in the absence of clinically significant complications.
  • The observed sequelae, particularly hemorrhages and edema, are generally not associated with adverse clinical outcomes in acute brain injury.