A Personalized Approach to Maintaining Brain Drainage: A Case Series with a Technical Note

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• External ventricular drains (EVDs) are vital for managing acute brain injuries by monitoring intracranial pressure and draining cerebrospinal fluid.
• EVDs are indicated for acute hydrocephalus resulting from various conditions, but complications like occlusion (19-47%) are frequent.
• Intraventricular fibrinolysis (IVF) using agents like urokinase-type plasminogen activator (uPA) aims to prevent EVD occlusion, but evidence is limited.

Purpose of the Study:

• To evaluate the efficacy and safety of intrathecal administration of urokinase-type plasminogen activator (uPA) for preventing external ventricular drain (EVD) occlusion.
• To assess the impact of uPA on clot resolution and patient outcomes in neurosurgical patients with EVDs.

Main Methods:

• Retrospective analysis of 20 neurosurgical patients receiving intrathecal uPA for EVD management.
• Patients presented with hydrocephalus (95%) and intraventricular hemorrhage (80%), with varying uPA dosages (25,000-100,000 IU).
• Evaluation of EVD patency, complication rates, and clot resolution using Graeb scores.

Main Results:

• Intraventricular fibrinolysis with uPA maintained EVD patency in 95% of cases.
• Early uPA administration demonstrated faster clot resolution (Graeb scores).
• Complications included one case of asymptomatic bleeding and four cases (20%) of post-treatment infections, potentially linked to prolonged EVD duration.

Conclusions:

• Intrathecal uPA administration is a feasible and safe option for managing EVD occlusion in selected neurosurgical patients.
• Personalized medicine approaches are crucial, considering the risk-benefit ratio for uPA use.
• Further research is warranted to clarify the role of uPA in preventing EVD-related complications.