Safety and feasibility of an irrigating external intracranial drain in children
Brandon Shin1,2, Jordan Davies3, Scott Self3
11Department of Neurological Surgery, Division of Pediatric Neurosurgery, Children's Nebraska, University of Nebraska Medical Center, Omaha, Nebraska.
Insights
This study shows that an irrigating external intracranial drain (EID) is safe and feasible for clearing infection or blood in pediatric patients. The system demonstrated potential utility in children, including infants, for managing various intracranial conditions.
Area of Science:
- Pediatric Neurosurgery
- Medical Devices
- Clinical Outcomes
Background:
- Irrigating external intracranial drainage systems are promising for adults with intraventricular hemorrhage, ventriculitis, and chronic subdural hematoma.
- Limited data exists on the safety and feasibility of these systems in pediatric populations.
Purpose of the Study:
- To evaluate the safety and feasibility of an irrigating external intracranial drainage (EID) system in pediatric patients.
- To assess the system's utility in clearing infection or blood from the ventricular system or extra-axial space in children.
Main Methods:
- Retrospective chart review of 12 pediatric patients (<18 years) treated with an irrigating EID.
- Analysis of irrigation parameters, cerebrospinal fluid (CSF) studies, adverse events, and outcomes of ventriculoperitoneal (VP) shunts up to 3 months postoperatively.
Main Results:
- The study included 12 pediatric patients, 4 of whom were infants (<1 year).
- Indications included ventriculitis, intraventricular hemorrhage, post-surgical blood clearance, and subdural hematomas.
- One adverse event (seizure) occurred, managed successfully; most irrigations used lactated Ringer's without antibiotics. Seven patients had VP shunts post-treatment, with 2 requiring revisions.
Conclusions:
- The irrigating EID system shows potential utility for clearing intracranial purulence and blood products in pediatric patients.
- This is the first published series detailing the safety and feasibility of irrigating EID in children, including infants.
Objective:
Use of an irrigating external intracranial drainage system has been an active and promising area of investigation in adult patients with intraventricular hemorrhage, ventriculitis, and chronic subdural hematoma. The objective of this study was to report on the safety and feasibility of an irrigating external intracranial drainage system for use in children.
Methods:
Retrospective chart review was undertaken of the medical records of children who required an irrigating external intracranial drain (EID) at two children's hospitals for clearance of infection or blood from the ventricular system or extra-axial space. Irrigation parameters, CSF study results, adverse events during and after the course of irrigation, and ventricular peritoneal shunt outcomes up to 3 months postoperatively were assessed.
Results:
Twelve patients younger than 18 years of age were treated between September 2023 and May 2025. Four patients were younger than 1 year of age (mean ± SD 4.72 ± 3.81 months), and 8 patients were between 4 and 18 years (mean 11.52 ± 4.33 years). Four patients required intracranial drainage for ventriculitis, 1 for intraventricular hemorrhage, 4 for postoperative clearance of blood following hemispherectomy or tumor resection, and 3 for subdural hematomas. The mean duration of irrigation was 6.45 ± 5.25 days. One patient had an adverse event during irrigation, which was a clinical seizure. Irrigation was stopped and the patient was treated with levetiracetam with no further seizures. This was the only patient who received irrigation using normal saline with vancomycin. All other patients received irrigation with lactated Ringer's solution without antibiotics. Seven patients had a ventriculoperitoneal shunt after treatment-5 of whom had a shunt on presentation-of which 2 required revisions for valve replacement within 3 months. All patients with ventricular pathology had stable ventricular configuration on follow-up imaging.
Conclusions:
The use of an irrigating EID has potential utility for clearance of intracranial purulence and blood products in children. This is the first published series to delineate the safety and feasibility of this system in a group of children, 4 of whom were infants younger than 1 year of age.
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