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Wang P, Luo S, Cheng S, Gong M, Zhang J, Liang R, Ma W, Li Y, Liu Y. Construction and validation of infection risk model for patients with external ventricular drainage: a multicenter retrospective study. Acta Neurochir (Wien) 2023; 165:3255-3266. [PMID: 37697007 DOI: 10.1007/s00701-023-05771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/13/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE External ventricular drainage (EVD) is a life-saving neurosurgical procedure, of which the most concerning complication is EVD-related infection (ERI). We aimed to construct and validate an ERI risk model and establish a monographic chart. METHODS We retrospectively analyzed the adult EVD patients in four medical centers and split the data into a training and a validation set. We selected features via single-factor logistic regression and trained the ERI risk model using multi-factor logistic regression. We further evaluated the model discrimination, calibration, and clinical usefulness, with internal and external validation to assess the reproducibility and generalizability. We finally visualized the model as a nomogram and created an online calculator (dynamic nomogram). RESULTS Our research enrolled 439 EVD patients and found 75 cases (17.1%) had ERI. Diabetes, drainage duration, site leakage, and other infections were independent risk factors that we used to fit the ERI risk model. The area under the receiver operating characteristic curve (AUC) and the Brier score of the model were 0.758 and 0.118, and these indicators' values were similar when internally validated. In external validation, the model discrimination had a moderate decline, of which the AUC was 0.720. However, the Brier score was 0.114, suggesting no degradation in overall performance. Spiegelhalter's Z-test indicated that the model had adequate calibration when validated internally or externally (P = 0.464 vs. P = 0.612). The model was transformed into a nomogram with an online calculator built, which is available through the website: https://wang-cdutcm.shinyapps.io/DynNomapp/ . CONCLUSIONS The present study developed an infection risk model for EVD patients, which is freely accessible and may serve as a simple decision tool in the clinic.
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Affiliation(s)
- Peng Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shuang Luo
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shuwen Cheng
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Min Gong
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jie Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Ruofei Liang
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Weichao Ma
- Department of Neurosurgery, Sichuan Cancer Hospital, Chengdu, Sichuan, China
| | - Yaxin Li
- West China Fourth Hospital/West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Zhang Z, Wu Y, Zhao X, Zhou J, Li L, Zhai X, Liang P. The insertion and management of an external ventricular drain in pediatric patients with hydrocephalus associated with medulloblastoma. Neurosurg Rev 2023; 46:170. [PMID: 37433938 DOI: 10.1007/s10143-023-02080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/24/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
An external ventricular drain (EVD) is used to facilitate cerebrospinal fluid (CSF) removal in medulloblastoma patients suffering from hydrocephalus. It is essential to recognize that EVD management plays a crucial role in influencing the incidence of drain-related complications. However, the ideal method for EVD management remains undetermined. Our research sought to examine the safety of EVD placement and the impact of EVD on the incidences of intracranial infections, postresection hydrocephalus, and posterior fossa syndrome (PFS). We conducted a single-center observational study involving a cohort of 120 pediatric medulloblastoma patients who were treated from 2017 to 2020. The rates of intracranial infection, postresection hydrocephalus, and PFS were 9.2%, 18.3%, and 16.7%, respectively. EVD did not influence the occurrence of intracranial infection (p = 0.466), postresection hydrocephalus (p = 0.298), or PFS (p = 0.212). A gradual EVD weaning protocol correlated with an elevated incidence of postresection hydrocephalus (p = 0.033), whereas a rapid weaning approach resulted in 4.09 ± 0.44 fewer drainage days (p < 0.001) than the gradual weaning strategy. EVD placement (p = 0.010) and intracranial infection (p = 0.002) were linked to delayed speech return, whereas a longer duration of drainage was conducive to the recovery of language function (p = 0.010). EVD insertion was not correlated with the incidence of intracranial infection, postoperative hydrocephalus, or PFS. The optimal EVD management method should encompass a rapid EVD weaning strategy, followed by prompt drain closure. We have presented additional evidence to improve the safety of EVD insertion and management in neurosurgical patients to ultimately facilitate the establishment of standardized institutional/national implementation and management protocols.
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Affiliation(s)
- Zaiyu Zhang
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuxin Wu
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xueling Zhao
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jianjun Zhou
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lusheng Li
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xuan Zhai
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ping Liang
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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Roethlisberger M, Eberhard NE, Rychen J, Al-Zahid S, Jayapalan RR, Zweifel C, Karuppiah R, Waran V. Supratentorial cerebrospinal fluid diversion using image-guided trigonal ventriculostomy during retrosigmoid craniotomy for cerebellopontine angle tumors. Front Surg 2023; 10:1198837. [PMID: 37288135 PMCID: PMC10242017 DOI: 10.3389/fsurg.2023.1198837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
Background Cerebellar contusion, swelling and herniation is frequently encoutered upon durotomy in patients undergoing retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors, despite using standard methods to obtain adequate cerebellar relaxation. Objective The aim of this study is to report an alternative cerebrospinal fluid (CSF)-diversion method using image-guided ipsilateral trigonal ventriculostomy. Methods Single-center retro- and prospective cohort study of n = 62 patients undergoing above-mentioned technique. Prior durotomy, CSF-diversion was performed to the point where the posterior fossa dura was visibly pulsatile. Outcome assessment consisted of the surgeon's intra- and postoperative clinical observations, and postoperative radiological imaging. Results Fifty-two out of n = 62 (84%) cases were eligible for analysis. The surgeons consistently reported successful ventricular puncture and a pulsatile dura prior durotomy without cerebellar contusion, swelling or herniation through the dural incision in n = 51/52 (98%) cases. Forty-nine out of n = 52 (94%) catheters were placed correctly within the first attempt, with the majority of catheter tips (n = 50, 96%) located intraventricularly (grade 1 or 2). In n = 4/52 (8%) patients, postoperative imaging revealed evidence of a ventriculostomy-related hemorrhage (VRH) associated with an intracerebral hemorrhage [n = 2/52 (4%)] or an isolated intraventricular hemorrhage [n = 2/52 (4%)]. However, these hemorrhagic complications were not associated with neurological symptoms, surgical interventions or postoperative hydrocephalus. None of the evaluated patients demonstrated radiological signs of upward transtentorial herniation. Conclusion The method described above efficiently allows CSF-diversion prior durotomy to reduce cerebellar pressure during retrosigmoid approach for CPA tumors. However, there is an inherent risk of subclinical supratentorial hemorrhagic complications.
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Affiliation(s)
- Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Surgery, Division of Neurosurgery, University Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology (ORL), University Malaya Specialist Centre, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | | | - Jonathan Rychen
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Saif Al-Zahid
- Department of Otorhinolaryngology (ORL), University Malaya Specialist Centre, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology, Hereford County Hospital, Hereford, United Kingdom
| | - Ronie Romelean Jayapalan
- Department of Surgery, Division of Neurosurgery, University Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | - Christian Zweifel
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery, Cantonal Hospital Graubuenden, Chur, Graubuenden, Switzerland
| | - Ravindran Karuppiah
- Department of Surgery, Division of Neurosurgery, University Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | - Vicknes Waran
- Department of Surgery, Division of Neurosurgery, University Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
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Yic CD, Pontet J, Mercado M, Muñoz M, Biestro A. Ultrasonographic measurement of the optic nerve sheath diameter to detect intracranial hypertension: an observational study. Ultrasound J 2023; 15:4. [PMID: 36729242 PMCID: PMC9895168 DOI: 10.1186/s13089-022-00304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/15/2022] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To evaluate the ultrasonographic measurement of optic nerve sheath diameter (ONSD) as a predictor of intracranial hypertension as compared to the invasive measurement of intracranial pressure (ICP). DESIGN Cross-sectional observational study. SETTING Intensive Care Unit (ICU) of two tertiary university hospitals in Montevideo, Uruguay. PATIENTS We included 56 adult patients, over 18 years of age, who required sedation, mechanical ventilation, and invasive ICP monitoring as a result of a severe acute neurologic injury (traumatic or non-traumatic) and had a Glascow Coma Score (GCS) equal to or less than 8 on admission to the ICU. INTERVENTIONS Ultrasonographic measurement of ONSD to detect intracranial hypertension. MEASUREMENTS AND MAIN RESULTS In our study, a logistic regression model was performed in which it was observed that the variable ONSD is statistically significant with a p value of 0.00803 (< 0.05). This model estimates and predicts the probability that a patient will have an ICP greater than 20 mmHg. From the analysis of the cut-off points, it is observed that a value of 5.7 mm of ONSD maximizes the sensitivity (92.9%) of the method (a greater number of individuals with ICP > 20 mmHg are correctly identified). CONCLUSIONS In sedated neurocritical patients, with structural Acute Brain Injury, the ONSD measurement correlates with the invasive measurement of ICP. It was observed that with ONSD values less than 5.7 mm, the probability of being in the presence of ICP above 20 mmHg is very low, while for ONSD values greater than 5.7 mm, said probability clearly increases.
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Affiliation(s)
- Christian Daniel Yic
- grid.414446.7Department of Critical Care Medicine, Hospital de Clínicas, Asociación Española Primera en Salud, Guillermo Arrospide, 5338 Montevideo, Uruguay
| | - Julio Pontet
- Department of Critical Care Medicine, Hospital Pasteur, Montevideo, Uruguay
| | - Mauricio Mercado
- grid.414446.7Department of Critical Care Medicine, Hospital de Clínicas, Asociación Española Primera en Salud, Guillermo Arrospide, 5338 Montevideo, Uruguay
| | - Matias Muñoz
- Comisión Honoraria para la salud Cardiovascular, Montevideo, Uruguay
| | - Alberto Biestro
- grid.414446.7Department of Critical Care Medicine, Hospital de Clínicas, Asociación Española Primera en Salud, Guillermo Arrospide, 5338 Montevideo, Uruguay
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Masson A, Boulouis G, Janot K, Herbreteau D, Cottier JP, Bibi R, Cohen C, Obry S, Velut S, Amelot A, Ifergan H. Acute hydrocephalus and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2022; 164:2401-2408. [PMID: 35918615 DOI: 10.1007/s00701-022-05321-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/17/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Delayed cerebral infarction (DCIn) following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbi-mortality; yet, the causes for DCIn remain incompletely understood. OBJECTIVE We tested the hypothesis that acute hydrocephalus could be related to the occurrence of DCIn, independently of the occurrence and severity of vasospasm. METHODS Radiological and clinical data of patients treated at a single large volume academic center for aSAH between 2017 and 2019 were retrospectively analyzed. DCIn was defined as imaging stigma of cerebral infarction visible on 6-week imaging follow-up after aSAH. Hydrocephalus was defined on baseline imaging as a relative bicaudate index above 1. Cerebral vasospasm was defined by reduction of artery diameter in comparison with initial diameter. We used uni- and multivariable models to test the associations between these variables, hydrocephalus and DCIn. RESULTS Of 164 included patients, vasospasm occurred in 58 patients (35.4%), and DCIn in 47 (28.7%). Acute hydrocephalus was present in 85 patients (51.8%) on baseline CT. No relation was found between acute hydrocephalus and delayed cerebral infarction in our multivariate analysis (adjusted OR: 1.20 95% CI [0.43-3.37]; p = 0.732). Only vasospasm occurrence was independently associated with DCIn (adjusted OR: 10.97 95% CI [4.60-26.01]). CONCLUSION Our study did not show an association between acute hydrocephalus and DCIn after aSAH, after adjustment for the presence and severity of cerebral vasospasm.
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Affiliation(s)
- Axel Masson
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France.
| | - Grégoire Boulouis
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Kevin Janot
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Denis Herbreteau
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Jean-Phlippe Cottier
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Richard Bibi
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Clara Cohen
- Department of Diagnostic Neuroradiology, Orleans Hospital Center, Orleans, France
| | - Sandra Obry
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France
| | - Stéphane Velut
- Department of Neurosurgery, Bretonneau Hospital, University of Tours, Tours, France
| | - Aymeric Amelot
- Department of Neurosurgery, Bretonneau Hospital, University of Tours, Tours, France
| | - Héloïse Ifergan
- Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France.
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