An interesting study comes from Dr. Gardner et al. at the Department of Neurological Surgery, University of Pittsburgh, Pennsylvania. The external ventricular drainage placement is a common practice in everyday neurosurgical activity but the complications relying on hemorrhage were not clearly depicted. This study involving 188 EVD placements tries to quantify and qualify the extent of this complication and interestingly 41% of the patients showed imaging evidence of hemorrhage. Most of the hemorrhages were of insignificant value (punctuate, trace SAH, or small volume) while 10.6% of the patients had >15ml hemorrhage or associated IVH. The study concludes that there is an increased risk concerning EVD placement and hemorrhage but rarely a surgical intervention is needed. There was no significant risk reduction when the placement was done in the OR or the NICU.
You can read the article here, at the Journal of Neurosurgery issue of May 2009.
Hemorrhage rates after external ventricular drain placement
Paul A. Gardner, M.D., Johnathan Engh, M.D., Dave Atteberry, M.D., and John J. Moossy, M.D.
Journal of Neurosurgery, May 2009 Volume 110, Number 5