title: Ventriculostomy for acute hydrocephalus in critically ill patients on the ICU--outcome analysis of two different procedures.
abstract: BACKGROUND
  Burr-hole trephine and insertion of an external ventricular drainage (EVD) is a common procedure in neurosurgical practice. In critically ill patients, the transport to the operating room, OR represents a major risk. Thus, the burr-hole trephine and implantation of an EVD is frequently performed on the Intensive Care Unit (ICU). Since 2004, we have applied two different procedures: the conventional method with a mechanical compressed air or an electric drill, and an alternative method with a manual twist drill, including fixation of the EVD in a skull screw (Bolt Kit, Raumedic AG, Germany). This study was designed to evaluate the outcome of both surgical procedures.
  
  
  METHODS
  In this retrospective analysis we included 166 consecutive patients with acute hydrocephalus due to intracranial hemorrhage that had been operated at our neurosurgical ICU in a six years interval. We reviewed the charts for gender and age, kind of surgical procedure, cerebrospinal fluid (CSF)-infections, duration of drainage, attempts of insertions, wound infections, misplacement rate, post-surgical hemorrhages, revisions, comorbidities and shunt-dependency.
  
  
  RESULTS
  In 122 patients we applied the Bolt Kit System, in 44 patients the conventional method was performed. We found a significantly lower rate of CSF-infections and significantly fewer attempts of insertions in the Bolt Kit group (p = 0.002 and p = 0.001, respectively). The rate of wound infections, misplacement, revisions, shunt-dependency and the post-surgical hemorrhages did not differ significantly.
  
  
  CONCLUSIONS
  Our data indicate that the manual drill and the skull screw are safe and feasible tools in the treatment of acute hydrocephalus. Presumably, the direct skin contact is causative for the higher rate of CSF-infections when the conventional method is performed. The skull screw guides the EVD into the ventricle without skin contact. The lower number of insertions needed may be due to the fact that the skull screw allows just one trajectory for the insertion of the EVD.
authors.affiliation: Department of Neurosurgery, Medical Center University of Regensburg, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Schödel
authors.forename: Martin
authors.initials: M
authors.lastname: Proescholdt
authors.forename: Alexander
authors.initials: A
authors.lastname: Brawanski
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bele
authors.forename: Karl-Michael
authors.initials: KM
authors.lastname: Schebesch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D004322:Drainage; D004867:Equipment Design; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D020300:Intracranial Hemorrhages / Q000150:complications*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014207:Trephining / Q000295:instrumentation / Q000379:methods; D014696:Ventriculostomy / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult