title: Long-tunneled versus short-tunneled external ventricular drainage: Prospective experience from a developing country.
abstract: BACKGROUND
  External ventricular drains (EVD) are commonly utilized for temporary diversion of cerebrospinal fluid (CSF). Many neurosurgeons prefer long-tunneled EVDs in their routine practice. However, it is still unclear whether this extended tunneling helps in reducing CSF infection. Keeping this in mind, we decided to compare infection rates in long-tunneled versus short-tunneled EVDs in the setting of a developing country.
  
  
  METHODS
  A prospective study of 60 patients was conducted. Consenting patients who underwent short-tunneled (Group A) or long-tunneled (Group B) EVDs between January 2008 and June 2009 were followed during the course of their inpatient care. All operational protocol was standardized during the trial. Serial samples of CSF were analyzed to detect infection.
  
  
  RESULTS
  Mean age of patients was 33.6 years with 32 males (53.3%). Mean duration of long-tunneled EVD was 13.4 ± 7.2 days, whereas that of short-tunneled EVD was 5.3 ± 2.7 days (P < 0.001). Three patients with long-tunneled EVD (10.0%), whereas one patient with short-tunneled EVD (3.3%) developed drain-related infections; however, this was non-significant (P = 0.301). However, patients with short-tunneled EVD got infected earlier on day 3when compared with the long-tunneled EVDs, which got infected after a mean duration of 7.3 days. The overall risk of infection for long-tunneled EVDs was 7.46 per 1,000 ventricular drainage days which was comparable to the risk of 6.33 per 1,000 ventricular drainage days seen for short-tunneled EVDs.
  
  
  CONCLUSIONS
  Long-tunneled EVDs appear to only delay potential infections without having any effect on the actual risk of infection. Long-tunneled EVD in a resource-limited setting is technically challenging and may not yield additional benefits to the patient. However, larger and prospective studies are needed to establish the rate of infections and other complications.
authors.affiliation: Department of Pediatric Neurosurgery, Alder Hey Children's NHS Trust, Liverpool, UK.
authors.forename: Muhammad Zubair
authors.initials: MZ
authors.lastname: Tahir
authors.affiliation: Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Zain A
authors.initials: ZA
authors.lastname: Sobani
authors.affiliation: Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Murtaza
authors.affiliation: Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Syed Ather
authors.initials: SA
authors.lastname: Enam
keywords: External ventricular drainage; Pakistan; hydrocephalus