{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:12Z","timestamp":1786125852836,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T00:00:00Z","timestamp":1602460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Hemorrhage is one of the most feared complications following ventriculostomy placement. Current studies have assessed factors associated with increased risk of ventriculostomy-related hemorrhage (VRH). However, the clinical significance of VRH has not been determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To correlate quantitative volumetric measurements of VRH with new neurological symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      A retrospective review of our institutional database of ventriculostomy patients during the last decade was performed. Patients\u2019 demographics and procedural details such as indication, number of passes and position of the catheter were recorded. VRH volume was quantified on noncontrast head computed tomography using the Picture Archiving Communication System (Carestream Vue\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , Rochester, New York) semi-automated livewire segmentation tool. Patients with new neurological symptoms within 48 h of VRH were considered symptomatic. Several clinical confounders were ruled out. Logistic regression analyses were performed. The best volumetric cut-offs in predicting symptomatic VRH were determined through receiver operating characteristic (ROC) curve analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A total of 3090 patients underwent ventriculostomy procedures and 179 (\u223c6%) developed VRH. A total of 41 (1.06%) patients with VRH developed new neurological symptoms. Only 12 (0.39%) were attributable to a new VRH. Multivariable logistic regression showed that volume of the hemorrhage (OR 1.17,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.006) is the only significant predictor of symptomatic VRH. ROC curve analysis demonstrated that VRH volume &lt;1.10 cc has 91.7% sensitivity to rule out symptomatic VRH, whereas a volume &gt;7.59 cc has 95.5% specificity to predict symptomatic VRH.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Approximately 6% of patients developed postprocedural VRH, but only 0.4% were symptomatic. VRH volumes &lt;1 cc are extremely unlikely to become symptomatic, whereas volumes &gt;7.5 cc may predict development of new neurological deficits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opaa319","type":"journal-article","created":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T19:24:43Z","timestamp":1602530683000},"page":"198-205","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Quantitative Assessment of Ventriculostomy-Related Hemorrhage: A Volume-Based Classification System to Predict New Neurological Symptoms"],"prefix":"10.1227","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4987-8853","authenticated-orcid":false,"given":"Jorge A","family":"Roa","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"},{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Fakih","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Zanaty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery","family":"Pazour","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2764-2268","authenticated-orcid":false,"given":"Edgar A","family":"Samaniego","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"},{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"},{"name":"Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,2]]},"reference":[{"issue":"2","key":"bib1-20251027","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s12028-009-9193-0","article-title":"Hemorrhagic complications of ventriculostomy placement: a meta-analysis","volume":"10","author":"Binz","year":"2009","journal-title":"Neurocrit Care"},{"issue":"2","key":"bib2-20251027","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1227\/NEU.0b013e31821a45ba","article-title":"Meta-analysis of hemorrhagic complications from ventriculostomy placement by neurosurgeons","volume":"69","author":"Bauer","year":"2011","journal-title":"Neurosurgery"},{"issue":"1","key":"bib3-20251027","doi-asserted-by":"crossref","first-page":"289","DOI":"10.3171\/2015.12.JNS152341","article-title":"Risk factors for hemorrhage associated with external ventricular drain placement and removal","volume":"126","author":"Miller","year":"2017","journal-title":"J Neurosurg"},{"issue":"6","key":"bib4-20251027","doi-asserted-by":"crossref","first-page":"625","DOI":"10.3109\/02688697.2010.505989","article-title":"External ventricular drainage following aneurysmal subarachnoid haemorrhage","volume":"24","author":"Gigante","year":"2010","journal-title":"Br J Neurosurg"},{"issue":"4 Suppl 2","key":"bib5-20251027","first-page":"ONS419","article-title":"Hemorrhagic complications of external ventricular drainage","volume":"59","author":"Maniker","year":"2006","journal-title":"Neurosurgery"},{"issue":"1 Suppl 1","key":"bib6-20251027","first-page":"ONS162","article-title":"Safety and accuracy of bedside external ventricular drain placement","volume":"63","author":"Kakarla","year":"2008","journal-title":"Neurosurgery"},{"issue":"1","key":"bib7-20251027","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12883-018-1030-7","article-title":"Intracerebral hemorrhage after external ventricular drain placement: an evaluation of risk factors for post-procedural hemorrhagic complications","volume":"18","author":"Rowe","year":"2018","journal-title":"BMC Neurol"},{"issue":"7","key":"bib8-20251027","doi-asserted-by":"crossref","first-page":"545","DOI":"10.2176\/nmc.oa.2013-0178","article-title":"Hemorrhage rates associated with two methods of ventriculostomy: external ventricular drainage vs. ventriculoperitoneal shunt procedure","volume":"54","author":"Ko","year":"2014","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"1","key":"bib9-20251027","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s12028-012-9713-1","article-title":"Safety of intraventricular hemorrhage (IVH) thrombolysis based on CT localization of external ventricular drain (EVD) fenestrations and analysis of EVD tract hemorrhage","volume":"19","author":"Jackson","year":"2013","journal-title":"Neurocrit Care"},{"issue":"1","key":"bib10-20251027","doi-asserted-by":"crossref","first-page":"E99","DOI":"10.1093\/neuros\/nyy489","article-title":"In Reply: External ventricular drain and hemorrhage in aneurysmal subarachnoid hemorrhage patients on dual antiplatelet therapy: a retrospective cohort study","volume":"84","author":"Samaniego","year":"2019","journal-title":"Neurosurgery"},{"issue":"1","key":"bib11-20251027","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1136\/svn-2018-000192","article-title":"Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms","volume":"4","author":"Samaniego","year":"2019","journal-title":"Stroke Vasc Neurol"},{"issue":"4","key":"bib12-20251027","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.3171\/2010.9.JNS10445","article-title":"Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling","volume":"114","author":"Kung","year":"2011","journal-title":"J Neurosurg"},{"key":"bib13-20251027","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/j.wneu.2019.05.148","article-title":"Methods and devices for posterior ventriculoperitoneal shunt placement surgery: 25 years of iterative refinement","volume":"129","author":"Zanaty","year":"2019","journal-title":"World Neurosurg"},{"issue":"1","key":"bib14-20251027","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s12028-015-0224-8","article-title":"The insertion and management of external ventricular drains: an evidence-based consensus statement: a statement for healthcare professionals from the neurocritical care society","volume":"24","author":"Fried","year":"2016","journal-title":"Neurocrit Care"},{"issue":"2","key":"bib15-20251027","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s00062-015-0481-0","article-title":"Rapid and accurate MRI segmentation of peritumoral brain edema in meningiomas","volume":"27","author":"Latini","year":"2017","journal-title":"Clin Neuroradiol"},{"issue":"11","key":"bib16-20251027","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1212\/01.wnl.0000304930.47751.75","article-title":"Intraventricular hemorrhage: Anatomic relationships and clinical implications","volume":"70","author":"Hallevi","year":"2008","journal-title":"Neurology"},{"issue":"5","key":"bib17-20251027","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.jamcollsurg.2018.08.183","article-title":"American College of Surgeons' guidelines for the perioperative management of antithrombotic medication","volume":"227","author":"Hornor","year":"2018","journal-title":"J Am Coll Surg"},{"issue":"2","key":"bib18-20251027","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1161\/STROKEAHA.118.023840","article-title":"Contemporary reversal of oral anticoagulation in intracerebral hemorrhage","volume":"50","author":"Bower","year":"2019","journal-title":"Stroke"},{"issue":"3","key":"bib19-20251027","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1227\/NEU.0000000000000624","article-title":"Bleeding and infection with external ventricular drainage: a systematic review in comparison with adjudicated adverse events in the ongoing Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase III (CLEAR-III IHV) trial","volume":"76","author":"Dey","year":"2015","journal-title":"Neurosurgery"},{"issue":"4","key":"bib20-20251027","doi-asserted-by":"crossref","first-page":"931","DOI":"10.3171\/2013.12.JNS131685","article-title":"Hemorrhagic complications of ventriculostomy: incidence and predictors in patients with intracerebral hemorrhage","volume":"120","author":"Sussman","year":"2014","journal-title":"J Neurosurg"},{"issue":"8","key":"bib21-20251027","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1161\/01.STR.27.8.1304","article-title":"The ABCs of measuring intracerebral hemorrhage volumes","volume":"27","author":"Kothari","year":"1996","journal-title":"Stroke"},{"issue":"2","key":"bib22-20251027","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1161\/01.STR.0000198806.67472.5c","article-title":"Comparison of ABC\/2 estimation technique to computer-assisted planimetric analysis in warfarin-related intracerebral parenchymal hemorrhage","volume":"37","author":"Huttner","year":"2006","journal-title":"Stroke"},{"issue":"3","key":"bib23-20251027","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1038\/s41551-018-0324-9","article-title":"An explainable deep-learning algorithm for the detection of acute intracranial haemorrhage from small datasets","volume":"3","author":"Lee","year":"2019","journal-title":"Nat Biomed Eng"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/advance-article-pdf\/doi\/10.1093\/ons\/opaa319\/33866086\/opaa319.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa319","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:03:33Z","timestamp":1786122213000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa319"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,12]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opaa319","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,12]]},"assertion":[{"value":"2020-04-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}