{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T22:46:54Z","timestamp":1774219614421,"version":"3.50.1"},"reference-count":16,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>The placement of an external ventricular drain (EVD) for the treatment of acute hydrocephalus is one of the most common life-saving procedures that neurosurgeons perform worldwide. There are many well-known complications associated with EVD placement, including tract hemorrhages, intra-parenchymal and subdural hemorrhages, infection, and catheter misplacement. Given the variety of complications associated with EVD placement and the inconsistent findings on the relationship of accuracy to complications, the present study reviewed short- and long-term complications related to EVD placement at our institution.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>A retrospective review was conducted for all consecutive patients who underwent bedside EVD placement for any indication between December 2020 and December 2021. Collected variables included demographic information, etiology of disease state, pre-and post-operative head computed tomography measurements, and post-procedural metrics (immediate and delayed complications).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>A total of 124 patients qualified for inclusion in our study. EVDs that were non-functioning\/exchanged were not significantly related to age, accuracy, ventriculomegaly, sex, disposition, laterality, type of EVD used, intraventricular hemorrhage (IVH), etiology, or Kakarla Grade (KG) (all <jats:italic>P<\/jats:italic> &gt; 0.17). The need for a second EVD was similarly not related to age, accuracy, ventriculomegaly, sex, disposition, location, laterality, type of EVD used, IVH, etiology, or KG (all <jats:italic>P<\/jats:italic> &gt; 0.130). Patients who died, however, were significantly more likely to have a second contralateral EVD placed (18.2% vs. 4.9% <jats:italic>P<\/jats:italic> = 0.029). We also found that left-sided EVDs were significantly more likely to fail within seven days of placement (29.4% vs 13.3%, <jats:italic>P<\/jats:italic> = 0.037; relative risk (RR) 1.93, 95% confidence interval: 1.09-3.43), unrelated to age, sex, etiology, type of EVD, IVH, location of the procedure, or accuracy (all <jats:italic>P<\/jats:italic> &gt; 0.07). This remained significant when using a binary logistic regression to control for ventriculomegaly, accuracy, mortality, age, sex, and etiology (<jats:italic>P<\/jats:italic> = 0.021, B = 3.43).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>In our cohort, although a clear relationship between inaccuracy and complication rates was not found, our data did demonstrate that left-sided EVDs were more likely to fail within the immediate postoperative time point, and patients who died were more likely to have a second, contralateral EVD placed.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_894_2023","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T13:19:30Z","timestamp":1709299170000},"page":"67","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy"],"prefix":"10.25259","volume":"15","author":[{"given":"Nikhil","family":"Sharma","sequence":"first","affiliation":[{"name":"School of Medicine, University of Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffery R.","family":"Head","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Medical School, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arka N.","family":"Mallela","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Medical School, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regan M.","family":"Shanahan","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen P.","family":"Canton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Pittsburgh, Pennsylvania, United States."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussam","family":"Abou-Al-Shaar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Medical School, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicol\u00e1s Matheo","family":"Kass","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fritz","family":"Steuer","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucille","family":"Cheng","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Raver","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward G.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Medical School, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2024,3,1]]},"reference":[{"key":"10.25259\/SNI_894_2023\/ref-1","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"},{"key":"10.25259\/SNI_894_2023\/ref-2","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"},{"key":"10.25259\/SNI_894_2023\/ref-3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s11910-011-0231-x","article-title":"External ventricular drainage for intraventricular hemorrhage","volume":"12","author":"Dey","year":"2012","journal-title":"Curr Neurol Neurosci Rep"},{"key":"10.25259\/SNI_894_2023\/ref-4","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.3171\/2008.9.JNS17661","article-title":"Hemorrhage rates after external ventricular drain placement","volume":"110","author":"Gardner","year":"2009","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_894_2023\/ref-5","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s00701-007-1458-9","article-title":"Risk factors for infections related to external ventricular drainage","volume":"150","author":"Hoefnagel","year":"2008","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_894_2023\/ref-6","first-page":"ONS162","article-title":"Safety and accuracy of bedside external ventricular drain placement","volume":"63","author":"Kakarla","year":"2008","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_894_2023\/ref-7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jocn.2021.12.036","article-title":"Freehand frontal external ventricular drain (EVD) placement: Accuracy and complications","volume":"97","author":"Maher Hulou","year":"2022","journal-title":"J Clin Neurosci"},{"key":"10.25259\/SNI_894_2023\/ref-8","first-page":"ONS419","article-title":"Hemorrhagic complications of external ventricular drainage","volume":"59","author":"Maniker","year":"2006","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_894_2023\/ref-9","doi-asserted-by":"crossref","first-page":"107126","DOI":"10.1016\/j.clineuro.2022.107126","article-title":"Updates on techniques and technology to optimize external ventricular drain placement: A review of the literature","volume":"213","author":"Ofoma","year":"2022","journal-title":"Clin Neurol Neurosurg"},{"key":"10.25259\/SNI_894_2023\/ref-10","doi-asserted-by":"crossref","first-page":"e509","DOI":"10.1016\/j.wneu.2018.11.196","article-title":"Factors predicting ventriculostomy revision at a large academic medical center","volume":"123","author":"Ramayya","year":"2019","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_894_2023\/ref-11","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.3171\/2017.11.JNS171892","article-title":"Image guidance and improved accuracy of external ventricular drain tip position particularly in patients with small ventricles","volume":"130","author":"Shtaya","year":"2018","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_894_2023\/ref-12","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.jocn.2021.10.014","article-title":"Systematic review and meta-analysis of external ventricular drain placement accuracy and narrative review of guidance devices","volume":"94","author":"Stuart","year":"2021","journal-title":"J Clin Neurosci"},{"key":"10.25259\/SNI_894_2023\/ref-13","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1227\/01.NEU.0000356973.39913.0B","article-title":"External ventricular drain insertion accuracy: Is there a need for change in practice?","volume":"65","author":"Toma","year":"2009","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_894_2023\/ref-14","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1097\/00003246-199903000-00045","article-title":"Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage","volume":"27","author":"Tuhrim","year":"1999","journal-title":"Crit Care Med"},{"key":"10.25259\/SNI_894_2023\/ref-15","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jhin.2021.06.006","article-title":"Chlorhexidine dressings could reduce external ventricular drain infections: Results from a systematic review and meta-analysis","volume":"117","author":"Waqar","year":"2021","journal-title":"J Hosp Infect"},{"key":"10.25259\/SNI_894_2023\/ref-16","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1308\/rcsann.2017.0221","article-title":"Complication rates of external ventricular drain insertion by surgeons of different experience","volume":"100","author":"Yuen","year":"2018","journal-title":"Ann R Coll Surg Engl"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/single-institution-series-describing-external-ventricular-drain-evd-placement-and-short-and-long-term-complications-related-to-placement-accuracy\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/single-institution-series-describing-external-ventricular-drain-evd-placement-and-short-and-long-term-complications-related-to-placement-accuracy\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T13:19:40Z","timestamp":1709299180000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/single-institution-series-describing-external-ventricular-drain-evd-placement-and-short-and-long-term-complications-related-to-placement-accuracy\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,1]]},"references-count":16,"alternative-id":["10.25259\/SNI_894_2023"],"URL":"https:\/\/doi.org\/10.25259\/sni_894_2023","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2024,3,1]]},"article-number":"67"}}