J Neurol Surg A Cent Eur Neurosurg 2018 Jul 18;79(4):279-284. Epub 2018 Jan 18.
Department of Neurosurgery, Jinnah Hospital, Lahore, Pakistan.
Background/aims: The use of single/dual external ventricular drains (EVD) for reducing intraventricular hemorrhage (IVH) is under investigation. A randomized controlled trial was conducted to compare postoperative reduction of IVH volume using single- and dual-catheter drainage in spontaneous IVH patients. We investigated factors that may influence an effective hematoma volume reduction by EVDs.
Materials And Methods: The average cerebrospinal fluid (CSF) drainage volumes were analyzed. Computed tomography (CT) scans were performed on admission, 24 hours and 48 hours after EVD placement, and then on days 5 and 8. Patient group 1 was treated with a single EVD; patient group 2 was treated with bilateral EVDs. The IVH volume was calculated in all ventricles. A multivariate analysis was conducted to investigate variables that can influence the extent of hematoma volume reduction with a bilateral EVD. Regression followed by a Pearson correlation was performed to observe the strength of association of cofounders with the IVH volume reduction.
Results: The percentage of IVH volume change was found to be significantly higher in the dual-catheter group compared with the single-catheter group ( = 0.0034) after 5 days of EVD. The mean reduction in IVH volume was 17.36 (mL) in patients ≤ 45 years of age and 20.50 (mL) in patients > 45 years. The multivariate analysis suggested the following significant predictors for IVH volume reduction: age of the patient ( = 0.011) and longer duration (days) of EVD ( = 0.028). The age of the patient had a weak positive association and duration of EVD had a positive association with the IVH volume reduction.
Conclusion: Intraventricular drainage via bilateral EVDs may provide a better draining of blood-mixed CSF because it led to faster clot clearance. It is suggested that a longer duration of bilateral EVDs may lead to a greater reduction in IVH volume. Older patients may experience a greater IVH volume reduction by EVD because the volume of CSF increases with cerebral atrophy.