External ventricular drains: common procedure, unanswered questions.

摘要

The external ventricular drain (EVD) is one of the commonest procedures performed in pediatric neurosurgery. The indications are wide and include trauma (for both intracranial pressure monitoring and possible treatment), cerebrospinal fluid shunt failure/infection, and acute hydro-cephalus from tumor or hemorrhage, for example. Technically, it is a relatively straightforward procedure that is usually mastered by junior-level neurosurgical trainees. The complications, however, can be significant. (I would bet that most experienced neurosurgeons have memories of at least one embarrassingly misplaced or complicated EVD performed at some time during their training-it is almost a right of passage!) Most of the literature that we rely on has come from adult experience, which we have had to extrapolate to children. Fortunately, Ngo et al (1) have presented to us a very nice review of the use of EVD in children from the Children's Hospital of Western Ontario. They provide details on 96 EVDs inserted over a 12-year period. Their analysis is thoughtful and honest, although hampered by a limited sample size and limited power, making many of their negative results less than conclusive. Their article highlights some of the current controversies surrounding EVDs.