Continuous external CSF drainage - A perpetual problem in neurosurgery

BACKGROUND: Continuous external CSF drainage represents a well established procedure which has been improved by many technical contributions. We present our experience in a prospective study of 212 needle trephinations in 165 consecutive patients with a new screw fixation device. METHODS: The entire procedure is performed at the bedside under local anesthesia with a twist drill. The trephination needle is inserted into the self-tapping cannulated screw fixed to the skull. RESULTS: The mean operation time was 6 min, and the duration of ventricular drainage ranged from 2 h to 44 days. Ninety-one percent (N = 193) of ventricular needles in our series were placed at the first targeting attempt. ICP-monitoring and -therapy (88%) were the main indications for needle trephination in our study. During the study period we observed needle associated complications, such as intracerebral hemorrhages (N = 2, 1%) and infections (N = 17, 8%). CONCLUSIONS: Concerning infection, primary insufficient fixation, and general surgical handling, we found a clear learning curve during the course of our study. In spite of the initial problems at the time of introduction we have to emphasize the outstanding advantages of the new ventriculostomy device: It is a time-saving bedside procedure equipped with an optimum fixation device and it enables uncomplicated exchange of the needle in case of obstruction.