PDF(Pubmed)
Abstract：
External ventricular drainage (EVD) is a common procedure in neurosurgical practice. Presently, the three methods used most often include direct EVD (dEVD), long-tunneled external ventricular drains (LTEVDs), and EVD via the Ommaya reservoir (EVDvOR). But they possess drawbacks such as limited duration of retention, vulnerability to iatrogenic secondary infections, and challenges in regulating drainage flow. This study aimed to explore the use of a modified ventriculoperitoneal shunt (mVPS)-the abdominal end of the VPS device was placed externally-as a means of temporary EVD to address the aforementioned limitations. This retrospective cohort study, included 120 cases requiring EVD. dEVD was performed for 31 cases, EVDvOR for 54 cases (including 8 cases with previously performed dEVD), and mVPS for 35 cases (including 6 cases with previously performed EVDvOR). The one-time success rate (no need for further other EVD intervention) for dEVD, EVDvOR, and mVPS were 70.97%, 88.89%, and 91.42%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Puncture needle displacement or detachment was observed in nearly all cases of EVDvOR, while no such complications have been observed with mVPS. Apart from this complication, the incidence of postoperative complications was 35.48%, 14.81%, and 8.5%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Mean postoperative retention for EVD was 14.68 ± 9.50 days, 25.96 ± 15.14 days, and 82.43 ± 64.45 days, respectively (P < 0.001). In conclusion, mVPS significantly extends the duration of EVD, which is particularly beneficial for patients requiring long-term EVD.
摘要：
脑室外引流（EVD）是神经外科实践中的常见程序。目前,最常用的三种方法包括直接EVD(dEVD)，长隧道外部心室引流管（LTEVDs），和EVD通过Ommaya水库（EVDvOR）。但是它们具有缺点，例如保留时间有限，易受医源性二次感染，以及在调节排水流量方面的挑战。这项研究旨在探索使用改良的脑室-腹膜分流术（mVPS）-将VPS设备的腹端放置在外部-作为临时EVD的手段，以解决上述限制。这项回顾性队列研究，包括120例需要EVD的病例。31例进行了dEVD，EVDvOR治疗54例（包括8例以前做过dEVD），mVPS为35例（包括6例以前进行过EVDvOR）。dEVD的一次性成功率（不需要进一步的其他EVD干预），EVDvor,MVPS为70.97%，88.89%,和91.42%，dEVD与EVDvOR（P<0.05），dEVD与mVPS（P<0.05），EVDvORvsmVPS(P>0.05)。在几乎所有EVDvOR病例中均观察到穿刺针移位或脱离。而mVPS未观察到此类并发症。除了这种并发症，术后并发症发生率为35.48%,14.81%,和8.5%，dEVD与EVDvOR（P<0.05），dEVD与mVPS（P<0.05），EVDvORvsmVPS(P>0.05)。EVD术后平均保留时间为14.68±9.50天，25.96±15.14天，82.43±64.45天，分别(P<0.001)。总之,mVPS显著延长了EVD的持续时间，这对需要长期EVD的患者特别有益。
