Stopping CSF leaks at external ventricular drain exit sites: a technical note
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TECHNICAL NOTES
Stopping CSF leaks at external ventricular drain exit sites: a technical note Jignesh K. Tailor 1 & Abhaya V. Kulkarni 1,2 Received: 18 March 2020 / Accepted: 16 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Cerebrospinal fluid (CSF) leak is a major risk factor for external ventricular drain infection. Here, we present a surgical technique to reduce the possibility of CSF leak at the external ventricular drain (EVD) exit site in high-risk patients. Methods Vertical mattress sutures are placed circumferentially around the EVD catheter tract as it passes under the skin, so to close off the tract along which CSF may travel toward the exit site. Results Specific case examples are discussed where the introduction of this technique was found to be helpful in stopping exitsite CSF leak. Conclusion In our experience, these surgical steps are useful adjuncts that should be considered in all high-risk patients undergoing EVD placement. Keywords External ventricular drain . CSF leak . Surgical technique
Introduction Cerebrospinal fluid (CSF) leak is a major risk factor for shunt and external ventricular drain (EVD) infections [1–4]. In infants and children with hydrocephalus, fluid will often bypass the EVD and leak through the exit site. Re-suturing the exit site at the bedside can be troublesome in children and may contribute to the risk of introducing infection. Risk factors for CSF leak may include poor wound healing, high intracranial pressure, and surgical factors including tunneling length and wound closure technique. The most common surgical method of preventing CSF leak from the exit site is to place a purse-string suture at the exit site prior to securing the drain. In this article, we describe a simple vertical mattress suture that encircles the ventricular catheter tract as an additional measure to prevent leaks. The suture is placed at the
* Abhaya V. Kulkarni [email protected] 1
The Hospital for Sick Children, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
2
The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
time of EVD tunneling and, in our experience, has been effective at stopping CSF leaks in high-risk patients, especially in patients with recurrent CSF leak problems. We describe the surgical technique and discuss our experience of using this suturing technique in EVD operations.
Surgical technique The suture technique is considered in all patients who are thought to be at high risk for CSF leak, including all neonates, children at risk of postoperative hydrocephalus, and patients with recurrent CSF leaks requiring EVD revision. The patients are monitored closely for CSF leak in the postoperative period until the EVD is removed. Following placement of a Bactiseal EVD catheter in the ventricle, the catheter is tunneled underneath the skin to more than 5 cm away from the burr hole site in a standard fashion using the metal tunneler. The tunneler is initially left in place under the s
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