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The Aalborg Bolt-Connected Drain (ABCD) study: a prospective comparison of tunnelled and bolt-connected external ventricular drains

  • Original Article - CSF Circulation
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Acutely increased intracranial pressure (ICP) is frequently managed by external ventricular drainage (EVD). This procedure is life-saving but marred by a high incidence of complications. It has recently been indicated that bolt-connected external ventricular drainage (BC-EVD) compared to the standard technique of tunnelled EVD (T-EVD) may result in less complications.

Aim

To prospectively sample and compare two cohorts by consecutive allocation to either BC-EVD or T-EVD from the introduction of the BC-EVD technique in our department and 12 months onward.

Methods

Patients undergoing ventriculostomy between the 1st of March 2017 and the 28th of February 2018 were considered for inclusion. The neurosurgeon on-call sovereignly set the indication and decided on EVD type (BC-EVD or T-EVD), consequently resulting in two cohorts as 3/7 senior neurosurgeons on call were open to the use of BC-EVD, while 4/7 were reluctant to use this technique. Data was continuously collected using patient records, including results of cerebrospinal fluid (CSF) culturing and available CT/MRI-scans. Recorded complications included CSF leakage, accidental discontinuation, placement-related intracranial haemorrhage, malfunction, migration, infection and revision.

Results

Forty-nine EVDs (32 T-EVDs/17 BC-EVDs) were included; 19/32 (59.4%) T-EVDs and 3/17 (17.6%) BC-EVDs were found to have complications (p = 0.007). The relative risk of complications when using T-EVD was 3.4 times that of BC-EVD.

Conclusion

Ventriculostomy by BC-EVD compared to T-EVD reduces incidence and risk of complications and should be the first choice in EVD placement. That said, T-EVD has a role in paediatric patients and for intraoperatively and occipitally placed EVDs.

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Abbreviations

BC-EVD:

Bolt-connected external ventricular drain

EVD:

External ventricular drain(age)

CSF:

Cerebrospinal fluid

ICH:

Intracerebral haemorrhage

ICP:

Intracranial pressure

ICU:

Intensive care unit

IVH:

Intraventricular haemorrhage

SAH:

Subarachnoid haemorrhage

SD:

Standard deviation

T-EVD:

Tunnelled external ventricular drain

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Authors and Affiliations

  1. Department of Neurosurgery, Institute of Clinical Medicine, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark

    Sofia Kamakh Asaad & Carsten Reidies Bjarkam

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  1. Sofia Kamakh Asaad
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  2. Carsten Reidies Bjarkam
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Correspondence to Sofia Kamakh Asaad.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on CSF Circulation

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Asaad, S.K., Bjarkam, C.R. The Aalborg Bolt-Connected Drain (ABCD) study: a prospective comparison of tunnelled and bolt-connected external ventricular drains. Acta Neurochir 161, 33–39 (2019). https://doi.org/10.1007/s00701-018-3737-z

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  • DOI: https://doi.org/10.1007/s00701-018-3737-z

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