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Background: Ventriculostomy placement is an important diagnostic and therapeutic tool for neurosurgeons. Multiple authors have presented retrospective series of patients evaluating periprocedure hemorrhage., Objective: We performed a meta-analysis of existing studies to determine a more accurate rate of hemorrhage., Methods: A MEDLINE and PubMed search was performed to find all studies of 25 or more patients conducted since 1970 that found a hemorrhagic complication rate from placement of a ventriculostomy. Studies in which a non-neurosurgeon placed the ventriculostomy and studies involving premature infants were excluded., Results: Sixteen studies were used to obtain data from 2428 ventriculostomy procedures. Hemorrhage was found after 203 procedures, and 52 of these hemorrhages were deemed significant by the authors. The cumulative rate of hemorrhage was 7.0% (95% confidence interval: 4.5%-9.4%), with P < .05. The cumulative rate of significant hemorrhage was 0.8% (95% confidence interval: 0.2%-1.4%) with P < .05., Conclusion: Based on our meta-analysis, the overall hemorrhagic complication rate from ventriculostomy placement by neurosurgeons is approximately 7%. The rate of significant hemorrhage from ventriculostomy placement is approximately 0.8%. Further prospective studies are warranted to better address this question.

Background: This study seeks to evaluate the relationship between the risk of symptomatic hemorrhage from ventriculostomy placement and International Normalized Ratio (INR) in patients who received a ventriculostomy after traumatic brain injury., Methods: Patients who received a ventriculostomy after traumatic brain injury between June 2007 and July 2008 were identified and their medical records were abstracted for information., Results: At the time of ventriculostomy placement, 32 patients had an INR<1.2, 26 patients had an INR 1.2 to 1.4, 12 patients had an INR 1.4 to 1.6, and one patient had an INR>1.6 (INR=1.61). No significant difference in the risk of hemorrhage between the groups was observed: 9.4%, 3.9%, 8.3%, and 0%, respectively (p=0.73). In a subgroup analysis of patients who received ventriculostomy in the Neurosurgical Intensive Care Unit within 24 hours of admission (n=54), the average time between admission and ventriculostomy placement in patients who did not receive fresh frozen plasma was 6.8 hours compared with 9.3 hours (p=0.03) for those who did., Conclusions: In this retrospective study, INRs between 1.2 and 1.6 appeared to be acceptable for a neurosurgeon to place an emergent ventriculostomy in a patient with traumatic brain injury.

Background: Intracranial pressure is routinely monitored in patients with severe traumatic brain injury (TBI). Patients with TBI sometimes develop hydrocephalus, requiring permanent cerebrospinal fluid (CSF) diversion., Objective: To quantify the need for permanent CSF diversion in patients with TBI., Methods: Patients who received a ventriculostomy after TBI between June 2007 and July 2008 were identified, and their medical records were abstracted to a database., Results: Sixteen of 71 patients (22.5%) receiving a ventriculostomy required a ventriculoperitoneal or ventriculoatrial shunt before discharge from the hospital. The average number of days between ventriculostomy and shunt was 18.3. Characteristics that predispose these patients to require permanent CSF diversion include the need for craniotomy within 48 hours of admission (odds ratio, 5.20; 95% confidence interval, 1.48-18.35) and history of culture-positive CSF (odds ratio, 5.52; 95% confidence interval, 1.19-25.52). Length of stay was increased in patients receiving permanent CSF diversion (average length of stay, 61 vs 31 days; P = .04). Patient discharge disposition was similar between shunted and nonshunted patients., Conclusion: In this retrospective study, 22% of TBI patients who required a ventriculostomy eventually needed permanent CSF diversion. Patients with TBI should be assessed for the need for permanent CSF diversion before discharge from the hospital. Care must be taken to prevent ventriculitis. Future studies are needed to evaluate more thoroughly the risk factors for the need for permanent CSF diversion in this patient population.

Introduction: Previously, the Seldinger technique has been used for insertion of difficult-to-place vascular catheters. The authors describe the use of this technique in exchanging difficult-to-place ventricular catheters in a child with multiloculated hydrocephalus and ventriculoperitoneal shunt infection., Patient and Methods: A thin, flexible, hydrophilic catheter (Radifocus Glidewire, Terumo Medical, NJ, USA) was truncated to 35 cm, and the angled tip was transected. This modified wire was then used to cannulate two existing ventricular catheters. Each catheter was exchanged for a ventriculostomy over the glidewire. No complications were observed., Results: Catheter placement was identical to preoperative location on postoperative imaging., Conclusions: The authors believe that the modified Seldinger technique may be of use in selected cases of ventricular catheter exchange. With the increase use of endoscopy to place intracranial catheters, holes in intracranial catheters are more common and, thus, the Seldinger technique may increase in its usage.