Comparison of External Ventricular Drains with Ventricular Access Devices for the Emergency Management of Adult Hydrocephalus

Abstract

We compared external ventricular drains (EVDs) with percutaneous continuous CSF drainage via ventricular access devices (VADs) for the acute management of hydrocephalus in adults. This was a retrospective review of all ventricular drains inserted for a new diagnosis of hydrocephalus into non-infected CSF over 4 years. We compared infection rates, return to theatre, and patient outcome between EVDs and VADs. We explored the effect of duration of drainage, frequency of sampling, hydrocephalus aetiology, and catheter location on these outcomes using multivariable logistic regression modelling. We included 179 drains (76 EVDs and 103 VADs). EVDs were associated with a higher rate of unplanned return to theatre for replacement or revision (27/76, 36%, vs 4/103, 4%, OR:13.4 95%CI:4.3-55.8). However, infection rates were higher in VADs (13/103, 13% vs 5/76, 7%, OR:2.0, 95%CI:0.65-7.7). EVDs were 91% antibiotic impregnated whereas VADs were 98% non-impregnated. In multivariable analysis, infection was associated with duration of drainage (median:11 days prior to infection for infected drains vs 7 days total for non-infected drains), but not drain type (VADs vs EVDs OR:1.6, 95%CI:0.5-6). EVDs had a higher rate of unplanned revisions but a lower infection rate compared to VADs. However, in multivariable analysis choice of drain type was not associated with infection. We suggest a prospective comparison of antibiotic impregnated VADs and EVDs using similar sampling protocols to assess whether VADs or EVDs for acute hydrocephalus have a lower overall complication rate.