External ventricular drainage: indications and outcome among Sudanese Children.

Abstract

This study reflects our experience in managing Sudanese children with different cranial conditions through external ventricular drainage (EVD): indications for EVD, pathologies faced, and early outcome. A prospective review of cases operated at the National Center for Neurological Sciences was carried out during the period from February 2014 to February 2016. The patients were closely followed up till EVD removal and discharge. Thirty-five Sudanese children were included in the study (age range between 6 days and 7 years). Majority of the cases had posterior fossa tumor with obstructive hydrocephalus (n = 19, 54.3%). Twenty (57.1%) patients presented with a decreased level of consciousness, while 28 (80%) patients presented with symptoms and signs of raised intracranial pressure (ICP). The decision for EVD was made preoperatively based on positive cranial computed tomography/magnetic resonance imaging findings in 10 (28.6%) patients. Additionally, 28 (80%) patients responded to single injectable antibiotic therapy with an average duration of 22 days. Subsequently, 25 (71.4%) patients improved or got cured, 5 deteriorated, and 11 died. We conclude that EVD can be used for many indications, including obstructive, postinfectious, and postmeningitic hydrocephalus as well as intraventricular hemorrhage. Most patients may present with either deteriorating levels of consciousness or symptoms and signs of raised ICP, but few of them may have positive brain imaging findings and therefore the decision for EVD was made intraoperatively. The average duration for EVD use was 3 weeks with single antibiotic therapy use, which was found as effective as when combined with intraventricular therapy.