Malplacement of ventricular catheters by neurosurgeons: A single institution experience

Introduction: The placement of cerebrospinal fluid (CSF) diversion devices requires an appropriate technical expertise associated with proper surgical training in order to minimize undue complications. This study sought to review a single institution's experience with placement of external ventricular drains (EVD) and ventriculoperitoneal (VP) shunts as performed by neurosurgeons with procedure-specific training. Methods: A retrospective database review was conducted for all patients who underwent intraventricular CSF diversion over a 5-year period from March 2003 to February 2008. Included in the analysis were ventriculostomy procedures that included EVDs, VP shunts, and ventriculoatrial shunts. Results: A total of 138 patients underwent 212 ventriculostomy procedures. Seventy-one (51%) patients were male and sixty-seven (49%) were female. The median age was 50.1 years. A ventriculostomy-related hemorrhage was identified in 15 (7.1%) patients-4 of whom developed new symptoms. Twenty-six (12.3%) ventriculostomy catheters were malplaced as determined from post-procedural imaging. Ventriculostomy-related infections were identified in 7 (3.3%) patients, 4 of whom had EVDs and 3 of whom had VP shunts. Conclusion: The placement of intraventricular catheters by neurosurgeons remains a relatively safe and effective procedure that is associated with infrequent rates of symptomatic hemorrhage and infection.