Araştırma Makalesi
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THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS

Yıl 2023, , 93 - 98, 27.09.2023
https://doi.org/10.46810/tdfd.1341318

Öz

Introduction
Patients with a lumbar catheter become prone to infection due to the outflow of CSF. This research aimed to investigate how tunneled lumbar drainage affected infection in patients undergoing lumbar drainage.
Materials and Methods
This study was conducted on patients with lumbar drainage who were hospitalized for various clinical reasons. Subcutaneous drain length was measured by post-procedural lumbar tomography. The length of the lumbar drainage catheter, the duration of lumbar drainage, fever monitoring, CSF leakage, biochemical blood tests, the length of hospitalization, infection were recorded.
Results
This study comprised a total of 93 cases with external lumbar drainage. 51 (54.8%) of the 93 cases were inserted using the classic technique, 42 (45.2%) were inserted using the tunneled technique. The rate of CSF leakage was decreased using the tunneling approach (p = 0.003). A significant correlation was established between CSF leakage around the drain and subcutaneous drain length. CSF culture was negative in 78.8% of patients with subcutaneous drain lengths between 0 cm and 3 cm, and 100% of patients with subcutaneous drain lengths of 5 cm or more. Seven days or less was the cutoff value for negative CSF culture.
Conclusion
External lumbar draining can lead to issues such as infection and CSF leakage. The tunneling procedure is straight forward, affordable, and successfully prevents these complications.

Kaynakça

  • [1] Basauri LT, Concha-Julio E, Selman JM, Cubillos P, Rufs J. Cerebrospinal fluid spinal lumbar drainage: indications, technical tips, and pitfalls. Crit Rev Neurosurg. 1999 Jan 26;9(1):21-27. doi: 10.1007/s003290050104. PMID: 9933364.
  • [2] El Ahmadieh TY, Wu EM, Kafka B, Caruso JP, Neeley OJ, Plitt A, et al. Lumbar drain trial outcomes of normal pressure hydrocephalus: a single-center experience of 254 patients. J Neurosurg. 2019 Jan 4;132(1):306-312. doi: 10.3171/2018.8.JNS181059. PMID: 30611143.
  • [3] Guo X, Zhu Y, Hong Y. Efficacy and Safety of Intraoperative Lumbar Drain in Endoscopic Skull Base Tumor Resection: A Meta-Analysis. Front Oncol. 2020 May 7;10:606. doi: 10.3389/fonc.2020.00606. PMID: 32457833; PMCID: PMC7221155.
  • [4] Shakeyeva A, Kuzmin V, Lozovoy V. Improving Methods of Diagnosis and Treatment of Posthemorrhagic Hydrocephalus in Young Children. Pediatr Neurol. 2023 Aug 3;148:1-7. doi: 10.1016/j.pediatrneurol.2023.07.023. Epub ahead of print. PMID: 37625173.
  • [5] Hetem DJ, Woerdeman PA, Bonten MJ, Ekkelenkamp MB. Relationship between bacterial colonization of external cerebrospinal fluid drains and secondary meningitis: A retrospective analysis of an 8-year period. J Neurosurg 2010; 113:1309–1313
  • [6] Hahn M, Murali R, Couldwell WT. Tunneled lumbar drain. Technical Note. J Neurosurg. 2002 Jun;96(6):1130-1. doi: 10.3171/jns.2002.96.6.1130. PMID: 12066917.
  • [7] Nigrovic LE, Kimia AA, Shah SS, Neuman MI. Relationship between cerebrospinal fluid glucose and serum glucose. N Engl J Med 2012; 366: 576–578.
  • [8] Hussein M, Abdellatif M. Continuous Lumbar Drainage for the Prevention and Management of Perioperative Cerebrospinal Fluid Leakage. Asian J Neurosurg. 2019 Apr-Jun;14(2):473-478. doi: 10.4103/ajns.AJNS_265_18. PMID: 31143264; PMCID: PMC6516026.
  • [9] Stevens AR, Soon WC, Chowdhury YA, Toman E, Yim S, Veenith T, et al. External Lumbar Drainage for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review. Cureus. 2022 Oct 7;14(10):e30033. doi: 10.7759/cureus.30033. PMID: 36348893; PMCID: PMC9637378.
  • [10] Ginalis EE, Fernández LL, Ávila JP, Aristizabal S, Rubiano AM. A review of external lumbar drainage for the management of intracranial hypertension in traumatic brain injury. Neurochirurgie. 2022 Feb;68(2):206-211. doi: 10.1016/j.neuchi.2021.05.004. Epub 2021 May 26. PMID: 34051245.
  • [11] Governale LS, Fein N, Logsdon J, Black PM. Techniques and complications of external lumbar drainage for normal pressure hydrocephalus. Neurosurgery. 2008 Oct;63(4 Suppl 2):379-84; discussion 384. doi: 10.1227/01.NEU.0000327023.18220.88. PMID: 18981847.
  • [12] Karvouniaris M, Brotis A, Tsiakos K, Palli E, Koulenti D. Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis. Infect Drug Resist. 2022 Feb 28;15:697-721. doi: 10.2147/IDR.S326456. PMID: 35250284; PMCID: PMC8896765.
  • [13] Dasic D, Hanna SJ, Bojanic S, Kerr RS. External ventricular drain infection: the effect of a strict protocol on infection rates and a review of the literature. Br J Neurosurg. 2006 Oct;20(5):296-300. doi: 10.1080/02688690600999901. PMID: 17129877.
  • [14] Shekhar H, Kalsi P, Dambatta S, Strachan R. Do antibiotic-impregnated external ventriculostomy catheters have a low infection rate in clinical practice? A retrospective cohort study. Br J Neurosurg. 2016;30(1):64-9. doi: 10.3109/02688697.2015.1096903. Epub 2015 Oct 15. PMID: 26469715.
  • [15] Khanna RK, Rosenblum ML, Rock JP, Malik GM. Prolonged external ventricular drainage with percutaneous long‑tunnel ventriculostomies. J Neurosurg 1995;83:791‑4.
  • [16] Shekhar H, Kalsi P, Dambatta S, Strachan R. Do antibiotic-impregnated external ventriculostomy catheters have a low infection rate in clinical practice? A retrospective cohort study. Br J Neurosurg. 2016;30(1):64-9. doi: 10.3109/02688697.2015.1096903. Epub 2015 Oct 15. PMID: 26469715.
  • [17] Leung GK, Ng KB, Taw BB, Fan YW. Extended subcutaneous tunnelling technique for external ventricular drainage. Br J Neurosurg 2007;21:359‑64.
  • [18] Cine HS, Suslu HT. Silviyan Araknoid Kist Tanısı İle Cerrahi Tedavi Ve Takip Yapılan Hastaların Semptomatik Ve Radyolojik Açıdan Retrospektif Olarak Değerlendirilmesi: Araştırma Makalesi. Acta Medica Ruha, 2023;1(2):116–125. https://doi.org/10.5281/zenodo.7964102
  • [19] Tahir MZ, Sobani ZA, Murtaza M, Enam SA. (2016). Long-tunneled versus short-tunneled external ventricular drainage: Prospective experience from a developing country. Asian Journal of Neurosurgery. 2016;11(2):114-117. https://doi.org/10.4103/1793-5482.145052

SUBKUTAN TÜNELLEMENİN EKSTERNAL LOMBER DRENAJ KOMPLİKASYONLARINA ETKİSİ

Yıl 2023, , 93 - 98, 27.09.2023
https://doi.org/10.46810/tdfd.1341318

Öz

Giriş
Bel bölgesinde uzun süre kateter bulunan hastalar, BOS sıvısının dış ortama çıkışı nedeniyle enfeksiyona yatkın hale gelebilir. Bu araştırma, tünelli lomber drenajın lomber drenaj uygulanan hastalarda enfeksiyonu nasıl etkilediğini araştırmayı amaçladı.
Gereç ve Yöntem
Bu çalışma, çeşitli klinik nedenlerle hastaneye yatırılan lomber drenajlı hastalar üzerinde yapılmıştır. Subkutan dren uzunluğu işlem sonrası lomber tomografi ile ölçüldü. Lomber drenaj kateterinin uzunluğu, lomber drenaj süresi, ardından ateş izlemi, lomber drenaj çevresinden BOS sızıntısı ve günlük biyokimyasal kan testleri, hastanede kalış süresi, enfeksiyon ve antibiyotik ihtiyacı kaydedildi.
Bulgular
Bu çalışma eksternal lomber drenajı olan toplam 93 olguyu içermektedir. Doksan üç olgunun 51'i (%54.8) klasik teknikle, 42'si (%45.2) ise tünelli teknikle yerleştirildi. BOS kaçağı oranı, tünelleme yaklaşımı kullanılarak azaltıldı (p = 0.003). Hastanede kalış süresi açısından iki işlem arasında fark yoktu. Dren etrafındaki BOS sızıntısı ile subkutan dren uzunluğu arasında istatistiksel olarak anlamlı bir ilişki saptandı. Subkutan dren uzunluğu 0-3 cm arasında olan hastaların %78.8'inde, 5 cm ve üzeri dren uzunluğu olan hastaların ise %100'ünde BOS kültürü negatifti. Negatif BOS kültürü için cut-0ff değeri yedi gün olarak belirlendi.
Tartışma ve Sonuç
Dış lomber drenaj, enfeksiyon ve BOS sızıntısı gibi sorunlara yol açabilir. Tünel açma prosedürü basittir, ekonomiktir ve bu komplikasyonları başarılı bir şekilde önler.

Kaynakça

  • [1] Basauri LT, Concha-Julio E, Selman JM, Cubillos P, Rufs J. Cerebrospinal fluid spinal lumbar drainage: indications, technical tips, and pitfalls. Crit Rev Neurosurg. 1999 Jan 26;9(1):21-27. doi: 10.1007/s003290050104. PMID: 9933364.
  • [2] El Ahmadieh TY, Wu EM, Kafka B, Caruso JP, Neeley OJ, Plitt A, et al. Lumbar drain trial outcomes of normal pressure hydrocephalus: a single-center experience of 254 patients. J Neurosurg. 2019 Jan 4;132(1):306-312. doi: 10.3171/2018.8.JNS181059. PMID: 30611143.
  • [3] Guo X, Zhu Y, Hong Y. Efficacy and Safety of Intraoperative Lumbar Drain in Endoscopic Skull Base Tumor Resection: A Meta-Analysis. Front Oncol. 2020 May 7;10:606. doi: 10.3389/fonc.2020.00606. PMID: 32457833; PMCID: PMC7221155.
  • [4] Shakeyeva A, Kuzmin V, Lozovoy V. Improving Methods of Diagnosis and Treatment of Posthemorrhagic Hydrocephalus in Young Children. Pediatr Neurol. 2023 Aug 3;148:1-7. doi: 10.1016/j.pediatrneurol.2023.07.023. Epub ahead of print. PMID: 37625173.
  • [5] Hetem DJ, Woerdeman PA, Bonten MJ, Ekkelenkamp MB. Relationship between bacterial colonization of external cerebrospinal fluid drains and secondary meningitis: A retrospective analysis of an 8-year period. J Neurosurg 2010; 113:1309–1313
  • [6] Hahn M, Murali R, Couldwell WT. Tunneled lumbar drain. Technical Note. J Neurosurg. 2002 Jun;96(6):1130-1. doi: 10.3171/jns.2002.96.6.1130. PMID: 12066917.
  • [7] Nigrovic LE, Kimia AA, Shah SS, Neuman MI. Relationship between cerebrospinal fluid glucose and serum glucose. N Engl J Med 2012; 366: 576–578.
  • [8] Hussein M, Abdellatif M. Continuous Lumbar Drainage for the Prevention and Management of Perioperative Cerebrospinal Fluid Leakage. Asian J Neurosurg. 2019 Apr-Jun;14(2):473-478. doi: 10.4103/ajns.AJNS_265_18. PMID: 31143264; PMCID: PMC6516026.
  • [9] Stevens AR, Soon WC, Chowdhury YA, Toman E, Yim S, Veenith T, et al. External Lumbar Drainage for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review. Cureus. 2022 Oct 7;14(10):e30033. doi: 10.7759/cureus.30033. PMID: 36348893; PMCID: PMC9637378.
  • [10] Ginalis EE, Fernández LL, Ávila JP, Aristizabal S, Rubiano AM. A review of external lumbar drainage for the management of intracranial hypertension in traumatic brain injury. Neurochirurgie. 2022 Feb;68(2):206-211. doi: 10.1016/j.neuchi.2021.05.004. Epub 2021 May 26. PMID: 34051245.
  • [11] Governale LS, Fein N, Logsdon J, Black PM. Techniques and complications of external lumbar drainage for normal pressure hydrocephalus. Neurosurgery. 2008 Oct;63(4 Suppl 2):379-84; discussion 384. doi: 10.1227/01.NEU.0000327023.18220.88. PMID: 18981847.
  • [12] Karvouniaris M, Brotis A, Tsiakos K, Palli E, Koulenti D. Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis. Infect Drug Resist. 2022 Feb 28;15:697-721. doi: 10.2147/IDR.S326456. PMID: 35250284; PMCID: PMC8896765.
  • [13] Dasic D, Hanna SJ, Bojanic S, Kerr RS. External ventricular drain infection: the effect of a strict protocol on infection rates and a review of the literature. Br J Neurosurg. 2006 Oct;20(5):296-300. doi: 10.1080/02688690600999901. PMID: 17129877.
  • [14] Shekhar H, Kalsi P, Dambatta S, Strachan R. Do antibiotic-impregnated external ventriculostomy catheters have a low infection rate in clinical practice? A retrospective cohort study. Br J Neurosurg. 2016;30(1):64-9. doi: 10.3109/02688697.2015.1096903. Epub 2015 Oct 15. PMID: 26469715.
  • [15] Khanna RK, Rosenblum ML, Rock JP, Malik GM. Prolonged external ventricular drainage with percutaneous long‑tunnel ventriculostomies. J Neurosurg 1995;83:791‑4.
  • [16] Shekhar H, Kalsi P, Dambatta S, Strachan R. Do antibiotic-impregnated external ventriculostomy catheters have a low infection rate in clinical practice? A retrospective cohort study. Br J Neurosurg. 2016;30(1):64-9. doi: 10.3109/02688697.2015.1096903. Epub 2015 Oct 15. PMID: 26469715.
  • [17] Leung GK, Ng KB, Taw BB, Fan YW. Extended subcutaneous tunnelling technique for external ventricular drainage. Br J Neurosurg 2007;21:359‑64.
  • [18] Cine HS, Suslu HT. Silviyan Araknoid Kist Tanısı İle Cerrahi Tedavi Ve Takip Yapılan Hastaların Semptomatik Ve Radyolojik Açıdan Retrospektif Olarak Değerlendirilmesi: Araştırma Makalesi. Acta Medica Ruha, 2023;1(2):116–125. https://doi.org/10.5281/zenodo.7964102
  • [19] Tahir MZ, Sobani ZA, Murtaza M, Enam SA. (2016). Long-tunneled versus short-tunneled external ventricular drainage: Prospective experience from a developing country. Asian Journal of Neurosurgery. 2016;11(2):114-117. https://doi.org/10.4103/1793-5482.145052
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi (Diğer)
Bölüm Makaleler
Yazarlar

Ece Uysal 0000-0002-2355-8395

Erken Görünüm Tarihi 27 Eylül 2023
Yayımlanma Tarihi 27 Eylül 2023
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

APA Uysal, E. (2023). THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS. Türk Doğa Ve Fen Dergisi, 12(3), 93-98. https://doi.org/10.46810/tdfd.1341318
AMA Uysal E. THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS. TDFD. Eylül 2023;12(3):93-98. doi:10.46810/tdfd.1341318
Chicago Uysal, Ece. “THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS”. Türk Doğa Ve Fen Dergisi 12, sy. 3 (Eylül 2023): 93-98. https://doi.org/10.46810/tdfd.1341318.
EndNote Uysal E (01 Eylül 2023) THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS. Türk Doğa ve Fen Dergisi 12 3 93–98.
IEEE E. Uysal, “THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS”, TDFD, c. 12, sy. 3, ss. 93–98, 2023, doi: 10.46810/tdfd.1341318.
ISNAD Uysal, Ece. “THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS”. Türk Doğa ve Fen Dergisi 12/3 (Eylül 2023), 93-98. https://doi.org/10.46810/tdfd.1341318.
JAMA Uysal E. THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS. TDFD. 2023;12:93–98.
MLA Uysal, Ece. “THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS”. Türk Doğa Ve Fen Dergisi, c. 12, sy. 3, 2023, ss. 93-98, doi:10.46810/tdfd.1341318.
Vancouver Uysal E. THE EFFECT OF SUBCUTANEOUS TUNNELING ON EXTERNAL LUMBAR DRAINAGE COMPLICATIONS. TDFD. 2023;12(3):93-8.