An outcome analysis of two different procedures of burr-hole trephine and external ventricular drainage in acute hydrocephalus.

Burr-hole trephine and insertion of external ventricular drainage (EVD) is the most common neurosurgical treatment of acute hydrocephalus. Until 2005, we performed this procedure conventionally in the operating room (OR) using a mechanical drill but in 2004 we started to use a manual drill and a skull screw (Bolt Kit System [BKS], Raumedic, Münchberg, Germany) for creating burr-holes in the Intensive Care Unit (ICU) exclusively. This retrospective study compares the outcomes after both surgical procedures of 312 consecutive patients (190 patients, conventional procedure; 122, the BKS system; total female 171, male 141; mean age 59.0 years) who suffered from acute hemorrhage-related hydrocephalus and who had undergone EVD via a frontal burr-hole from January 2004 until April 2010. We reviewed the charts for surgical procedure, number of attempted insertions, radiological signs of misplacement and procedural-related hemorrhage, cerebrospinal fluid (CSF) infection rate and shunt-dependency. The CSF infection rate, the number of attempted insertions and the procedural-related hemorrhage were significantly lower in the BKS group (p=0.034; p=0.018 and 0.015 respectively). Our data indicate that the application of the manually driven drill and the skull screw in the ICU is safe and effective. In addition, there is no need for transfer and transportation of critically ill patients from the ICU to the OR.