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Keen's Point for External Ventricular Drainage in Traumatic Brain Injury Patients: An Uncommon Indication for an Old Technique.
World Neurosurg. 2017 Apr 08;:
Authors: Huang KT, Chavakula V, Gormley WB
Abstract
BACKGROUND: In cases of severe traumatic brain injury (TBI), cerebrospinal fluid (CSF) diversion though an external ventricular drain (EVD) is a proven method to assist in the control of elevated intracranial pressure (ICP). Under normal circumstances, the EVD is placed in a frontal location. However, in cases of multifocal intracranial injury and swelling, collapse of the frontal horns of the lateral ventricles leads to frequent failure of frontal CSF drainage. In this series we describe the utility of the Keen's point EVD as a safe alternative to maintain continuous CSF diversion for patients in whom frontal drainage is not feasible.
CASE DESCRIPTIONS: Three patients (ages 30-46 years) with diffuse intracranial injury following severe trauma were admitted to our neurointensive care unit. One of these patients had decompressive craniectomy prior to transfer, while the other two patients did not undergo any surgical procedures. Each of these patients had severe refractory elevation of intracranial pressure and significant frontal swelling, ultimately necessitating bedside placement of a Keen's point EVD.
CONCLUSIONS: In all cases, we were able to reliably maintain continuous CSF diversion for an extended period of time. There was one mortality due to severity of initial injuries. In the remaining two patients, ICP was able to be normalized following placement of Keen's point EVD. The Keen's point EVD is a viable option to maintain continuous CSF drainage in patients with diffuse intracranial injury and should be considered in patients for whom frontal EVD cannot reliably maintain continuous drainage of CSF.
PMID: 28400228 [PubMed - as supplied by publisher]
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