PROLONGED EXTERNAL VENTRICULAR DRAINAGE WITH PERCUTANEOUS LONG-TUNNELVENTRICULOSTOMIES

External ventricular drainage has been used extensively for management of several neurosurgical disorders. The main limitation of this proce dure has been the high risk of infection: especially with prolonged dr ainage. In an effort to minimize the risk of infection, the authors ha ve used a new ventriculostomy technique that involves tunneling the ve ntricular catheter subcutaneously to an exit site in the lower chest o r upper abdomen. This report describes the results of this procedure o n 100 consecutive cases. Patients requiring emergency ventriculostomie s had short-tunnel ventriculostomies placed at the bedside that were c onverted to long-tunnel ventriculostomies in the operating room within 5 days. The average duration of drainage was 18.3 days (range 5-40 da ys). Cerebrospinal fluid was routinely sent for Gram staining and cult ure to monitor for infection. Prophylactic antibiotic medications were administered only perioperatively. No infection was observed during t he first 16 days of drainage in any patient. The overall incidence of infection was 4% and blockage occurred in 6% of the cases. In this ser ies the incidence of ventricular infection was 2.37 per 1000 ventricul ar drainage days, one of the lowest reported incidences of infection i n the literature. This procedure provides a simple and effective metho d of maintaining long-term ventricular drainage with a very low risk o f infection or blockage.