The insertion of an external ventricular drain (EVD) is a standard procedure for the treatment of acute hydrocephalus. To compare the regularly adopted surgical procedures in our clinic in terms of complications, the first analysis on a pediatric population was performed.

101 patients were included in this retrospective study (62 males, 39 females, mean age 7,1 years, range from 17,5 to 0 years) and dichotomized considering two different surgical procedures to reach the ventricular system: an electric or mechanical compressed air drill and the BoltKit-System (BS). The first procedure implies an under-scalp drain tunneling, the second one entails the fixation of the EVD in a skull bolted screw. In both techniques a catheter fixation by the skull skin is required.

Statistical analyses were performed balancing gender, age, side and the location of the drainage with the occurrence of complications like cerebrospinal fluid (CSF) infections, multiple insertion attempts, malpositions, revisions and bleedings. The group comparison was conducted using a chi square dependency test.

79 patients were treated using the tunneling procedure, 22 the BS procedure. 81 EVDs were placed frontal, 18 occipital, 68 right and 25 left. Revisions (n=22) represented the most frequent complication, followed by CSF infections (n=13), multiple insertion attempts (n=11), malpositions (n=10) and bleedings (n=4). Considering the EVD positioning, CSF infections occured more frequently frontal than occipital (p=0.009). No other differences in terms of complications could be found, not even in relation to the side of the drainage, age and gender. Multiple insertion attempts, malpositions and revisions were significantly higher by the BS-procedure (p=0.017; p=0.037; p=0.019). Regarding CSF infections and bleeding no significant differences between the two procedures could be detected.

We could report a higher rate of complications by the BS procedure compared with the tunneling procedure for the treatment of children with acute hydrocephalus. No difference concerning CSF-infections could be described.