An Unexpected Complication by Misplacement of an External Ventricular Drain; Transient Oculomotor Palsy Due to Direct Compression by a Drain—A Case Report
- 1 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
- 2 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
- 3 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
- 4 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
- 5 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
- 6 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
- 7 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
- 8 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
Abstract
Background: Insertion of an external ventricular drain (EVD) is an important neurosurgical technique. There is a minor risk of misplacement, and complications including infections or hemorrhages have been reported. Transient neurological complications are, however, very rare, especially when EVD is placed under endoscope assistance. We report a case of unilateral transient oculomotor palsy after an EVD procedure. Case presentation: An 11-year-old boy with past medical history of moyamoya disease suffered from intraventricular hemorrhage and acute hydrocephalus. Insertion of EVD and hematoma removal was performed with endoscope assistance. After the surgery, transient oculomotor palsy occurred by the direct compression of the brain stem by the drainage tube. Conclusion: Transient unilateral oculomotor palsy due to the direct compression of the midbrain by an EVD tube is a very rare, but possible complication, even under endoscopic assistance. Attention through the procedure is required until skin closure to avoid tube dislocation.
- Kakarla, U.K., Kim, L.J., Chang, S.W., Theodore, N. and Spetzler, R.F. (2008) Safety and Accuracy of Bedside External Ventricular Drain Placement. Operative Neurosurgery, 63, ONS162-ONS166, Discussion ONS166-ONS167. http://dx.doi.org/10.1227/01.neu.0000312390.83127.7f
- Park, Y.G., Woo, H.J., Kim, E. and Park, J. (2011) Accuracy and Safety of Bedside External Ventricular Drain Placement at Two Different Cranial Sites: Kocher’s Point versus Forehead. Journal of Korean Neurosurgical Society, 50, 317-321. http://dx.doi.org/10.3340/jkns.2011.50.4.317
- Saladino, A., White, J.B., Wijdicks, E.F. and Lanzino, G. (2009) Malplacement of Ventricular Catheters by Neurosurgeons: A Single Institution Experience. Neurocritical Care, 10, 248-252. http://dx.doi.org/10.1007/s12028-008-9154-z
- Toma, A.K., Camp, S., Watkins, L.D., Grieve, J. and Kitchen, N.D. (2009) External Ventricular Drain Insertion Accuracy: Is There a Need for Change in Practice? Neurosurgery, 65, 1197-1200, Discussion 1200-1191.
- Woernle, C.M., Burkhardt, J.K., Bellut, D., Krayenbuehl, N. and Bertalanffy, H. (2011) Do Iatrogenic Factors Bias the Placement of External Ventricular Catheters? A Single Institute Experience and Review of the Literature.
- Ngo, Q.N., Ranger, A., Singh, R.N., Kornecki, A., Seabrook, J.A. and Fraser, D.D. (2009) External Ventricular Drains in Pediatric Patients. Pediatric Critical Care Medicine, 10, 346-351. http://dx.doi.org/10.1097/pcc.0b013e3181a320cd
- Chai, F.Y., Farizal, F. and Jegan, T. (2013) Coma due to Malplaced External Ventricular Drain. Turkish Neurosurgery, 23, 561-563.