Neural injury by frontal approach of external ventricular drainage in stroke patients

Abstract

Objectives: No study on the characteristics of injury of neural tracts following external ventricular drainage (EVD) in a large number of consecutive patients following EVD has been reported. In this study, using diffusion tensor tractography (DTT), we attempted to investigate the characteristics of injury of neural tracts associated with EVD using a frontal approach in stroke patients. Methods: We recruited 43 consecutive hemorrhagic stroke patients with a history of EVD using a frontal approach. Five neural tracts were reconstructed [corticospinal-tract (CST), corticoreticular-pathway (CRP), arcuate-fasciculus (AF), cingulum, and superior-longitudinal-fasciculus (SLF)]. Results: Among five neural tracts, neural injury by EVD was observed on only two neural tracts (the CRP and the cingulum): CRP—seven (16.3%, five patients—partial tearing and two patients—complete discontinuation) of 43 patients and cingulum—eight (18.6%, eight patients—complete discontinuation of the anterior portion of the cingulum) of 43 patients. Conclusions: It appears that neural injury occurred in a considerable number of patients who underwent EVD; therefore, conduct of further studies on measures to prevent or minimize neural injury by EVD should be encouraged.

KEYWORDS:

• external ventricular drainage
• neural tract injury
• diffusion tensor tractography
• stroke

Acknowledgement

This work was supported by the 2013 Yeungnam University Research Grant.

Funding statement

Name of funder: Yeungnam University Research Grant number: 2013.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Contributor ship statement

Sung Ho Jang: Conceiving and designing the study, funding, data acquisition, manuscript development and manuscript writing. Yong Min Kwon: Manuscript development, data acquisition, manuscript writing and manuscript authorization.