2 research outputs found
The Risk Factors of External Ventricular Drainage-Related Infection at Hospital Kuala Lumpur: An Observational Study
Background: External ventricular drainage (EVD) has been widely used
for the purpose of cerebrospinal fluid (CSF) diversion at Hospital
Kuala Lumpur (HKL). Methods: This prospective observational study was
conducted in HKL from December 2006 to December 2008 among patients who
were subjected for EVD, following strict inclusion and exclusion
criteria. Results: The frequency of EVD-related infection was as high
as 32.2% (95% CI 23.3% to 42.57%) among 87 patients studied. This study
clearly demonstrates that tunnelling the catheter for more than 5 cm
under the scalp, from the burr hole to the exit site of the skin,
carried a significantly lower risk of infection compared with
tunnelling the catheter for 5 cm or less (OR = 0.184, 95% CI 0.083 to
0.406, P < 0.001). The majority of cases (19 out of 28) with
EVD-related infection occurred among patients catheterised for more
than 10 days (OR = 0.334, 95% CI 0.171 to 0.652, P < 0.001).
Conclusion: The technique of subgaleal tunnelling of more than 5cm and
the duration of the ventricular catheterisation of 10 days and less
should be implemented as standardised protocol at health institutions
to reduce the risk of EVD-related infections
Treatment Outcome of Superficial Cerebral Abscess: An Analysis of Two Surgical Methods
Background: The purpose of the study is to compare the two surgical
methods (burr hole and craniotomy) used as treatment for superficial
cerebral abscess and its outcome in terms of radiological clearance on
brain CT, improvement of neurological status, the need for repeated
surgery, and survival and morbidity at three months after surgery. This
report is a retrospective case review of the patients who were treated
surgically for superficial cerebral abscess in Hospital Kuala Lumpur
(HKL) and Hospital Sultanah Aminah (HSA) over a period of four years
(2004 to 2007). Methods: Fifty-one cases were included in this study:
64.7% of patients were male and 35.5% were female. Most of the patients
were Malay (70.6%); 28 patients (54.9%) had undergone craniotomy and
excision of abscess, and the rest had undergone burr hole aspiration as
their first surgical treatment. Results: This study reveals that
patients who had undergone craniotomy and excision of abscess showed a
significantly earlier improvement in neurological function, better
radiological clearance and lower rate of re-surgery as compared to the
burr hole aspiration group (P-value < 0.05). However, with respect
to neurological improvement at 3 months, morbidity and mortality, there
is no significant difference between the two surgical methods.
Conclusion: The significance of these findings can only be confirmed by
a prospective randomised series. Further study will be required to
assess the cost effectiveness, intensive care needs, and possibility of
shorter antibiotic usage as compared to burr hole aspiration