Intraventricular hemorrhage following removal of external ventricular drains: Report of 2 pediatric cases

Risk of intraventricular bleeding following External Ventricular Drains (EVDs) placement is well recognized. On the contrary, hemorrhage following removal of EVD is considered highly unlikely. We report two cases of massive, symptomatic intraventricular hemorrhage that occurred soon after removal of EVD, in two pediatric patients, one affected by posterior fossa tumor, and the other by acute post-traumatic hydrocephalus. This complication significantly affected outcome: in both cases EVD should be replaced, hospitalization was prolonged and further surgery was required for persisting hydrocephalus. The first patient also presented neurological deficits and delay in starting oncological therapies. There are currently no articles that specifically address hemorrhagic risk in EVDs removal. Only one paper that evaluates EVD associated hemorrhage also discuss about hemorrhages caused by removal of the catheter in children. Such risk appears to be not negligible, with hemorrhagic rate of 21.9%. More often, these hemorrhages have few clinical significance, but severe sequelae, may also occur. This should be considered in decision making, and in discussing the risks with a patient's family. Keywords: Hydrocephalus, Pediatric, Complication, Shuntin