Turkish Neurosurgery
How to secure CSF external drainage to the skin: Hints from an international survey and the current literature
Carolina Noya1, Anna Maria Auricchio1, Luca Massimi2, Federico Bianchi2, Gianpiero Tamburrini2, Paolo Frassanito2
1Università Cattolica del Sacro Cuore, Neurosurgery, Rome,
2Fondazione Policlinico Universitario A. Gemelli IRCCS, Neurosurgery, Rome,
DOI: 10.5137/1019-5149.JTN.37155-21.1

Cerebrospinal Fluid (CSF) external drainages (EDs), either ventricular or spinal, represents a universal practice in neurosurgery. Insufficient attention has been given to the methods used to secure EDs to the skin and related complications in the literature to date. This international survey is aimed at investigating the current practice of neurosurgeons and their perception of complications related to securement of ED to the skin. We created on Google Forms a 24-points English language questionnaire concerning 5 main domains of care. The survey was sent to members of European Society for Pediatric Neurosurgery (ESPN) in April 2020. Results were entirely self-reported, without any independent validation. 51 neurosurgeons practicing in different centers participated in this survey. Sutures remain the most common method to secure to the skin CSF ventricular (49/51 respondents) and spinal ED (37/51). Perception of the risk of pullout is estimated as <1% by 25.5% of respondents, 1-5% by 39.2%, 5-10% by 17.6%, >10% by 11.8%. Twenty out of 51 respondents recognize their method of securement burdened by drawbacks and 49% may also affect the risk of infection. Factors eventually affecting the risk of pullout are: young age (62.7%), etiology (25.5%), neurological status (90.2%), occipital exit site (37.3%), inadequate length of subcutaneous tunnel (58%), duration of ED (70.6%), and hospital stay in a service (84.3%). 39.2% of respondents agree that pediatric population deserves a different device/technique to secure ED to the skin. 21.6% of respondents probably underestimate the risk of accidental pullout. 86.3% of respondents have never read about ‘sutureless subcutaneous anchoring device’. Sutures remain the most common method to secure CSF ED to the skin, despite well-known complications and drawbacks. Complications as the risk of pullout and the risk of infection related to securement method, are probably under-estimated. Further studies are advocated to implement effective guidelines in this field.

Corresponding author : Paolo Frassanito