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HydrocephalusNCT02408757

Sonographic Monitoring of Weaning of Cerebrospinal Fluid Drainages

An observational study of Hydrocephalus, run by Insel Gruppe AG, University Hospital Bern at 1 site in Switzerland.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

As elaborated above only one study reported ultrasonographic changes of the width of the lateral ventricle during clamping of EVD/LD and indicated that ultrasound monitoring might be suitable. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Hydrocephalus
What is being tested?
Sonographic monitoring
Type of treatment
Surgery or procedure
How many people
44 participants
Where
1 siteSwitzerland
Study dates
Sep 2015to 27 Nov 2023
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: The study population consists of consecutive patients undergoing clamping of EVD/LD treated at the Departments of Neurosurgery or Intensive Care Medicine at the University Hospital Bern

Who may be able to join

  • Informed consent of patient or relative and statement of independent physician
  • Patient treated with EVD or LD undergoing clamping of EVD/LD
  • Age ≥18 ≤ 80 years

Who cannot join

  • Pregnancy and breastfeeding
  • Acute coronary syndromes, severe ischemic heart disease (requiring revascularisation), severe aortic and mitral valve disease, severe congestive heart failure (NYHA >III/IV)
  • Severe pulmonary or renal dysfunction
  • Known allergy or adverse reaction to contrast material

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • Inselspital Bern

    Bern, 3010

Other trials in Switzerland

About this study

Official title: Multimodal Sonographic Monitoring of Cerebral Perfusion, Ventricle Seize and Optic Nerve Diameter During Weaning of Cerebrospinal Fluid Drainage Catheters: a Single Centre Observational Trial

As elaborated above only one study reported ultrasonographic changes of the width of the lateral ventricle during clamping of EVD/LD and indicated that ultrasound monitoring might be suitable. No firm data exists about the change of the width of the third ventricle, the diameter of the optic nerve or brain perfusion during clamping of the EVD/LD, although the width of these structures has been shown to depend on intracranial pressure. Ultrasonographic measurements of changes of the width of the third ventricle or the diameter of the optic nerve would have some advantages compared to the ultrasonographic assessments of the lateral ventricles. First, the width of the third ventricle can be measured easier and more reliable than the width of the lateral ventricles (better defined insonation plane and therefore higher repeatability of measurements) 3. Second, whereas assessments of the width of the side and third ventricles with ultrasound depend on the temporal bone windows (10 to 15% of patients have insufficient temporal bone windows), the measurement of the diameter of the optic nerve does not have this limitation and can therefore be performed in almost all patients. Hence, measurement of the diameter of the optic nerve would allow to overcome one major limitation of transcranial ultrasound. The latter limitation for transcranial ultrasound could also be minimized by the use of an ultrasound contrast agent (SonoVue®), but this was also not yet studied. The use of an ultrasound contrast agent would in addition allow to study changes of brain perfusion during clamping of EVD/LD.

Read the detailed description

Background

Placement of a CSF drainage catheter (external ventricular drainage (EVD) or lumbar drainage (LD)) is a frequent neurosurgical emergency intervention. It is used in case of obstructive hydrocephalus as it can occur after e.g. intracerebral hemorrhage with intraventricular involvement, subarachnoid hemorrhage or traumatic brain injury but also in situations with reduced CSF resorption or increased CSF production (e.g. meningitis, ventriculitis). Furthermore, this technique can be used to monitor intracranial pressure. In all these situations, the EVD/LD can be used to reduce the elevated intracranial pressure during the acute phase. However, because of impairment of the Paccioni granulations by blood and its breakdown products, a continuing hydrocephalus may develop, leading to permanent necessity of CSF drainage. To evaluate the need for a permanent (implanted) drainage system (e.g. ventriculoperitoneal or ventriculoatrial shunt) attempts to clamp the EVD/LD are carried out during the subacute phase. Successful clamping is verified by absent increase of intracranial pressure, absent clinical deterioration and lack of ventricular enlargement on serial CT scans. The latter means that a first CT scan has to be performed before clamping of the drainage catheter (baseline examination) and again 24 hours after clamping of the drainage catheter. This leads to the need for repeated transportations of critically ill patients with possible harm of the patient, high costs, need for more staff and repeated exposure of the patient to radiation. Hence, a simple, repeatable, non-invasive, bedside tool for diagnosis of ventricular enlargement due to clamping of EVD/LD is strongly needed.

Transcranial ultrasound has become a widely used technique mainly for measuring arterial blood flow velocities. More recently, transcranial ultrasound has been also used to assess brain tissue, brain perfusion and ventricular size. The major advantages of ultrasound are its non-invasive character, the possibility for bedside application, low costs and safety (no X-ray exposure). Some studies have tried to use transcranial ultrasound for indirect assessment of intracranial pressure. As target structures for transcranial ultrasound either the lateral ventricles, the third ventricle or the diameter of the optic nerve were used. All studies could demonstrate a correlation between the width of the lateral or third ventricle or the diameter of the optic nerve with intracranial pressure. To the investigators' knowledge, only one study assessed the change of the width of the lateral ventricles during clamping of EVD/LD.

To summarize, a bedside method for assessment of changes of ventricle width/diameter of the optic nerve during clamping of EVD/LD is urgently needed and would facilitate the procedure, higher patient safety and lower costs. By now, there are some promising ultrasound methods (transcranial ultrasound with or without contrast enhancing agent to determine the width of the side and third ventricle, diameter of the optic nerve), which might substitute repeated CT scans but have not been evaluated for monitoring clamping of EVD/LD.

Objective

The investigators hypothesize that clamping of EVD/LD can be monitored using repeated bedside ultrasound examinations instead of repeated CT scans. The purpose of this study is to investigate if a multimodal approach consisting of ultrasonographic determination of changes of the width of the third and the side ventricles as well as the diameter of the optic nerve can be used to screen for ventricle enlargement during clamping of EVD/LD. To this end, the investigators will compare a classifier based on ultrasound with the clinical decision based on CT.

Methods

The study consists of two additional ultrasonographic examinations . The standard treatment of patients undergoing clamping of EVD/LD is not affected by the study. The first ultrasonographic examination is performed in parallel to the baseline CT scan (either immediately before or after the CT scan) before clamping of the EVD/LD. The second ultrasound is made 24 hours after clamping of the EVD/LD in parallel to the follow-up CT Scan (either immediately before or after the CT scan). The examinations will be made bedside in the supine position on the ward where the patient is treated.

Conditions
Hydrocephalus
Being tested
Sonographic monitoring
Keywords
ultrasound, cerebral perfusion, cerebrospinal fluid drainage
Medical subject headings
Hydrocephalus, Cerebrospinal Fluid Leak

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Sonographic monitoringProcedure or surgery

    Sonographic monitoring during weaning of cerebrospinal fluid drainage catheters

Study groups in NCT02408757
Study groupRoleWhat they receive
All study participantsThe study population consists of consecutive patients undergoing clamping of EVD/LD treated at the Departments of Neurosurgery or Intensive Care Medicine at the University Hospital Bern
Receives: Procedure: Sonographic monitoring

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. binary classification of patients in terms of change of width of cerebrospinal fluid spaces by ultrasound

    Measured: 24 hours after clamping of EVD/LD

Secondary outcomes (7)
  1. change of width of the third ventricle measured with transcranial ultrasound without ultrasound contrast agent

    Measured: 24 hours after clamping of EVD/LD

  2. change of width of the third ventricle measured with transcranial ultrasound with ultrasound contrast agent

    Measured: 24 hours after clamping of EVD/LD

  3. change of width of the lateral ventricles measured with transcranial ultrasound without ultrasound contrast agent

    Measured: 24 hours after clamping of EVD/LD

  4. change of diameter of the optic nerve

    Measured: 24 hours after clamping of EVD/LD

  5. change of width of the third ventricle in the CT scan

    Measured: 24 hours after clamping of EVD/LD

  6. change of width of the lateral ventricles in the CT scan

    Measured: 24 hours after clamping of EVD/LD

  7. change of brain perfusion in the brain regions adjacent to the third ventricle

    Measured: 24 hours after clamping of EVD/LD

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Apr 2015 (estimated)
  2. Study startSep 2015
  3. Primary completion31 Oct 2023
  4. Study completion27 Nov 2023

Why it stopped: Insufficient recruitment

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
44 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02408757
Sponsor's protocol ID
KEK 077/15
Status last verified
Nov 2023
First submitted
31 Mar 2015
Last updated
6 Dec 2023
Results posted
No
Data monitoring committee
No

Publications

  • Voigt LP, Pastores SM, Raoof ND, Thaler HT, Halpern NA. Review of a large clinical series: intrahospital transport of critically ill patients: outcomes, timing, and patterns. J Intensive Care Med. 2009 Mar-Apr;24(2):108-15. doi: 10.1177/0885066608329946. Epub 2009 Feb 2.

    PubMed 19188270
  • Waydhas C. Intrahospital transport of critically ill patients. Crit Care. 1999;3(5):R83-9. doi: 10.1186/cc362. Epub 1999 Sep 24.

    PubMed 11094486
  • Becker G, Bogdahn U, Strassburg HM, Lindner A, Hassel W, Meixensberger J, Hofmann E. Identification of ventricular enlargement and estimation of intracranial pressure by transcranial color-coded real-time sonography. J Neuroimaging. 1994 Jan;4(1):17-22. doi: 10.1111/jon19944117.

    PubMed 7907896
  • Bolesch S, von Wegner F, Senft C, Lorenz MW. Transcranial ultrasound to detect elevated intracranial pressure: comparison of septum pellucidum undulations and optic nerve sheath diameter. Ultrasound Med Biol. 2015 May;41(5):1233-40. doi: 10.1016/j.ultrasmedbio.2014.12.023. Epub 2015 Jan 28.

    PubMed 25638313
  • Kiphuth IC, Huttner HB, Struffert T, Schwab S, Kohrmann M. Sonographic monitoring of ventricle enlargement in posthemorrhagic hydrocephalus. Neurology. 2011 Mar 8;76(10):858-62. doi: 10.1212/WNL.0b013e31820f2e0f. Epub 2011 Feb 2.

    PubMed 21288979
  • Jungehulsing GJ, Brunecker P, Nolte CH, Fiebach JB, Kunze C, Doepp F, Villringer A, Schreiber SJ. Diagnostic transcranial ultrasound perfusion-imaging at 2.5 MHz does not affect the blood-brain barrier. Ultrasound Med Biol. 2008 Jan;34(1):147-50. doi: 10.1016/j.ultrasmedbio.2007.07.006. Epub 2007 Sep 14.

    PubMed 17854981
  • Engelhardt M, Hansen C, Eyding J, Wilkening W, Brenke C, Krogias C, Scholz M, Harders A, Ermert H, Schmieder K. Feasibility of contrast-enhanced sonography during resection of cerebral tumours: initial results of a prospective study. Ultrasound Med Biol. 2007 Apr;33(4):571-5. doi: 10.1016/j.ultrasmedbio.2006.10.007.

    PubMed 17337111
  • Kopp R, Zurn W, Weidenhagen R, Meimarakis G, Clevert DA. First experience using intraoperative contrast-enhanced ultrasound during endovascular aneurysm repair for infrarenal aortic aneurysms. J Vasc Surg. 2010 May;51(5):1103-10. doi: 10.1016/j.jvs.2009.12.050.

    PubMed 20420978
  • Shah AJ, Callaway M, Thomas MG, Finch-Jones MD. Contrast-enhanced intraoperative ultrasound improves detection of liver metastases during surgery for primary colorectal cancer. HPB (Oxford). 2010 Apr;12(3):181-7. doi: 10.1111/j.1477-2574.2009.00141.x.

    PubMed 20590885
  • Wu H, Lu Q, Luo Y, He XL, Zeng Y. Application of contrast-enhanced intraoperative ultrasonography in the decision-making about hepatocellular carcinoma operation. World J Gastroenterol. 2010 Jan 28;16(4):508-12. doi: 10.3748/wjg.v16.i4.508.

    PubMed 20101780
  • Bokor D, Chambers JB, Rees PJ, Mant TG, Luzzani F, Spinazzi A. Clinical safety of SonoVue, a new contrast agent for ultrasound imaging, in healthy volunteers and in patients with chronic obstructive pulmonary disease. Invest Radiol. 2001 Feb;36(2):104-9. doi: 10.1097/00004424-200102000-00006.

    PubMed 11224758
  • Piscaglia F, Bolondi L; Italian Society for Ultrasound in Medicine and Biology (SIUMB) Study Group on Ultrasound Contrast Agents. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol. 2006 Sep;32(9):1369-75. doi: 10.1016/j.ultrasmedbio.2006.05.031.

    PubMed 16965977

Questions about this trial

What is this clinical trial studying?

An observational study of Hydrocephalus, run by Insel Gruppe AG, University Hospital Bern at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 6 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was stopped early (reason given: Insufficient recruitment). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

binary classification of patients in terms of change of width of cerebrospinal fluid spaces by ultrasound (time frame: 24 hours after clamping of EVD/LD). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02408757, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Dec 2023.

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