Background: Insertion of a frontal external ventricular drain (EVD) is a common emergency procedure in neurosurgery. Malpositioning of the EVD and/or triggering a new intracerebral or intraventricular hemorrhage (nICVH) are typical complications. The standard procedure (SP) uses a tape measure to identify the Kocher's point for placement of a frontal burr hole. A faster alternative to determine the correct position is the freehand technique (FHT). This study compared both techniques with regard to the correct positioning of the EVD tip and the induction catheter-induced nICVH.
Methods: We performed a retrospective analysis of patients who required an EVD for acute or chronic hydrocephalus between January 2013 and March 2014. The study consisted of two groups. In the first group, EVDs were placed with the FHT. In the second group the SP was used. Postoperative computed tomography scans were analyzed regarding correct positioning of the ventricular catheter, malpositioning of the tip of the EVD using a 4-point-scale, and evidence for catheter-induced nICVH.
Results: A total of 95 patients could be included. The FHT was performed in 43 cases and the SP in 52 cases. No significant differences between the two groups were found regarding the correct position of the EVD tip ( = 0.38) and nICVH ( = 0.12). There was no significant difference in malpositioning of the EVD tip between the groups ( = 0.34).
Conclusion: Our results show no significant differences between the two methods with regard to correct position, malpositioning, and nICVH. Thus we conclude that the FHT is a fast, safe, and effective alternative to the SP.
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- The study evaluates the effectiveness and safety of a guideless catheter placement technique for revision surgeries related to external ventricular drainage and ventricular shunt systems in hydrocephalus treatment.
- The analysis was conducted on 111 patients who underwent these revisions between January 2020 and January 2023, focusing on demographic and clinical data, including complication rates.
- Results showed that the guideless technique significantly lowered postoperative complications, with only 1.8% experiencing bleeding and 4.5% facing catheter malposition, highlighting its potential benefits in clinical practice.
Improving Successful Cannulation of External Ventricular Drain: 3D-Printed Surgical Guide for Inexperienced Neurosurgeons.
World Neurosurg
October 2024
Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore. Electronic address:
Objective: External ventricular drain (EVD) is a fundamental neurosurgical procedure that is commonly performed by junior neurosurgeons. Expedient, successful cannulation of the ventricles can be lifesaving. Yet, the free-hand technique of EVD insertion is associated with significant malpositioning rates.
View Article and Find Full Text PDFNavigated bedside implantation of external ventricular drains with mobile health guidance: technical note and case series.
Acta Neurochir (Wien)
February 2024
Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Purpose: External ventricular drain (EVD) implantation is one of the fundamental procedures of emergency neurosurgery usually performed freehand at bedside or in the operating room using anatomical landmarks. However, this technique is frequently associated with malpositioning leading to complications or dysfunction. Here, we describe a novel navigated bedside EVD insertion technique, which is evaluated in a clinical case series with the aim of safety, accuracy, and efficiency in neurosurgical emergency settings.
View Article and Find Full Text PDFTunneled antibiotic-impregnated vs. bolt-connected, non-coated external ventricular drainage: a comparison of complications.
Front Neurol
August 2023
Department of Neurosurgery, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.
Background: External ventricular drainage (EVD) is a common emergency neurosurgical procedure, but it is not free of adverse events. The aim of this study is to compare the complication rate of two frequently used EVD types, namely, tunneled antibiotic-impregnated catheters (Bactiseal) and bolt-connected non-coated devices (Camino).
Methods: All EVDs placed between 1 March 2015 and 31 December 2017 were registered.
Bullseye EVD: preclinical evaluation of an intra-procedural system to confirm external ventricular drainage catheter positioning.
Int J Comput Assist Radiol Surg
July 2022
Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, ON, Canada.
Purpose: External ventricular drainage (EVD) is a life-saving procedure indicated for elevated intracranial pressure. A catheter is inserted into the ventricles to drain cerebrospinal fluid and release the pressure on the brain. However, the standard freehand EVD technique results in catheter malpositioning in up to 60.
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