Freehand frontal external ventricular drain (EVD) placement: Accuracy and complications

Hulou, M. Maher; Maglinger, Benton; McLouth, Christopher J.; Reusche, Catalina M.; Fraser, Justin F.

doi:10.1016/j.jocn.2021.12.036

Cited by 3 publications

(9 citation statements)

References 19 publications

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“…(72.5% accuracy for KG-1) found a statistically significant impact of trauma diagnosis, low bicaudate index, high midline shift, and left-sided placement on rates of accuracy, our present study isolated the size of ventricles as the only significant variable affecting accurate EVD placement. [ 7 ] However, despite accuracy being an important measure, within our cohort, there was no significant relationship between accuracy and outcomes. The low rate of malpositioned catheters in the study likely contributed to the lack of a significant relationship between accuracy and outcomes.…”

Section: Discussionmentioning

confidence: 68%

“…The placement of an external ventricular drain (EVD) for the treatment of acute hydrocephalus or elevated intracranial pressure (ICP) is one of the most common life-saving procedures that neurosurgeons perform worldwide. [ 7 , 12 ] EVDs can be used to both monitor and treat intracranial hypertension through the diversion of cerebrospinal fluid (CSF) in a multitude of disease states, including acute hydrocephalus from aneurysmal subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), severe traumatic brain injury, and obstructive hydrocephalus from certain tumors. [ 4 , 9 , 12 ] Given the acute and life-threatening nature of acute hydrocephalus and elevated ICP and the time-sensitive need for CSF diversion, it is widely accepted that EVDs can be placed at the bedside, employing a “free-hand” technique using anatomical landmarks to accurately cannulate the frontal horn of the ipsilateral ventricle.…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 , 9 , 12 ] Given the acute and life-threatening nature of acute hydrocephalus and elevated ICP and the time-sensitive need for CSF diversion, it is widely accepted that EVDs can be placed at the bedside, employing a “free-hand” technique using anatomical landmarks to accurately cannulate the frontal horn of the ipsilateral ventricle. [ 7 , 9 , 12 ]…”

Section: Introductionmentioning

confidence: 99%

“…[ 3 ] Complication rates vary but have been reported to be as high as 20–30% for hemorrhagic complications,[ 8 , 12 ] up to 45% for catheter misplacement,[ 12 ] and infection rates from 4% to 40%. [ 7 , 9 , 15 , 16 ] These complications are associated with an increase in hospital length of stay (LOS) and patient morbidity and mortality. [ 3 , 5 , 16 ] EVD misplacement may be associated with EVD failure, intracranial hemorrhage, higher reinsertion rates, and drain blockages.…”

Section: Introductionmentioning

confidence: 99%

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Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy

Sharma,

Head,

Mallela

et al. 2024

Surgical Neurology International

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Background: The placement of an external ventricular drain (EVD) for the treatment of acute hydrocephalus is one of the most common life-saving procedures that neurosurgeons perform worldwide. There are many well-known complications associated with EVD placement, including tract hemorrhages, intra-parenchymal and subdural hemorrhages, infection, and catheter misplacement. Given the variety of complications associated with EVD placement and the inconsistent findings on the relationship of accuracy to complications, the present study reviewed short- and long-term complications related to EVD placement at our institution. Methods: A retrospective review was conducted for all consecutive patients who underwent bedside EVD placement for any indication between December 2020 and December 2021. Collected variables included demographic information, etiology of disease state, pre-and post-operative head computed tomography measurements, and post-procedural metrics (immediate and delayed complications). Results: A total of 124 patients qualified for inclusion in our study. EVDs that were non-functioning/exchanged were not significantly related to age, accuracy, ventriculomegaly, sex, disposition, laterality, type of EVD used, intraventricular hemorrhage (IVH), etiology, or Kakarla Grade (KG) (all P > 0.17). The need for a second EVD was similarly not related to age, accuracy, ventriculomegaly, sex, disposition, location, laterality, type of EVD used, IVH, etiology, or KG (all P > 0.130). Patients who died, however, were significantly more likely to have a second contralateral EVD placed (18.2% vs. 4.9% P = 0.029). We also found that left-sided EVDs were significantly more likely to fail within seven days of placement (29.4% vs 13.3%, P = 0.037; relative risk (RR) 1.93, 95% confidence interval: 1.09-3.43), unrelated to age, sex, etiology, type of EVD, IVH, location of the procedure, or accuracy (all P > 0.07). This remained significant when using a binary logistic regression to control for ventriculomegaly, accuracy, mortality, age, sex, and etiology (P = 0.021, B = 3.43). Conclusion: In our cohort, although a clear relationship between inaccuracy and complication rates was not found, our data did demonstrate that left-sided EVDs were more likely to fail within the immediate postoperative time point, and patients who died were more likely to have a second, contralateral EVD placed.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy

Sharma,

Head,

Mallela

et al. 2024

Surgical Neurology International

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“…In such cases, repeated trajectory corrections could lead to otherwise avoidable and potentially fatal complications. 3 In day-to-day clinical practice, EVD placement is most commonly performed urgently in the operating room under general anesthesia, and the trajectory is determined according to anatomical landmarks. 4 The entry point of choice is Kocher's point.…”

mentioning

confidence: 99%

IMAGINER: improving accuracy with a mixed reality navigation system during placement of external ventricular drains. A feasibility study

Grunert,

Winkler,

Wach

et al. 2024

Neurosurgical Focus

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OBJECTIVE The placement of a ventricular catheter, that is, an external ventricular drain (EVD), is a common and essential neurosurgical procedure. In addition, it is one of the first procedures performed by inexperienced neurosurgeons. With or without surgical experience, the placement of an EVD according to anatomical landmarks only can be difficult, with the potential risk for inaccurate catheter placement. Repeated corrections can lead to avoidable complications. The use of mixed reality could be a helpful guide and improve the accuracy of drain placement, especially in patients with acute pathology leading to the displacement of anatomical structures. Using a human cadaveric model in this feasibility study, the authors aimed to evaluate the accuracy of EVD placement by comparing two techniques: mixed reality and freehand placement. METHODS Twenty medical students performed the EVD placement procedure with a Cushing’s ventricular cannula on the right and left sides of the ventricular system. The cannula was placed according to landmarks on one side and with the assistance of mixed reality (Microsoft HoloLens 2) on the other side. With mixed reality, a planned trajectory was displayed in the field of view that guides the placement of the cannula. Subsequently, the actual position of the cannula was assessed with the help of a CT scan with a 1-mm slice thickness. The bony structure as well as the left and right cannula positions were registered to the CT scan with the planned target point before the placement procedure. CloudCompare software was applied for registration and evaluation of accuracy. RESULTS EVD placement using mixed reality was easily performed by all medical students. The predefined target point (inside the lateral ventricle) was reached with both techniques. However, the scattering radius of the target point reached through the use of mixed reality (12 mm) was reduced by more than 54% compared with the puncture without mixed reality (26 mm), which represents a doubling of the puncture accuracy. CONCLUSIONS This feasibility study specifically showed that the integration and use of mixed reality helps to achieve more than double the accuracy in the placement of ventricular catheters. Because of the easy availability of these new tools and their intuitive handling, we see great potential for mixed reality to improve accuracy.

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External ventricular drains and risk of freehand placement: A systematic review and meta-analysis

Nawabi

Stopa

Lassarén

et al. 2023

Clinical Neurology and Neurosurgery

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Freehand frontal external ventricular drain (EVD) placement: Accuracy and complications

Cited by 3 publications

References 19 publications

Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy

Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy

IMAGINER: improving accuracy with a mixed reality navigation system during placement of external ventricular drains. A feasibility study

External ventricular drains and risk of freehand placement: A systematic review and meta-analysis

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