External ventricular drain insertion accuracy: is there a need for change in practice?

Abstract:

OBJECTIVE:Free-hand insertion of an external ventricular drain (EVD) is a common emergency neurosurgical procedure, mostly performed for critically ill patients. Although EVD complications have been studied thoroughly, the accuracy of EVD positioning has been audited only occasionally. METHODS:Post-EVD insertion computed tomographic scans performed in our unit over a 2-year period were analyzed for EVD tip location and intracranial catheter length. RESULTS:A total of 183 post-EVD insertion scans were reviewed. Of those, 73 EVD tips (39.9%) were in the ipsilateral frontal horn of the lateral ventricle (the desired target); of those, 18 (25%) required EVD revision/reinsertion. Of the others, 35 (19.1%) were in the third ventricle, 33 (18%) in the body of the lateral ventricle, 19 (10.4%) in the subarachnoid space, 5 (2.7%) in the contralateral frontal horn, and 18 (9.8%) within the brain parenchyma. When the EVD tip was outside the desired target, 44 of the patients (40%) required EVD revision/reinsertion procedure (P = 0.0383). CONCLUSION:Free-hand insertion of an EVD is an inaccurate procedure, and further studies are required to assess the accuracy and feasibility of the routine use of neuronavigation, ultrasonography, or other guidance techniques and the possible implication of the decreasing revision rate, complications, and length of hospital stay.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Toma AK,Camp S,Watkins LD,Grieve J,Kitchen ND

doi

10.1227/01.NEU.0000356973.39913.0B

subject

Has Abstract

pub_date

2009-12-01 00:00:00

pages

1197-200; discussion 1200-1

issue

6

eissn

0148-396X

issn

1524-4040

pii

00006123-200912000-00033

journal_volume

65

pub_type

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