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
Neurosurgeryjournal_title
Neurosurgeryauthors
Toma AK,Camp S,Watkins LD,Grieve J,Kitchen NDdoi
10.1227/01.NEU.0000356973.39913.0Bsubject
Has Abstractpub_date
2009-12-01 00:00:00pages
1197-200; discussion 1200-1issue
6eissn
0148-396Xissn
1524-4040pii
00006123-200912000-00033journal_volume
65pub_type
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