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Related Experiment Video

Updated: Jun 18, 2026

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
14:59

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus

Published on: October 14, 2022

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

Ahmed K Toma1, Sophie Camp, Laurence D Watkins

  • 1Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, England. Ahmedktoma@yahoo.com

Neurosurgery
|November 26, 2009
PubMed
Summary

Free-hand insertion of external ventricular drains (EVDs) is often inaccurate, with nearly 40% of EVD tips misplaced. This neurosurgical technique frequently requires revision, highlighting the need for improved guidance methods.

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Area of Science:

  • Neurosurgery
  • Medical Imaging

Background:

  • External ventricular drains (EVDs) are critical for managing intracranial pressure in critically ill patients.
  • While EVD complications are well-documented, the accuracy of free-hand insertion remains under-investigated.

Purpose of the Study:

  • To audit the accuracy of EVD tip placement following free-hand insertion.
  • To determine the rate of EVD revision required due to inaccurate placement.

Main Methods:

  • Retrospective analysis of 183 post-insertion computed tomographic (CT) scans over a 2-year period.
  • Evaluation of EVD tip location relative to the targeted lateral ventricle.
  • Correlation of tip location with the need for revision or reinsertion.

Main Results:

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Last Updated: Jun 18, 2026

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
14:59

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus

Published on: October 14, 2022

  • Only 39.9% of EVD tips were accurately placed in the ipsilateral frontal horn of the lateral ventricle.
  • 39% of misplaced EVDs required revision or reinsertion.
  • Significant rates of malpositioning were observed in the third ventricle (19.1%), lateral ventricle body (18%), and subarachnoid space (10.4%).

Conclusions:

  • Free-hand EVD insertion is an imprecise neurosurgical technique.
  • Further research is needed to evaluate image-guided techniques like neuronavigation and ultrasonography for improving EVD accuracy.
  • Implementing guided techniques may reduce revision rates, complications, and hospital stay.