Electromagnetic stereotactic navigation for external ventricular drain placement in the intensive care unit

Area of Science:

• Neurosurgery
• Medical Technology
• Intensive Care Medicine

Background:

• External ventricular drains (EVDs) are crucial for managing intracranial pressure but carry risks.
• Traditional free-hand EVD placement has a notable rate of complications, including malposition and hemorrhage.
• Improving the accuracy and safety of EVD placement is a clinical priority.

Purpose of the Study:

• To evaluate the accuracy and safety of electromagnetic image-guided ventriculostomy placement in the intensive care unit (ICU).
• To compare the complication rates and accuracy of image-guided EVD placement with historical data from free-hand techniques.

Main Methods:

• A single-arm trial involving 35 patients undergoing bedside ventriculostomy using electromagnetic image guidance technology in the ICU.
• Quantification of procedure duration, operative time, and imaging time.
• Assessment of catheter placement accuracy and complication rates, including tract hemorrhage and malposition.

Main Results:

• No unacceptably placed ventriculostomy catheters were identified; only two required minor repositioning.
• A single case of tract hemorrhage occurred.
• Image guidance added 36 minutes to the time to drainage but only 4 minutes to operative time.
• Statistically significant improvement in placement accuracy compared to historical free-hand data.
• Two registration failures occurred, managed by converting to the traditional technique.

Conclusions:

• Electromagnetic image guidance is a feasible and accurate technology for bedside ventriculostomy in the ICU.
• Image-guided technology eliminates unacceptably placed catheters.
• This method may reduce the incidence of catheter-associated intracerebral hemorrhages.