Bedside external ventricular drain placement: can multiple passes be predicted on the computed tomography scan before...

Area of Science:

• Neurosurgery
• Neurology
• Medical Devices

Background:

• Bedside external ventricular drain (EVD) placement is a critical neurosurgical procedure.
• Current EVD placement techniques can be suboptimal, frequently requiring multiple attempts.
• The impact of multiple passes on complication rates, particularly hemorrhage, requires further investigation.

Purpose of the Study:

• To determine the reasons for multiple passes during bedside EVD placement.
• To assess whether an increased number of passes correlates with a higher incidence of intracranial hemorrhage.
• To identify pre-procedural variables associated with the need for multiple EVD passes.

Main Methods:

• Prospective study analyzing 47 bedside external ventricular drain (EVD) placement procedures.
• Comparison of the number of insertion passes with the incidence of post-procedural hemorrhage.
• Analysis of pre-procedural computed tomography (CT) scans to identify factors correlating with multiple passes.

Main Results:

• 28% of EVD procedures required multiple passes (average 4.1 passes), while 72% were single pass.
• Overall tract hemorrhage incidence was 10.6%, with no statistically significant difference between single-pass (11.8%) and multiple-pass (7.7%) groups.
• Midline rostral hematoma (P = 0.0011) and larger targeted frontal horn volume (P = 0.035) were significantly associated with multiple passes.

Conclusions:

• Multiple passes are an intrinsic aspect of bedside external ventricular drain (EVD) placement.
• The number of passes during EVD insertion does not elevate the risk of intracranial hemorrhage.
• Pre-existing midline rostral hematoma and frontal horn volume are predictive factors for requiring multiple passes.