Real-time ultrasound-guided external ventricular drain placement: technical note.

Area of Science:

• Neurosurgery
• Medical Imaging
• Surgical Techniques

Background:

• Ultrasound-guided external ventricular drain (EVD) insertion is increasingly standard in the UK to reduce complications.
• Real-time ultrasound visualization of ventricular cannulation is superior to preinsertion trajectory checks, especially in small ventricles.
• Simultaneous probe manipulation and catheter insertion pose technical challenges for real-time ultrasound navigation.

Purpose of the Study:

• To describe a simple, user-friendly technique for precise EVD placement using readily available equipment.
• To demonstrate a method for real-time ultrasound navigation during ventricular cannulation.
• To minimize catheter malposition and reduce multiple cannulation attempts.

Main Methods:

• Utilized a bur hole ultrasound transducer attached to a 10-gauge needle guide channel.
• Accommodated a ventriculostomy catheter within the guide channel.
• Projected the anticipated trajectory line onto the display for real-time navigation into the ipsilateral lateral ventricle.

Main Results:

• A representative case and video illustrate the technique.
• The method is described as rapid, user-friendly, and reliable.
• Potential to minimize risks associated with catheter misplacement and multiple attempts.

Conclusions:

• The described technique offers a practical solution for precise EVD placement.
• This approach can be particularly beneficial for junior neurosurgeons in challenging situations.
• Encourages wider adoption to improve patient safety and procedural efficiency.