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Updated: Dec 3, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a
Ivan Cabrilo1, Claudia L Craven2, Hazem Abuhusain2
1Neurosurgery Department, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals, London, WC1N 3BG, UK. iv.cabrilo@gmail.com.
Background:
The insertion of bolt external ventricular drains (EVD) on the intensive care unit (ICU) has enabled rapid cranial cerebrospinal fluid (CSF) diversion. However, bolt EVDs tend to be perceived as a more challenging technique, particularly when dealing with small ventricles or when there is midline shift distorting the ventricular morphology. Furthermore, if neuronavigation guidance is felt to be necessary, this usually assumes a transfer to an operating theatre. In this technical note, we describe the use of electromagnetic neuronavigation for bolt EVD insertion on the ICU and assess the protocol's feasibility and accuracy.
Methods:
Case series of neuronavigation-assisted bolt EVD insertion in ICU setting, using Medtronic Flat Emitter for StealthStation EM.
Results:
Neuronavigation-guided bolt EVDs were placed at the bedside in n = 5 patients on ICU. Their widest frontal ventricular horn diameter in the coronal plane ranged from 11 to 20 mm. No procedural complications were encountered. Post-procedural CT confirmed the optimal placement of the EVDs.
Conclusions:
Electromagnetic neuronavigation is feasible at the ICU bedside and can assist the insertion of bolt EVDs in this setting. The preference for a bolt EVD to be inserted in ICU-as is standard practice at this unit-should not prohibit patients from benefitting from image guidance if required.
