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Freehand external ventricular drain insertion - is there a learning curve?
B Ashan P Jayasekera1, Alaa Al-Mousa2, Anan Shtaya3
1Department of Neurosurgery, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Surgical Neurology International
|June 4, 2021
Summary
Accuracy of external ventricular drains (EVDs) insertion by junior neurosurgery trainees is good. While trainees perform more procedures with experience, placement accuracy did not significantly improve across training levels.
Area of Science:
- Neurosurgery
- Surgical Training
- Medical Imaging
Background:
- External ventricular drains (EVDs) are crucial for managing intracranial pressure.
- Accuracy of freehand EVD insertion can be affected by patient factors like midline shift.
- Assessing trainee performance in EVD placement is essential for surgical education.
Purpose of the Study:
- To evaluate the learning curve and accuracy of junior neurosurgical trainees in performing EVD insertions.
- To determine if EVD insertion accuracy improves with progressive training experience.
Main Methods:
- Retrospective review of EVD insertion procedures performed by neurosurgical trainees over their first three years.
- Analysis of postoperative CT head scans to radiologically grade the accuracy of EVD tip placement and intraventricular catheter length.
- Exclusion of assisted, revised, parietal, or occipital insertions to focus on primary frontal EVDs.
Main Results:
- 40 frontal EVDs performed primarily by trainees were analyzed.
- Approximately 80% of EVDs were deemed optimally inserted.
- No statistically significant differences in placement accuracy or catheter length were observed between different training grades (ST1, ST2, ST3).
Conclusions:
- Junior neurosurgical trainees demonstrate good accuracy in EVD tip placement.
- The number of independently performed EVD procedures increases with training progression.
- Further research should encompass senior training years and incorporate procedural factors and patient outcomes.
