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Freehand frontal external ventricular drain (EVD) placement: Accuracy and complications
M Maher Hulou1, Benton Maglinger1, Christopher J McLouth2
1Department of Neurosurgery, University of Kentucky, Lexington, KY, USA.
Summary
Predictors of inaccurate external ventricular drain (EVD) placement were identified. Left-sided EVD placement and lower bicaudate index were associated with suboptimal catheter placement in trauma patients.
Area of Science:
- Neurosurgery
- Neurological Surgery
- Critical Care Medicine
Background:
- Ventriculostomy, or external ventricular drain (EVD) placement, is a critical neurosurgical procedure for managing intracranial pressure.
- Accurate EVD placement is crucial for effective cerebrospinal fluid (CSF) drainage and patient outcomes.
- Factors influencing EVD misplacement, infection, and hemorrhage require further investigation to optimize surgical techniques.
Purpose of the Study:
- To identify predictors of inaccurate external ventricular drain (EVD) placement.
- To determine the rates of infection and hemorrhage associated with EVD placement.
- To analyze the relationship between patient factors, EVD placement, and suboptimal outcomes.
Main Methods:
- Retrospective analysis of 131 consecutive freehand EVD placements between January and November 2019.
- Data collection included indications for EVD, infection, hemorrhage, and catheter placement accuracy (Kakarla grade).
- Univariate and multivariate regression analyses were performed to identify predictors of suboptimal EVD placement.
Main Results:
- Indications included subarachnoid hemorrhage (27.5%), hemorrhagic stroke (27.5%), and trauma (24.4%).
- Rates of CSF bacterial infection were 6.8%, small tract hemorrhage 12.2%, and large intraparenchymal hemorrhage 6.1%.
- Predictors of Kakarla grade 3 suboptimal placement included trauma diagnosis, left-sided EVD placement, increased midline shift, and lower bicaudate index. Low bicaudate index and left-sided EVD placement were significant predictors in the multivariable model.
Conclusions:
- Left-sided EVD placement and a lower bicaudate index are significant predictors of suboptimal catheter placement.
- These findings may help neurosurgeons refine EVD placement techniques to improve accuracy and patient safety.
- Further research could explore image-guided techniques to mitigate risks associated with freehand EVD placement.
