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Image-Guided versus Freehand Ventricular Drain Insertion: Systematic Review and Meta-analysis
Majid Aljoghaiman1, Bradley Bergen2, Radwan Takroni2
1Neurosurgery Division, Surgery Department, McMaster University, Hamilton, Ontario, Canada; Neurosurgery Division, Surgery Department, King Faisal University, Al-Ahsa, Saudi Arabia.
World Neurosurgery
|January 16, 2022
Summary
Image guidance in ventricular drain insertion improves accuracy and reduces failure rates. However, it likely does not decrease the number of insertion attempts, according to this review of neurosurgical procedures.
Area of Science:
- Neurosurgery
- Medical Imaging
- Clinical Effectiveness Research
Background:
- Ventricular drain insertion is a standard neurosurgical procedure.
- Current freehand techniques may have limitations in accuracy and success rates.
- Image guidance offers potential for improved outcomes in this procedure.
Purpose of the Study:
- To evaluate the impact of image guidance on ventricular drain placement.
- To assess the effect on drain accuracy and failure rates.
- To determine if image guidance influences the number of cannulation attempts.
Main Methods:
- Systematic review of MEDLINE, Embase, and Cochrane Library databases.
- Inclusion of 17 non-randomized studies with 3404 patients.
- Data synthesis using random effects models and assessment of bias/evidence quality.
Main Results:
- Image guidance showed a favorable effect on drain accuracy (RR 1.31, low quality evidence).
- Image guidance reduced drain failure rates (RR 0.63, moderate quality evidence).
- Evidence regarding the number of attempts was equivocal (MD -0.14, very low quality evidence).
Conclusions:
- Image guidance may enhance accuracy and decrease failure rates for ventricular drains.
- The number of drain insertion attempts is unlikely to be reduced by image guidance.
- Further research may be needed to clarify the role of image guidance in reducing procedural attempts.
