Conical drill bit for optimized external ventricular drain placement: a proof-of-concept study.

Area of Science:

• Neurosurgery
• Medical Device Engineering

Background:

• External ventricular drain (EVD) placement is common in neurosurgery but faces challenges with suboptimal accuracy and potential complications.
• The standard cylindrical drill bit's limitations include deep, narrow holes, poor visibility, restricted catheter adjustment, and risk of dural puncture.

Purpose of the Study:

• To evaluate the efficacy of novel cone-shaped drill bits designed to overcome the limitations of standard drill bits for EVD placement.

Main Methods:

• Conical drill bits (30° and 45°) were designed and tested in laboratory and human cadaver models.
• Drilling temperatures, times, and neurosurgical trainee performance ratings (Likert scale) were compared to standard drill bits.

Main Results:

• Drilling temperatures were comparable between conical and standard bits, except for a significant increase under the 45° bit.
• Conical drill bits resulted in significantly longer drilling times but received significantly higher performance ratings.
• Conical bits provided a 6-9x greater catheter adjustment range and a zero inadvertent dural puncture rate.

Conclusions:

• The 30° conical drill bit offers a safe alternative or rescue tool for EVD placement.
• It enhances confidence, visualization, targeting, and precision while virtually eliminating dural puncture risk.
• Minimal increase in procedure time supports the clinical utility of conical drill bits for EVD procedures.