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Ultrasound-Guided External Ventricular Drain Insertion After Decompressive Craniectomy
Alick P Wang1, Ryan Sandarage2, Anne-Sophie Parent2
1Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Canada; Department of Bioengineering, Imperial College London, London, United Kingdom.
World Neurosurgery
|March 21, 2025
Summary
Ultrasound guidance using a curvilinear probe facilitates bedside external ventricular drain (EVD) placement in post-craniectomy patients. This method allows safe visualization and accurate insertion of the drain, even with distorted anatomy.
Area of Science:
- Neurosurgery
- Medical Imaging
- Critical Care Medicine
Background:
- Ultrasound guidance provides real-time anatomical visualization during external ventricular drain (EVD) insertion.
- A craniectomy defect acts as a sonolucent window, allowing use of low-frequency probes for deep penetration and wide field of view.
- The use of a curvilinear probe through a craniectomy defect for bedside EVD placement is a novel approach.
Purpose of the Study:
- To describe the technique and assess the feasibility of ultrasound-guided bedside EVD insertion using a curvilinear probe through a craniectomy defect.
Main Methods:
- Ultrasound-guided bedside insertion of a left frontal EVD was performed using a curvilinear probe through a hemicraniectomy flap.
Main Results:
- Bedside ultrasound allowed visualization of the entire supratentorial ventricular system.
- Successful drain insertion was achieved, with the catheter tip immediately visualized sonographically in the left frontal horn.
- Computed tomography confirmed accurate drain placement.
Conclusions:
- Bedside ultrasound-guided EVD insertion in post-craniectomy patients is a valuable technique.
- It enables safe ventricular access despite abnormal or distorted anatomy.
- This method offers a reliable approach for EVD placement in complex cases.
