Common Endpoints in Studies of Image-Based Guidance in External Ventricular Drain Placement: A Scoping Review

External ventricular drain placement (EVD), is a widely used procedure utilized to relieve intracranial pressure due to a variety of pathological conditions, such as hemorrhage or hydrocephalus. EVD placement is generally performed at the bedside using a freehand technique. This can lead to malpositioning of the catheter tip, especially in patients with pathologies that result in displacement of the lateral ventricles, midline shift, and a low bicaudate index. Novel developments in technology have allowed for image-guided navigation systems to be implemented into EVD placement procedures, reducing the risks for malpositioning and potential complications. This scoping review aims to identify common outcomes and design elements within prospective studies focused on comparing image-guided EVD placement to the freehand technique.

ClinicalTrials.gov was queried for EVD placement trials evaluating image guidance techniques in at least one arm. Prevalence of study design were summarized. Results were reported in accordance to PRISMA guidelines.

Of the seven studies included, most studies had one week of follow-up data to ascertain endpoints, and compared image-guided versus freehand approaches. The most common outcomes of importance were Kakarla grade for EVD tip placement and the number of passes required. Studies commonly emphasized characterizing accuracy of placement and procedural efficiency.

Although challenges remain to optimize these methods and standardize research protocols, future studies incorporating standardized endpoints and addressing current gaps in existing studies will help drive conduct of studies well-designed to improve patient outcomes.