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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(01): 45-50
DOI: 10.4103/ajns.AJNS_292_19
Original Article

Freehand insertion of external ventricular drainage catheter: Evaluation of accuracy in a single center

Keng Lee
Division of Neurosurgery, Department of Surgery, National University Hospital
,
John Zhang
Division of Neurosurgery, Department of Surgery, National University Hospital
,
Nagarjun Bolem
Division of Neurosurgery, Department of Surgery, National University Hospital
,
May Leong
Division of Neurosurgery, Department of Surgery, National University Hospital
,
Chun Goh
Division of Neurosurgery, Department of Surgery, National University Hospital
,
Rashidul Hassan
Division of Neurosurgery, Department of Surgery, National University Hospital
,
Al Amin Salek
Division of Neurosurgery, Department of Surgery, National University Hospital
,
Asher Sein Lwin
Division of Neurosurgery, Department of Surgery, National University Hospital
,
Kejia Teo
Division of Neurosurgery, Department of Surgery, National University Hospital
,
Ning Chou
Division of Neurosurgery, Department of Surgery, National University Hospital
,
Vincent Nga
Division of Neurosurgery, Department of Surgery, National University Hospital
,
Tseng Yeo
Division of Neurosurgery, Department of Surgery, National University Hospital
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Introduction: External ventricular drain (EVD) placement is the gold standard for managing acute hydrocephalus. Freehand EVD, using surface anatomical landmarks, is performed for ventricular cannulation due to its simplicity and efficiency. This study evaluates accuracy and reason(s) for misplacements as few studies have analyzed the accuracy of freehand EVD insertion. Patients and Methods: Preoperative and postoperative computed tomography scans of patients who underwent EVD insertion in 2014 were retrospectively reviewed. Diagnosis, Evans ratio, midline shift, position of burr hole, length of the catheter, and procedural complications were tabulated. The procedures were classified as satisfactory (catheter tip in the frontal horn ipsilateral lateral ventricle) and unsatisfactory. Unsatisfactory cases were further analyzed in relation to position of burr hole from midline and length of the catheter. Results: Seventy-seven EVD placements in seventy patients were evaluated. The mean age of the patients was 57.5 years. About 83.1% were satisfactory placements and 11.7% were unsatisfactory in the contralateral ventricle, corpus callosum, and interhemispheric fissure. Nearly 5.2% were in extraventricular locations. Almost 2.6% EVD placements were complicated by hemorrhage and 1 catheter was reinserted. Suboptimal placements were significantly associated with longer intracranial catheter length. The mean length was 66.54 ± 10.1 mm in unsatisfactory placements compared to 58.32 ± 4.85 mm in satisfactory placements. Between the two groups, no significant difference was observed in Evans ratio, midline shift, surgeon's experience, distance of burr hole from midline, and coronal suture. Conclusion: Freehand EVD insertion is safe and accurate. In small number of cases, unsatisfactory placement is related to longer catheter length.

Key-words:

Accuracy - acute hydrocephalus - external ventricular drain - ipsilateral ventricle - ventriculostomy

Financial support and sponsorship

Nil.




Publication History

Received: 20 September 2019

Accepted: 10 January 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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