Utility of image-guided external ventriculostomy: analysis of contemporary practice in the United Kingdom and Ireland
- 1 October 2021
- journal article
- research article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 135 (4), 1146-1154
- https://doi.org/10.3171/2020.8.jns20321
Abstract
OBJECTIVE Freehand external ventricular drain (EVD) insertion is associated with a high rate of catheter misplacement. Image-guided EVD placement with neuronavigation or ultrasound has been proposed as a safer, more accurate alternative with potential to facilitate proper placement and reduce catheter malfunction risk. This study aimed to determine the impact of image-guided EVD placement on catheter tip position and drain functionality. METHODS This study is a secondary analysis of a data set from a prospective, multicenter study. Data were collated for EVD placements undertaken in the United Kingdom and Ireland from November 2014 to April 2015. In total, 21 large tertiary care academic medical centers were included. RESULTS Over the study period, 632 EVDs were inserted and 65.9% had tips lying free-floating in the CSF. Only 19.6% of insertions took place under image guidance. The use of image guidance did not significantly improve the position of the catheter tip on postoperative imaging, even when stratified by ventricular size. There was also no association between navigation use and drain blockage. CONCLUSIONS Image-guided EVD placement was not associated with an increased likelihood of achieving optimal catheter position or with a lower rate of catheter blockage. Educational efforts should aim to enhance surgeons’ ability to apply the technique correctly in cases of disturbed cerebral anatomy or small ventricles to reduce procedural risks and facilitate effective catheter positioning.This publication has 43 references indexed in Scilit:
- Accuracy of external ventricular drainage catheter placementActa Neurochirurgica, 2011
- EXTERNAL VENTRICULAR DRAIN INSERTION ACCURACYNeurosurgery, 2009
- Robotic catheter ventriculostomy: feasibility, efficacy, and implicationsJournal of Neurosurgery, 2008
- Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scansJournal of Neurosurgery, 2008
- Catheter Placement for Ommaya Reservoirs with Frameless Surgical Navigation: Technical NoteStereotactic and Functional Neurosurgery, 2007
- Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studiesBMJ, 2007
- Efficacy of the Ghajar Guide revisited: a prospective studyJournal of Neurosurgery, 2000
- Continuous External CSF Drainage—A Perpetual Problem in NeurosurgerySurgical Neurology, 1998
- Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomiesJournal of Neurosurgery, 1995
- Continuous-Pressure Controlled, External Ventricular Drainage for Treatment of Acute Hydrocephalus—Evaluation of Risk FactorsNeurosurgery, 1992