Utility of image-guided external ventriculostomy: analysis of contemporary practice in the United Kingdom and Ireland

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  • 1 Department of Neurosurgery, Jena University Hospital, Jena, Germany;
  • 2 Department of Clinical Neuroscience, Western General Hospital, NHS Lothian, Edinburgh;
  • 3 Usher Institute, University of Edinburgh;
  • 4 Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton;
  • 5 Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston;
  • 6 Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne;
  • 7 Department of Neurosurgery, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth;
  • 8 Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol; and
  • 9 Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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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.

ABBREVIATIONS BNTRC = British Neurosurgical Trainee Research Collaborative; EVD = external ventricular drain; HCRN = Hydrocephalus Clinical Research Network; ORION = Outcome Registry Intervention and Operation Network; UK = United Kingdom.

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Contributor Notes

Correspondence Aaron Lawson McLean: Jena University Hospital, Jena, Germany. aaron.lawsonmclean@med.uni-jena.de.

INCLUDE WHEN CITING Published online January 29, 2021; DOI: 10.3171/2020.8.JNS20321.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Hsieh CT, Chen GJ, Ma HI, The misplacement of external ventricular drain by freehand method in emergent neurosurgery. Acta Neurol Belg. 2011;111(1):2228.

    • Search Google Scholar
    • Export Citation
  • 2

    Jamjoom AAB, Joannides AJ, Poon MT, Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry. 2018;89(2):120126.

    • Search Google Scholar
    • Export Citation
  • 3

    Cinibulak Z, Aschoff A, Apedjinou A, Current practice of external ventricular drainage: a survey among neurosurgical departments in Germany. Acta Neurochir (Wien). 2016;158(5):847853.

    • Search Google Scholar
    • Export Citation
  • 4

    Fried HI, Nathan BR, Rowe AS, The insertion and management of external ventricular drains: an evidence-based consensus statement: a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care. 2016;24(1):6181.

    • Search Google Scholar
    • Export Citation
  • 5

    Muralidharan R. External ventricular drains: management and complications. Surg Neurol Int. 2015;6(6)(suppl 6):S271S274.

  • 6

    Kim YB, Lee JW, Lee KS, Lee KC. Image-guided placement of ventricular shunt catheter. J Clin Neurosci. 2006;13(1):5054.

  • 7

    Strowitzki M, Komenda Y, Eymann R, Steudel WI. Accuracy of ultrasound-guided puncture of the ventricular system. Childs Nerv Syst. 2008;24(1):6569.

    • Search Google Scholar
    • Export Citation
  • 8

    Tai BL, Rooney D, Stephenson F, Development of a 3D-printed external ventricular drain placement simulator: technical note. J Neurosurg. 2015;123(4):10701076.

    • Search Google Scholar
    • Export Citation
  • 9

    Patil V, Gupta R, San José Estépar R, Smart stylet: the development and use of a bedside external ventricular drain image-guidance system. Stereotact Funct Neurosurg. 2015;93(1):5058.

    • Search Google Scholar
    • Export Citation
  • 10

    Eftekhar B. App-assisted external ventricular drain insertion. J Neurosurg. 2016;125(3):754758.

  • 11

    Ann J-M, Bae H-G, Oh J-S, Yoon S-M. Device for catheter placement of external ventricular drain. J Korean Neurosurg Soc. 2016;59(3):322324.

    • Search Google Scholar
    • Export Citation
  • 12

    Yoon S-Y, Kwak Y, Park J. Adjustable Ghajar guide technique for accurate placement of ventricular catheters: a pilot study. J Korean Neurosurg Soc. 2017;60(5):604609.

    • Search Google Scholar
    • Export Citation
  • 13

    Schirmer CM, Elder JB, Roitberg B, Lobel DA. Virtual reality–based simulation training for ventriculostomy. Neurosurgery. 2013;73(suppl_1):S66S73.

    • Search Google Scholar
    • Export Citation
  • 14

    Patil V, Lacson R, Vosburgh KG, Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository. Acta Neurochir (Wien). 2013;155(9):17731779.

    • Search Google Scholar
    • Export Citation
  • 15

    O’Leary ST, Kole MK, Hoover DA, Efficacy of the Ghajar Guide revisited: a prospective study. J Neurosurg. 2000;92(5):801803.

  • 16

    Morone PJ, Bekelis K, Root BK, Singer RJ. Development and validation of a mobile device-based external ventricular drain simulator. Oper Neurosurg (Hagerstown). 2017;13(5):603608.

    • Search Google Scholar
    • Export Citation
  • 17

    Lollis SS, Roberts DW. Robotic catheter ventriculostomy: feasibility, efficacy, and implications. J Neurosurg. 2008;108(2):269274.

  • 18

    Lemole GM Jr, Banerjee PP, Luciano C, Virtual reality in neurosurgical education: part-task ventriculostomy simulation with dynamic visual and haptic feedback. Neurosurgery. 2007;61(1):142149.

    • Search Google Scholar
    • Export Citation
  • 19

    Li Y, Chen X, Wang N, A wearable mixed-reality holographic computer for guiding external ventricular drain insertion at the bedside. J Neurosurg. 2018;131(5):15991606.

    • Search Google Scholar
    • Export Citation
  • 20

    Hepburn-Smith M, Dynkevich I, Spektor M, Establishment of an external ventricular drain best practice guideline: the quest for a comprehensive, universal standard for external ventricular drain care. J Neurosci Nurs. 2016;48(1):5465.

    • Search Google Scholar
    • Export Citation
  • 21

    Toma AK, Camp S, Watkins LD, External ventricular drain insertion accuracy: is there a need for change in practice? Neurosurgery. 2009;65(6):11971201.

    • Search Google Scholar
    • Export Citation
  • 22

    Abdoh MG, Bekaert O, Hodel J, Accuracy of external ventricular drainage catheter placement. Acta Neurochir (Wien). 2012;154(1):153159.

    • Search Google Scholar
    • Export Citation
  • 23

    Stangl AP, Meyer B, Zentner J, Schramm J. Continuous external CSF drainage—a perpetual problem in neurosurgery. Surg Neurol. 1998;50(1):7782.

    • Search Google Scholar
    • Export Citation
  • 24

    Khanna RK, Rosenblum ML, Rock JP, Malik GM. Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies. J Neurosurg. 1995;83(5):791794.

    • Search Google Scholar
    • Export Citation
  • 25

    Huyette DR, Turnbow BJ, Kaufman C, Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans. J Neurosurg. 2008;108(1):8891.

    • Search Google Scholar
    • Export Citation
  • 26

    Bogdahn U, Lau W, Hassel W, Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus—evaluation of risk factors. Neurosurgery. 1992;31(5):898904.

    • Search Google Scholar
    • Export Citation
  • 27

    Anderson RCE, Kan P, Klimo P, Complications of intracranial pressure monitoring in children with head trauma. J Neurosurg. 2004;101(1)(suppl):5358.

    • Search Google Scholar
    • Export Citation
  • 28

    Nimsky C, Carl B. Historical, current, and future intraoperative imaging modalities. Neurosurg Clin N Am. 2017;28(4):453464.

  • 29

    Harrisson SE, Shooman D, Grundy PL. A prospective study of the safety and efficacy of frameless, pinless electromagnetic image-guided biopsy of cerebral lesions. Neurosurgery. 2012;70(1 Suppl Operative): 2933.

    • Search Google Scholar
    • Export Citation
  • 30

    Chari A, Jamjoom AA, Edlmann E, The British Neurosurgical Trainee Research Collaborative: five years on. Acta Neurochir (Wien). 2018;160(1):2328.

    • Search Google Scholar
    • Export Citation
  • 31

    Gray LD, Morris CG. Organisation and planning of anaesthesia for emergency surgery. Anaesthesia. 2013;68(suppl 1):313.

  • 32

    von Elm E, Altman DG, Egger M, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806808.

    • Search Google Scholar
    • Export Citation
  • 33

    Manfield JH, Yu KKH. Real-time ultrasound-guided external ventricular drain placement: technical note. Neurosurg Focus. 2017;43(5):E5.

  • 34

    Smit JM, Raadsen R, Blans MJ, Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis. Crit Care. 2018;22(1):65.

    • Search Google Scholar
    • Export Citation
  • 35

    Saugel B, Scheeren TWL, Teboul J-L. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017;21(1):225.

    • Search Google Scholar
    • Export Citation
  • 36

    Saladino A, White JB, Wijdicks EFM, Lanzino G. Malplacement of ventricular catheters by neurosurgeons: a single institution experience. Neurocrit Care. 2009;10(2):248252.

    • Search Google Scholar
    • Export Citation
  • 37

    Shtaya A, Roach J, Sadek A-R, Image guidance and improved accuracy of external ventricular drain tip position particularly in patients with small ventricles. J Neurosurg. 2019;130(4):12681273.

    • Search Google Scholar
    • Export Citation
  • 38

    Krötz M, Linsenmaier U, Kanz KG, Evaluation of minimally invasive percutaneous CT-controlled ventriculostomy in patients with severe head trauma. Eur Radiol. 2004;14(2):227233.

    • Search Google Scholar
    • Export Citation
  • 39

    Morgenstern PF, Connors S, Reiner AS, Greenfield JP. Image guidance for placement of Ommaya reservoirs: comparison of fluoroscopy and frameless stereotactic navigation in 145 patients. World Neurosurg. 2016;93:154158.

    • Search Google Scholar
    • Export Citation
  • 40

    Greenfield JP, Schwartz TH. Catheter placement for Ommaya reservoirs with frameless surgical navigation: technical note. Stereotact Funct Neurosurg. 2008;86(2):101105.

    • Search Google Scholar
    • Export Citation
  • 41

    Weiner GM, Chivukula S, Chen C-J, Ommaya reservoir with ventricular catheter placement for chemotherapy with frameless and pinless electromagnetic surgical neuronavigation. Clin Neurol Neurosurg. 2015;130:6166.

    • Search Google Scholar
    • Export Citation
  • 42

    Ruchholtz S, Waydhas C, Müller A, Percutaneous computed tomographic-controlled ventriculostomy in severe traumatic brain injury. J Trauma. 1998;45(3):505511.

    • Search Google Scholar
    • Export Citation
  • 43

    Mahan M, Spetzler RF, Nakaji P. Electromagnetic stereotactic navigation for external ventricular drain placement in the intensive care unit. J Clin Neurosci. 2013;20(12):17181722.

    • Search Google Scholar
    • Export Citation
  • 44

    Whitehead WE, Riva-Cambrin J, Wellons JC III, No significant improvement in the rate of accurate ventricular catheter location using ultrasound-guided CSF shunt insertion: a prospective, controlled study by the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr. 2013;12(6):565574.

    • Search Google Scholar
    • Export Citation
  • 45

    Whitehead WE, Riva-Cambrin J, Kulkarni AV, Ventricular catheter entry site and not catheter tip location predicts shunt survival: a secondary analysis of 3 large pediatric hydrocephalus studies. J Neurosurg Pediatr. 2017;19(2):157167.

    • Search Google Scholar
    • Export Citation

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