Year-end Sale % OFF 
Abstract
BackgroundAn external ventricular drain (EVD) is typically indicated in the presence of hydrocephalus and increased intracranial pressure (ICP). Procedural challenges have prompted the development of different methods to improve accuracy, safety, and logistics.ObjectivesEVD placement and complications rates were compared using two surgical techniques; the standard method (using a 14-mm trephine burrhole with the EVD tunnelated through the skin) was compared to a less invasive method (EVD placed through a 2.7–3.3-mm twist drill burrhole and fixed to the bone with a bolt system).MethodsRetrospective observational study in a single-centre setting between 2008 and 2018. EVD placement was assessed using the Kakarla scoring system. We registered postoperative complications, surgery duration and number of attempts to place the EVD.ResultsTwo hundred seventy-two patients received an EVD (61 bolt EVDs, 211 standard EVDs) in the study period. Significant differences between the bolt system and the standard method were observed in terms of revision surgeries (8.2% vs. 21.5%, p = 0.020), surgery duration (mean 16.5 vs. 28.8 min, 95% CI 7.64, 16.8, p < 0.001) and number of attempts to successfully place the first EVD (mean 1.72 ± 1.2 vs. 1.32 ± 0.8, p = 0.017). There were no differences in accuracy of placement or complication rates.ConclusionsThe two methods show similar accuracy and postoperative complication rates. Observed differences in both need for revisions and surgery duration favoured the bolt group. Slightly, more attempts were needed to place the initial EVD in the bolt group, perhaps reflecting lower flexibility for angle correction with a twist drill approach.
Highlights
Placement of an external ventricular drain (EVD) is one of the most common and important surgical procedures in the acute neurosurgical setting
Of all patients presenting with intracranial haemorrhage, intraventricular blood was present in approximately 80% in both groups
We found a significant difference in the duration of surgery, where the use of the bolt system proved an efficient method for placing an EVD, despite the mean number of passes being greater than in the tunnelated group; it seems appropriate to conclude that the surgical method is responsible for the longer duration of surgery and not necessarily the number of passes
Summary
Placement of an external ventricular drain (EVD) is one of the most common and important surgical procedures in the acute neurosurgical setting. Developing and improving surgical methods to improve accuracy and minimise complications rates continue to be of great interest. Objectives EVD placement and complications rates were compared using two surgical techniques; the standard method (using a 14-mm trephine burrhole with the EVD tunnelated through the skin) was compared to a less invasive method (EVD placed through a 2.7–3.3-mm twist drill burrhole and fixed to the bone with a bolt system). Significant differences between the bolt system and the standard method were observed in terms of revision surgeries (8.2% vs 21.5%, p = 0.020), surgery duration (mean 16.5 vs 28.8 min, 95% CI 7.64, 16.8, p < 0.001) and number of attempts to successfully place the first EVD (mean 1.72 ± 1.2 vs 1.32 ± 0.8, p = 0.017). There were no differences in accuracy of placement or complication rates
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
