Development and validation of a rapidly deployable CT-guided stereotactic system for external ventricular drainage: preclinical study

Abhijeet S Barath,Hojin Shin,Juan M Rojas Cabrera,Stephan J Goerss,Charles D Blaha,Yoonbae Oh,Aaron E Rusheen,Kevin E Bennet,Kendall H Lee

doi:10.1038/s41598-021-97080-2

Abhijeet S Barath, Hojin Shin + Show 7 more

Open Access

https://doi.org/10.1038/s41598-021-97080-2

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Abstract

External ventricular drainage (EVD) is an emergency neurosurgical procedure to decrease intracranial pressure through a catheter mediated drainage of cerebrospinal fluid. Most EVD catheters are placed using free hands without direct visualization of the target and catheter trajectory, leading to a high rate of complications- hemorrhage, brain injury and suboptimal catheter placement. Use of stereotactic systems can prevent these complications. However, they have found limited application for this procedure due to their long set-up time and expensive hardware. Therefore, we have developed and pre-clinically validated a novel 3D printed stereotactic system for rapid and accurate implantation of EVD catheters. Its mechanical and imaging accuracies were found to be at par with clinical stereotactic systems. Preclinical trial in human cadaver specimens revealed improved targeting accuracy achieved within an acceptable time frame compared to the free hand technique. CT angiography emulated using cadaver specimen with radio-opaque vascular contrast showed vessel free catheter trajectory. This could potentially translate to reduced hemorrhage rate. Thus, our 3D printed stereotactic system offers the potential to improve the accuracy and safety of EVD catheter placement for patients without significantly increasing the procedure time.

Highlights

External ventricular drainage (EVD) is an emergency neurosurgical procedure to decrease intracranial pressure through a catheter mediated drainage of cerebrospinal fluid
External ventricular drainage (EVD) is an emergency, life-saving procedure for patients presenting with increased intracranial pressure (ICP), not responding to medical management
The EVD key, functional equivalent of stereotactic base-frame in our system could be attached to the head by a single operator using a clamp mechanism tightened with adjustable side screws (Figs. 1A, C, 3B)

Summary

Introduction

External ventricular drainage (EVD) is an emergency neurosurgical procedure to decrease intracranial pressure through a catheter mediated drainage of cerebrospinal fluid. These include an increased dose of radiation from repeated CT scans, need for specialized ultrasound probes or bulky neuronavigation hardware, limited trajectories available for selection, and increased total procedural time[14,17] These limitations with current devices prevent widespread adoption of stereotaxy for EVD catheter placement. We have developed and pre-clinically validated a novel 3D printed stereotactic system for EVD catheter implantation which meets the above-described criteria The mechanics of this system were designed to facilitate a fast and user-friendly surgical workflow through use of a compact skull-mounted EVD key and a stereotactic targeting device that can be handled by a single operator. We have achieved a clinically desirable accuracy (< 5 mm) and a robust safety profile through a rigorous three level testing scheme which includes—mechanical and imaging accuracy tests and a human cadaveric preclinical study

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