Improving Successful Cannulation of External Ventricular Drain: 3D-Printed Surgical Guide for Inexperienced Neurosurgeons

Abstract

ObjectiveExternal Ventricular Drain (EVD) is a fundamental neurosurgical procedure that is commonly performed by junior neurosurgeons. Expedient, successful cannulation of the ventricles can be lifesaving. Yet, the free-hand technique of EVD insertion is associated with significant mal-positioning rates. This study aims to improve EVD placement by junior neurosurgeons with the aid of a customized 3D printed surgical guide. MethodsA 3D printed surgical guide was developed and customized to our institution’s EVD insertion procedure. First year neurosurgical residents were taught how to perform pre-operative trajectory planning based on coronal brain images and how to use the surgical guide during standard EVD insertion procedure. Number of passes, accuracy of EVD placement, operative complications, need for revision, and surgeon’s experience with the guide were recorded. Results14 patients underwent guide-assisted EVD insertion by first year neurosurgical residents. Significantly, 6 (43%) patients had ventricular anatomy distorted by midline shift. All surgeons achieved successful ventricular cannulation using the EVD guide on first pass (100%). 13 out of 14 (93%) of the guide-assisted EVDs were optimally placed (Karkarla Grade 1). 1 (7%) guide-assisted EVD was suboptimally placed (Karkarla Grade 2). There was no intra or post-operative complication and there was no EVD revision. ConclusionsFor inexperienced surgeons, the 3D printed EVD guide can improve ventricular cannulation even in cases of altered ventricular anatomy. The benefit of 3D printing would also allow the guide to be widely adopted by other institutions worldwide.