• Aaron Lawson McLean, JamjoomAimun A BAAB2Department of Clinical Neuroscience, Western General Hospital, NHS Lothian, Edinburgh., Michael T C Poon, Difei Wang, Isaac Phang, Mohamed Okasha, Matthew Boissaud-Cooke, Adam P Williams, and Aminul I Ahmed.
• 1Department of Neurosurgery, Jena University Hospital, Jena, Germany.
• J. Neurosurg. 2021 Oct 1; 135 (4): 114611541146-1154.

ObjectiveFreehand 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.MethodsThis 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.ResultsOver 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.ConclusionsImage-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.

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