Articles: external-ventricular-drains.
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Aneurysmal subarachnoid hemorrhage (SAH) is frequently complicated by permanent shunt-dependent hydrocephalus, but it is difficult to predict which patients are at highest risk. This study seeks to identify novel variables associated with shunt dependency after aneurysmal SAH and to create a predictive algorithm that improves upon existing models. ⋯ Our study suggests that elevated modified Graeb score on initial computed tomography and high cerebrospinal fluid protein levels prior to EVD wean are important prognostic indicators for the development of shunt dependency after aneurysmal SAH. Integrating these findings into clinical practice may aid in earlier and more targeted decision-making.
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To assess the efficacy of machine learning models in identifying factors associated with the need for permanent ventricular shunt placement in patients experiencing intracerebral hemorrhage (ICH) who require emergency cerebrospinal fluid (CSF) diversion. ⋯ This research demonstrates that machine learning models can effectively predict the need for permanent CSF diversion in patients with ICH who underwent external ventricular drain placement for urgent CSF diversion, offering important prognostic insights that could facilitate early intervention and lead to potential cost reductions.
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External 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 malpositioning rates. This study aimed to improve EVD placement by junior neurosurgeons with the aid of a customized 3D-printed surgical guide. ⋯ For inexperienced surgeons, the 3D-printed EVD guide can improve ventricular cannulation even in cases of altered ventricular anatomy. The use of 3D printing would also allow the guide to be widely adopted by other institutions worldwide.
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In the management of traumatic brain injury (TBI), intracranial pressure monitoring (ICPm) is crucial for the timely management of severe cases that show rapid neurological deterioration. External ventricular drains (EVDs) and intraparenchymal pressure monitors (IPMs) are the primary methods used in this setting; however, the debate over their comparative efficacy persists, primarily because of reliance on observational study data. This underscores the need for a meta-analysis to guide clinical decision-making. ⋯ However, IPM may offer significant advantages in reducing the duration of ICPm and intensive care unit length of stay. EVD may be preferable for certain mid-term to long-term monitoring. The predominance of observational studies in the current literature highlights the need for further clinical trials to compare these interventions.
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Journal of neurosurgery · Oct 2024
Development of an adjustable patient-specific rigid guide to improve the accuracy of external ventricular catheter placement.
The most common method for external ventricular drain (EVD) placement is the freehand approach, which has reported inaccuracy rates of 12.3%-44.9%, especially in the case of altered ventricular anatomy. Current assistive devices require added time or equipment or do not account for shifted ventricles. To improve the accuracy of emergent EVD placement in the setting of altered ventricular anatomy, the authors designed a patient-specific EVD (PS-EVD) guide. ⋯ The PS-EVD guide allows consistent and accurate EVD placement in phantom skulls with both normal and altered ventricular anatomy. Further trials comparing this device to the freehand approach are required.