Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Radiology, Division of Interventional Neuroradiology, University of California Los Angeles, 757 Westwood Plaza, Suite 2129, Los Angeles, CA, 90095-7430, USA.
Acta Neurochir (Wien). 2021 Apr;163(4):1113-1119. doi: 10.1007/s00701-020-04671-5. Epub 2021 Jan 6.
The external ventricular drain (EVD) placement is one of the most common neurosurgical procedures. This operation is performed by freehand technique in the majority of cases; therefore, the operator's experience plays an important role in success and possible morbidity of this procedure.
To evaluate the accuracy and safety of EVD placement by junior neurosurgery residents and factors predicting accuracy of EVD placement.
This is a prospective cohort study conducted at our academic medical center, between September 2017 and August 2018. All patients 18 years or older who required EVD placement were included. The accuracy and complications of EVD placement were assessed in the first and second year resident cohorts as well as by their level of experience, using descriptive statistics. Univariate and multivariate models were used to assess predictive factors for optimal EVD.
A total of 100 EVDs were placed in 100 patients during the study period. According to Kakarla classification, the catheter was optimally placed in 80% of cases. The first year residents had a significantly higher rate of suboptimal burr hole placement compared to the second year residents (66.7% versus 27.1%, p = 0.004). The trainees with less than 10 EVD placement experience also had a significantly higher rate of suboptimal burr hole placement (55.2% vs. 23.9%, p = 0.003), significantly longer duration of operation (43.1 min ± 14.9SD vs 34.2 min ± 9.6 p = 0.005), and significantly lower rate of optimal EVD location (85.9% versus 65.5%, p = 0.023). Optimal location of the burr hole was the only significant predictor of optimal EVD placement in multivariate analysis (OR 11.9, 95% CI 3.2-44.6, p < 0.001).
Neurosurgery residents experience and optimal burr hole placement are the main predicators of accurate EVD placement.
脑室外引流（EVD）置管是最常见的神经外科手术之一。在大多数情况下，该手术采用徒手技术进行；因此，术者的经验对于该操作的成功率和可能的发病率起着重要作用。
评估初级神经外科住院医师进行 EVD 置管的准确性和安全性，以及预测 EVD 置管准确性的因素。
这是一项在我们学术医学中心进行的前瞻性队列研究，时间为 2017 年 9 月至 2018 年 8 月。所有需要 EVD 置管的 18 岁及以上患者均纳入研究。使用描述性统计方法评估初级住院医师和高年住院医师两个队列中 EVD 置管的准确性和并发症，以及根据经验水平评估 EVD 置管的准确性。使用单变量和多变量模型评估最佳 EVD 的预测因素。
在研究期间，共对 100 例患者的 100 例 EVD 进行了置管。根据 Kakarla 分类，导管的最佳位置为 80%。与第二年住院医师相比，第一年住院医师的钻孔位置不理想的比例显著更高（66.7%比 27.1%，p=0.004）。经验不足 10 例 EVD 置管的住院医师钻孔位置不理想的比例也显著更高（55.2%比 23.9%，p=0.003），手术时间显著更长（43.1 分钟±14.9 标准差比 34.2 分钟±9.6 p=0.005），EVD 位置理想的比例也显著更低（85.9%比 65.5%，p=0.023）。多变量分析中，仅钻孔位置理想是 EVD 置管位置理想的唯一显著预测因素（OR 11.9，95%CI 3.2-44.6，p<0.001）。
神经外科住院医师的经验和理想的钻孔位置是 EVD 置管准确性的主要预测因素。
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