McLean Aaron Lawson, Jamjoom Aimun A B, Poon Michael T C, Wang Difei, Phang Isaac, Okasha Mohamed, Boissaud-Cooke Matthew, Williams Adam P, Ahmed Aminul I
1Department of Neurosurgery, Jena University Hospital, Jena, Germany.
2Department of Clinical Neuroscience, Western General Hospital, NHS Lothian, Edinburgh.
J Neurosurg. 2021 Jan 29;135(4):1146-1154. doi: 10.3171/2020.8.JNS20321. Print 2021 Oct 1.
Freehand 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.
This 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.
Over 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.
Image-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.
徒手置入脑室外引流管（EVD）与导管误置率高相关。已提出使用神经导航或超声进行影像引导下的EVD置入，作为一种更安全、更准确的替代方法，有可能促进正确置入并降低导管故障风险。本研究旨在确定影像引导下EVD置入对导管尖端位置和引流功能的影响。
本研究是对一项前瞻性多中心研究数据集的二次分析。整理了2014年11月至2015年4月在英国和爱尔兰进行的EVD置入的数据。总共纳入了21家大型三级医疗学术医学中心。
在研究期间，共置入632根EVD，65.9%的导管尖端漂浮在脑脊液中。只有19.6%的置入是在影像引导下进行的。即使按脑室大小分层，使用影像引导也未显著改善术后成像时导管尖端的位置。导航使用与引流管堵塞之间也没有关联。
影像引导下的EVD置入与实现最佳导管位置的可能性增加或导管堵塞率降低无关。教育工作应旨在提高外科医生在脑解剖结构紊乱或脑室较小的情况下正确应用该技术的能力，以降低手术风险并促进有效的导管定位。
