Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA, Fralin Biomedical Research Institute, Roanoke, VA, USA.
Clin Neurol Neurosurg. 2023 Aug;231:107852. doi: 10.1016/j.clineuro.2023.107852. Epub 2023 Jun 29.
External ventricular drains (EVDs) are used to monitor and treat elevated intracranial pressure. EVDs are often placed blindly without the use of imaging guidance, and successful placement with respect to pass attempts and final catheter location may suffer as a result of this freehand technique.
A systematic literature search was conducted in PubMed, Embase, Web of Science, and Cochrane databases to identify studies pertaining to freehand EVD placement through March 30, 2022. Studies were included if they reported percentage of EVDs placed successfully on the first pass attempt, or final catheter location as defined by the Kakarla Grading System. Pooled weighted incidence estimates and 95% confidence intervals (95%CI) were calculated using a random effects model.
Of the 2964 results returned from the literature search, 39 studies were included in this meta-analysis. These studies reported on 6313 EVDs placed via freehand technique in 6070 patients with the following respective incidence: successful EVD placement on the first attempt (78%, 95%CI: 67-86%); placement with a Kakarla Grade of 1 (optimal location) (72%, 95%CI: 66-77%); hemorrhage (7%, 95%CI: 6-10%), and infection (5%, 95%CI: 3-8%).
Only 78% of EVDs in this meta-analysis were placed successfully on the first pass, and only 72% of final placements were deemed optimal. This represents a relatively high rate of suboptimal outcomes with respect to EVD placement, which could potentially be avoided with the use of navigation-assisted placement techniques.
外部脑室引流（EVD）用于监测和治疗颅内压升高。EVD 通常在没有影像学引导的情况下盲目放置，由于这种徒手技术，初次尝试通过和最终导管位置的成功率可能会受到影响。
系统检索 PubMed、Embase、Web of Science 和 Cochrane 数据库，以确定截至 2022 年 3 月 30 日与徒手 EVD 放置相关的研究。如果研究报告了首次尝试放置 EVD 的成功率，或者根据 Kakarla 分级系统定义的最终导管位置，则纳入研究。使用随机效应模型计算汇总加权发生率估计值和 95%置信区间（95%CI）。
从文献检索中返回的 2964 项结果中，有 39 项研究纳入了本荟萃分析。这些研究报告了 6070 例患者通过徒手技术放置的 6313 个 EVD，各自的发生率如下：首次尝试放置 EVD 成功（78%，95%CI：67-86%）；位置为 Kakarla 分级 1（最佳位置）（72%，95%CI：66-77%）；出血（7%，95%CI：6-10%）和感染（5%，95%CI：3-8%）。
在本荟萃分析中，只有 78%的 EVD 能在首次尝试时成功放置，只有 72%的最终位置被认为是最佳位置。这代表了 EVD 放置中相对较高的次优结果发生率，使用导航辅助放置技术可能会避免这种情况。
