Liang Sai, Lee Rui Zhi, Lim Yuan Guang, Lim Huiling, Misbaah Fatimah, Wan Kai Rui
Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore.
Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore.
World Neurosurg. 2025 Jan;193:715-721. doi: 10.1016/j.wneu.2024.09.136. Epub 2024 Oct 24.
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.
A 3D-printed surgical guide was developed and customized to our institution's EVD insertion procedure. First-year neurosurgical residents were taught how to perform preoperative trajectory planning based on coronal brain images and how to use the surgical guide during the standard EVD insertion procedure. Number of passes, accuracy of EVD placement, operative complications, need for revision, and surgeon's experience with the guide were recorded.
First-year neurosurgical residents performed guide-assisted EVD insertion in 14 patients. Significantly, 6 (43%) patients had ventricular anatomy distorted by midline shift. All surgeons achieved successful ventricular cannulation using the EVD guide on first pass (100%). Of 14 guide-assisted EVDs, 13 (93%) were optimally placed (Kakarla grade 1). Only 1 (7%) guide-assisted EVD was suboptimally placed (Kakarla grade 2). There were no intraoperative or postoperative complications and no EVD revisions.
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.
脑室外引流（EVD）是一项基本的神经外科手术，通常由初级神经外科医生进行。迅速、成功地插入脑室可以挽救生命。然而，EVD插入的徒手技术与较高的位置不当率相关。本研究旨在借助定制的3D打印手术导板，提高初级神经外科医生放置EVD的水平。
根据我们机构的EVD插入程序开发并定制了一个3D打印手术导板。向第一年的神经外科住院医师教授如何根据冠状位脑图像进行术前轨迹规划，以及如何在标准EVD插入程序中使用手术导板。记录穿刺次数、EVD放置的准确性、手术并发症、是否需要修正以及外科医生使用导板的经验。
第一年的神经外科住院医师对14例患者进行了导板辅助的EVD插入。值得注意的是，6例（43%）患者的脑室解剖结构因中线移位而扭曲。所有外科医生在首次穿刺时使用EVD导板均成功插入脑室（100%）。在14个导板辅助的EVD中，13个（93%）放置最佳（卡卡拉拉1级）。只有1个（7%）导板辅助的EVD放置欠佳（卡卡拉拉2级）。没有术中或术后并发症，也没有EVD修正。
对于经验不足的外科医生，3D打印的EVD导板即使在脑室解剖结构改变的情况下也能提高脑室插管的成功率。3D打印的应用还将使该导板能够被全球其他机构广泛采用。
