Accuracy and complication rates of External Ventricular Drain (EVD) placement using two different surgical methods: a retrospective population-based study
EANS Academy. Mansoor N. 09/25/19; 275751; EP08007
Nadia Mansoor
Nadia Mansoor

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Abstract
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Background: An external ventricular drain (EVD) is an important procedure in the acute neurosurgical setting. It is indicated in cases with development of increased intracranial pressure (ICP). The placement of an EVD can be challenging, and different methods have been developed to improve accuracy.
Objective: Two surgical techniques were assessed in terms of EVD placement and complication rates; the standard method, using a 14 mm burrhole, with the EVD tunnelated through the skin in a separate incision, was compared to a minimally invasive method where the EVD is placed through a 2,7-3,3 mm burrhole and fixed to the bone with a bolt system.
Method: Retrospective observational study. All patients that received an EVD between 01.01.2008 and 01.01.2018 were identified. We assessed the different methods in terms of EVD placement using the Kakarla scoring system (Kakarla et al. 2008). Furthermore, we registered postoperative complications (meningitis, postoperative hemorrhage, malplacement requiring reoperation), as well as duration of surgery and number of trials to place the EVD.
Results: In total, 243 patients received an EVD, with 42 receiving a bolt and 201 receiving a standard EVD. No significant difference between the two techniques in terms of EVD placement, postoperative complications or number of revisions was detected. We found a statistically significant difference in surgery duration between the bolt and standard method, mean 19.1 vs. 27.8 minutes respectively (p=0.002, -8.73, 95% CI -14.11, -3.31).
Conclusions: The techniques are similar in regards to accuracy and postoperative complication rates. Shorter surgery duration using the bolt system can probably be attributed to surgery being performed bedside, whereas the standard method requires use of an electric drill, performing a corticotomi and closing of incisions. This is an important finding with possible implications for surgeons and patients in acute settings where available time in the operating room can be limited.
Background: An external ventricular drain (EVD) is an important procedure in the acute neurosurgical setting. It is indicated in cases with development of increased intracranial pressure (ICP). The placement of an EVD can be challenging, and different methods have been developed to improve accuracy.
Objective: Two surgical techniques were assessed in terms of EVD placement and complication rates; the standard method, using a 14 mm burrhole, with the EVD tunnelated through the skin in a separate incision, was compared to a minimally invasive method where the EVD is placed through a 2,7-3,3 mm burrhole and fixed to the bone with a bolt system.
Method: Retrospective observational study. All patients that received an EVD between 01.01.2008 and 01.01.2018 were identified. We assessed the different methods in terms of EVD placement using the Kakarla scoring system (Kakarla et al. 2008). Furthermore, we registered postoperative complications (meningitis, postoperative hemorrhage, malplacement requiring reoperation), as well as duration of surgery and number of trials to place the EVD.
Results: In total, 243 patients received an EVD, with 42 receiving a bolt and 201 receiving a standard EVD. No significant difference between the two techniques in terms of EVD placement, postoperative complications or number of revisions was detected. We found a statistically significant difference in surgery duration between the bolt and standard method, mean 19.1 vs. 27.8 minutes respectively (p=0.002, -8.73, 95% CI -14.11, -3.31).
Conclusions: The techniques are similar in regards to accuracy and postoperative complication rates. Shorter surgery duration using the bolt system can probably be attributed to surgery being performed bedside, whereas the standard method requires use of an electric drill, performing a corticotomi and closing of incisions. This is an important finding with possible implications for surgeons and patients in acute settings where available time in the operating room can be limited.
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