Accuracy and complication rates of external ventricular drain placement with twist drill and bolt system versus standard trephine and tunnelation: a retrospective population-based study

Abstract

Background An external ventricular drain (EVD) is typically indicated in the presence of hydrocephalus and increased intracranial pressure (ICP). Procedural challenges have prompted the development of different methods to improve accuracy, safety, and logistics. Objectives EVD placement and complications rates were compared using two surgical techniques; the standard method (using a 14-mm trephine burrhole with the EVD tunnelated through the skin) was compared to a less invasive method (EVD placed through a 2.7-3.3-mm twist drill burrhole and fixed to the bone with a bolt system). Methods Retrospective observational study in a single-centre setting between 2008 and 2018. EVD placement was assessed using the Kakarla scoring system. We registered postoperative complications, surgery duration and number of attempts to place the EVD. Results Two hundred seventy-two patients received an EVD (61 bolt EVDs, 211 standard EVDs) in the study period. Significant differences between the bolt system and the standard method were observed in terms of revision surgeries (8.2% vs. 21.5%, p = 0.020), surgery duration (mean 16.5 vs. 28.8 min, 95% CI 7.64, 16.8, p < 0.001) and number of attempts to successfully place the first EVD (mean 1.72 ± 1.2 vs. 1.32 ± 0.8, p = 0.017). There were no differences in accuracy of placement or complication rates. Conclusions The two methods show similar accuracy and postoperative complication rates. Observed differences in both need for revisions and surgery duration favoured the bolt group. Slightly, more attempts were needed to place the initial EVD in the bolt group, perhaps reflecting lower flexibility for angle correction with a twist drill approach. Keywords Bolt drain. External ventricular drain. Hydrocephalus. Kakarla score. Tunnelated drain. Neurosurgery This article is part of the Topical Collection on Neurosurgical technique evaluation

Augmented reality–assisted ventriculostomy

“…Due to the high frequency of ventriculostomy in neurosurgical practice, complications resulting from failed puncture or inadequate anatomical position are relatively common. 13 To improve precision, technical tools such as neuronavigation can be employed. 14 Despite strong evidence that freehand ventriculostomy has been identified as a risk factor for malposition of ventricular catheters, 15 a survey showed that neurosurgeons would be reluctant to use technical help if the time expense exceeded 10 minutes.…”

Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note

“…Bolt EVDs are gaining increasing acceptance over the traditional burr-hole technique among both the neurosurgical and neuro-intensive care communities. This is following a number of reports over the past years that have demonstrated their more favourable rate of procedure-related complications [2,3,17] (or, at the least, comparable to that of traditional external ventriculostomy [16,12]). Furthermore, bolt EVDs placed in ICU impart a non-measurable logistical and medical advantage by avoiding transfer of potentially unstable patients to the operating theatre.…”

“…However, bolt EVDs come with their own unique challenge, notably the limited possibility for correcting errors in trajectory [12]. This is in contrast to the traditional technique where a change in catheter trajectory is possible if the initial attempt at reaching the ventricle is unsuccessful, owing to the burr-hole's relatively larger diameter.…”

Augmented Reality–Assisted versus Freehand Ventriculostomy in a Head Model

“…5,15,16 Results are also influenced by the system used to rate success. 17,18 Our experiments were not conducted in patients, which makes direct comparison to the literature difficult. However, the raw numbers in this study reflect success rates described in previous studies.…”