External ventricular drain

External ventricular drainage or ventriculostomy is a common neurosurgical technique and accurate placement of the ventricular catheter is one of the most important variables in the longevity of shunt survival 1) 2).

External ventricular drain indications.

Plain catheter

Antibiotic impregnated catheter: Bactiseal.

Silver impregnated catheter.

Bolt-connected external ventricular drainage.

Ventriculostomy entry sites are commonly selected by freehand estimation of Kocher's point or approximations from skull landmarks and a trajectory toward the ipsilateral frontal horn of the lateral ventricles.

Endoscopic third ventriculostomy.

see Frontal ventriculostomy.

see Fourth ventriculostomy.

Tunneled external ventricular drainage.

Standard external ventricular drainage.

see Ventricular catheter placement.

A study design of a single center, prospective, randomized controlled trial to investigate whether guided ventriculostomy is superior to the standard freehand technique. One strength of this study is the prospective, randomized, interventional type of study testing a new easy-to-handle guided versus freehand ventricular catheter placement. A second strength of this study is that the power calculation is based on catheter accuracy using an available grading system for catheter tip location, and is calculated with the use of recent study results of our own population, supported by data from prominent studies 3).

see External ventricular drainage complications.

see External ventricular drainage case series.

Wan KR, Toy JA, Wolfe R, Danks A. Factors affecting the accuracy of ventricular catheter placement. J Clin Neurosci. 2011 Apr;18(4):485-8. doi: 10.1016/j.jocn.2010.06.018. Epub 2011 Jan 20. PubMed PMID: 21256029.
Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M. Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg. 2000 Jan;92(1):31-8. PubMed PMID: 10616079.
Sarrafzadeh A, Smoll N, Schaller K. Guided (VENTRI-GUIDE) versus freehand ventriculostomy: study protocol for a randomized controlled trial. Trials. 2014 Dec 5;15:478. doi: 10.1186/1745-6215-15-478. PubMed PMID: 25480528; PubMed Central PMCID: PMC4289205.
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