Ventricular catheter placement

Ventricular catheter placement, also known as ventriculostomy, is the gold standard for managing acute hydrocephalus and for intracranial pressure monitoring. Common indications of EVD are hydrocephalus due to subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), or intraventricular hemorrhage (IVH) and traumatic brain injury (TBI). EVD was described as early as the 1950s 1).

A study was conducted to investigate a novel realistic design for a clinical simulation-based, low-cost alternative of external ventricular drain (EVD) placement, an essential basic neurosurgical procedure that is necessary for clinicians to master. A low-cost three-dimensional (3D) printed head using thermoplastic polylactic acid was designed with the tactile feedback of the outer table, cancellous bone, and inner tables for drilling with replaceable frontal bone pieces for multi-use purposes. An agar gel filled with water was designed to simulate tactile passage through the cortex and into the ventricles. Neurosurgical and emergency resident physicians participated in a didactic session and then attempted placement of an EVD using the model to gauge the simulated model for accuracy and realism. Positioning, procedural time, and realism were evaluated. Improvements in procedural time and positioning were identified for both neurosurgical and emergency medicine (EM) residents. Catheter placement was within the ideal position for all participants by the third attempt. All residents stated they felt more comfortable with placement with subsequent attempts. Neurosurgical residents subjectively noted similarities in tactile feedback during drilling compared to in-vivo. A low-cost realistic 3D printed model simulating basic neurosurgical procedures demonstrated improved procedural times and precision with neurosurgical and EM residents. Further, similarities between in-vivo tactile feedback and the low-cost simulation technology were noted. This low cost-model may be used as an adjunct for teaching to promote early procedural competency in neurosurgical techniques to promote learning without predisposition to patient morbidity 2).

Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus–evaluation of risk factors. Neurosurgery. 1992;31(5):898-904. doi:10.1227/00006123-199211000-00011
Podkovik S, Patchana T, Farr S, Brazdzionis J, Marino M, Savla P, Kashyap S, Chin B, Crouch A, Miulli DE. External Ventricular Drain (EVD) Placement Using a Hands-On Training Session on a Simple Three-Dimensional (3D) Model. Cureus. 2022 Aug 14;14(8):e28014. doi: 10.7759/cureus.28014. PMID: 36134074; PMCID: PMC9470865.
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