Freehand frontal external ventricular drain (EVD) placement: Accuracy and complications

2022 ◽  
Vol 97 ◽  
pp. 7-11
Author(s):  
M. Maher Hulou ◽  
Benton Maglinger ◽  
Christopher J. McLouth ◽  
Catalina M. Reusche ◽  
Justin F. Fraser
Keyword(s):  
External Ventricular Drain ◽  
Placement Accuracy

scholarly journals Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

2013 ◽  
Vol 155 (9) ◽  
pp. 1773-1779 ◽  
Author(s):  
Vaibhav Patil ◽  
Ronilda Lacson ◽  
Kirby G. Vosburgh ◽  
Judith M. Wong ◽  
Luciano Prevedello ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
External Ventricular Drain ◽  
Health Record ◽  
Factors Associated ◽  
Placement Accuracy ◽  
Drain Placement ◽  
Electronic Health ◽  
Accuracy Data

scholarly journals Freehand external ventricular drain insertion – is there a learning curve?

2021 ◽  
Vol 12 ◽  
pp. 193
Author(s):  
B. Ashan P. Jayasekera ◽  
Alaa Al-Mousa ◽  
Anan Shtaya ◽  
Erlick Pereira
Keyword(s):  
Good Accuracy ◽  
External Ventricular Drain ◽  
Midline Shift ◽  
Training Performance ◽  
Significant Difference ◽  
Ct Head ◽  
Placement Accuracy ◽  
The Mean ◽  
Tip Position ◽  
Radiological Grading

Background: Accuracy of freehand insertion of external ventricular drains (EVDs) is influenced by many factors including etiology and presence of midline shift. We sought to assess if junior neurosurgical trainees’ performance in accurately inserting EVDs improves with experience, using a radiological grading system. Methods: EVD insertion procedures from the first 3 years of training were identified from the operative logbooks of three trainees. Postoperative CT head scans were graded for accuracy of placement and intraventricular catheter length. Results: 40 frontal EVDs performed primarily by the trainees were identified, after 34 assists, revision surgeries, parietal, or occipital insertions were excluded from the study. The mean number (±1 SD) of procedures was 7.7 ± 4.5 at ST3, 4.7 ± 2.5 at ST2, and 1 ± 1 at ST1. About 80% of EVDs were optimally inserted. There was no statistically significant difference in placement accuracy between the three training grades (P = 0.669), nor any difference in intraventricular catheter length (P = 0.697). There were no statistically significant differences between surgeons’ accuracy at each grade. Conclusion: We report good accuracy of EVDs tip position inserted by junior neurosurgery trainees. Trainees perform more procedures independently as they progress in their career. Further studies including senior years of training performance, other procedure factors and outcome should be considered.

External Ventricular Drain Placement Accuracy and Safety When Done by Midlevel Practitioners

Neurosurgery ◽  
2018 ◽  
Vol 84 (1) ◽  
pp. 235-241 ◽  
Author(s):  
Nathaniel R Ellens ◽  
D Luke Fischer ◽  
Jason E Meldau ◽  
Brett A Schroeder ◽  
Sanjay E Patra
Keyword(s):  
External Ventricular Drain ◽  
Placement Accuracy ◽  
Drain Placement

Augmented reality–assisted pedicle screw insertion: a cadaveric proof-of-concept study

2019 ◽  
Vol 31 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Camilo A. Molina ◽  
Nicholas Theodore ◽  
A. Karim Ahmed ◽  
Erick M. Westbroek ◽  
Yigal Mirovsky ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
User Experience ◽  
Pedicle Screws ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Insertion Method ◽  
Comparative Accuracy ◽  
Placement Accuracy ◽  
Surgical Field

OBJECTIVEAugmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator’s retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods.METHODSFive cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures.RESULTSThe overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification.CONCLUSIONSAR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

Nimodipine pharmacokinetics after intraventricular injection of sustained-release nimodipine for subarachnoid hemorrhage

2021 ◽  
Vol 134 (1) ◽  
pp. 95-101 ◽  
Author(s):  
R. Loch Macdonald ◽  
Daniel Hänggi ◽  
Poul Strange ◽  
Hans Jakob Steiger ◽  
J Mocco ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Sustained Release ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Plasma Concentrations ◽  
Intraventricular Injection ◽  
World Federation ◽  
Maximum Plasma ◽  
Clinical Trial Registration ◽  
Sustained Release Formulation

OBJECTIVEThe objective of this study was to measure the concentration of nimodipine in CSF and plasma after intraventricular injection of a sustained-release formulation of nimodipine (EG-1962) in patients with aneurysmal subarachnoid hemorrhage (SAH).METHODSPatients with SAH repaired by clip placement or coil embolization were randomized to EG-1962 or oral nimodipine. Patients were classified as grade 2–4 on the World Federation of Neurosurgical Societies grading scale for SAH and had an external ventricular drain inserted as part of their standard of care. Cohorts of 12 patients received 100–1200 mg of EG-1962 as a single intraventricular injection (9 per cohort) or they remained on oral nimodipine (3 per cohort). Plasma and CSF were collected from each patient for measurement of nimodipine concentrations and calculation of maximum plasma and CSF concentration, area under the concentration-time curve from day 0 to 14, and steady-state concentration.RESULTSFifty-four patients in North America were randomized to EG-1962 and 18 to oral nimodipine. Plasma concentrations increased with escalating doses of EG-1962, remained stable for 14 to 21 days, and were detectable at day 30. Plasma concentrations in the oral nimodipine group were more variable than for EG-1962 and were approximately equal to those occurring at the EG-1962 800-mg dose. CSF concentrations of nimodipine in the EG-1962 groups were 2–3 orders of magnitude higher than in the oral nimodipine group, in which nimodipine was only detected at low concentrations in 10% (21/213) of samples. In the EG-1962 groups, CSF nimodipine concentrations were 1000 times higher than plasma concentrations.CONCLUSIONSPlasma concentrations of nimodipine similar to those achieved with oral nimodipine and lasting for 21 days could be achieved after a single intraventricular injection of EG-1962. The CSF concentrations from EG-1962, however, were at least 2 orders of magnitude higher than those with oral nimodipine. These results supported a phase 3 study that demonstrated a favorable safety profile for EG-1962 but yielded inconclusive efficacy results due to notable differences in clinical outcome based on baseline disease severity.Clinical trial registration no.: NCT01893190 (ClinicalTrials.gov).

Cortrak feeding tube placement: accuracy of the ‘GI flexure system’ versus manufacturer guidance

2020 ◽  
Vol 29 (21) ◽  
pp. 1277-1281
Author(s):  
Stephen Taylor ◽  
Alex Manara ◽  
Jules Brown ◽  
Kaylee Sayer ◽  
Rowan Clemente ◽  
...  
Keyword(s):  
Feeding Tube ◽  
Tube Placement ◽  
Gastric Body ◽  
Major Morbidity ◽  
System Versus ◽  
Placement Accuracy ◽  
Feeding Tube Placement ◽  
Left Quadrant

Electromagnetic (EM) guided enteral tube placement may reduce lung misplacement to almost zero in expert centres, but more than 60 undetected misplacements had occurred by 2016 resulting in major morbidity or death. Aim: Determine the accuracy of manufacturer guidance in trace interpretation against what is referred to as the ‘GI flexure system’. Methods: The authors prospectively observed the accuracy of the ‘GI flexure system’ of trace interpretation against manufacturer guidance in primary nasointestinal (NI) tube placements. Findings: Contrary to manufacturer guidance, 33% of traces deviated >5 cm from the sagittal midline and 26.5% were oesophageal when entering the lower left quadrant, incorrectly indicating lung and gastric placement, respectively. Conversely, the GI flexure system identified ≥99.4% of GI traces when they reached the gastric body flexure; 100% at the superior duodenal flexure. All lung misplacements were identified by the absence of GI flexures. Conclusion: Current manufacturer guidance should be updated to the GI flexure system of interpretation.

The Use of Staples for External Ventricular Drain Catheter Fixation: A Single Institution Case Series

2021 ◽  
pp. 106761
Author(s):  
Mohamed M. Salem ◽  
Luis C. Ascanio ◽  
Alejandro Enriquez-Marulanda ◽  
Santiago Gomez-Paz ◽  
Charles E. Mackel ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Case Series ◽  
Single Institution
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