Abstract
Objective
The accuracy of tunneled external ventricular drain (EVD) placement has been shown to be similar among practitioners of varying experience, but this has not yet been investigated for bolt EVDs. Tunneled and bolt EVDs are distinct techniques, and it is unclear if conclusions regarding accuracy can be inferred from one method to the other. The goal of this study was to determine whether neurosurgical experience influences the accuracy of bolt EVD placement.
Methods
We performed a single-center retrospective analysis of accuracy of bolt EVD placement between 1st December 2018 and 31st May 2020, comparing the accuracy outcomes between three levels of training (junior trainees (JT); mid-grade trainees (MT); senior trainees/fellows (ST)). Accuracy was determined radiologically by two methods: Kakarla grade and by measuring the distance of the catheter tip to its optimal position (DTOP) at the foramen of Monro.
Results
Eighty-seven patients underwent insertion of bolt EVDs, of which n = 19 by JT, n = 40 by MT and n = 28 by ST, with a significant difference found between training grades in the median Kakarla grade (p = 0.0055) and in the accuracy of placement as per DTOP (p = 0.0168).
Conclusions
In contrast to previous published results on tunneled EVDs, we demonstrate that the accuracy of bolt EVD placement is dependent on neurosurgical experience. Our results draw awareness to the fact that the bolt EVD technique can represent a challenge for less experienced practitioners and underline the importance of dedicated training to support the safe insertion of bolt ventricular catheters.
Similar content being viewed by others
Abbreviations
- CSF:
-
Cerebrospinal fluid
- CT:
-
Computed tomography
- DTOP:
-
Distance of catheter tip from optimal position
- EVD:
-
External ventricular drain
- JT:
-
Junior trainees
- MT:
-
Mid-grade trainees
- MRI:
-
Magnetic resonance imaging
- ST:
-
Senior trainees/fellows
References
Asaad SK, Bjarkam CR (2019) The Aalborg bolt-connected drain (ABCD) study: a prospective comparison of tunnelled and bolt-connected external ventricular drains. Acta Neurochir 161:33–39. https://doi.org/10.1007/s00701-018-3737-z
Bergdal O, Springborg JB, Holst AV, Hauerberg J, Way S, Breum P, Romner B (2013) Accuracy of tunnelated vs. bolt-connected external ventricular drains. Clin Neurol Neurosurg 115:1972–1975. https://doi.org/10.1016/j.clineuro.2013.05.026
Cabrilo I, Craven CL, Abuhusain H, Pradini-Santos L, Asif H, Marcus HJ, Reddy U, Watkins LD, Toma AK (2020) Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note. Acta Neurochir. https://doi.org/10.1007/s00701-020-04634-w
Ellens NR, Fischer DL, Meldau JE, Schroeder BA, Patra SE (2019) External ventricular drain placement accuracy and safety when done by midlevel practitioners. Neurosurgery 84:235–241. https://doi.org/10.1093/neuros/nyy090
Enriquez-Marulanda A, Ascanio LC, Salem MM, Maragkos GA, Jhun R, Alturki AY, Moore JM, Ogilvy CS, Thomas AJ (2018) Accuracy and safety of external ventricular drain placement by physician assistants and nurse practitioners in aneurysmal acute subarachnoid hemorrhage. Neurocrit Care 29:435–442. https://doi.org/10.1007/s12028-018-0556-2
Fichtner J, Jilch A, Stieglitz LH, Beck J, Raabe A, Graggen WJZ (2014) Infection rate of emergency bolt-kit vs. non-emergency conventional implanted silver bearing external ventricular drainage catheters. Clin Neurol Neurosurg 122:70–76. https://doi.org/10.1016/j.clineuro.2014.04.018
Greenberg SM (2010) Handbook of neurosurgery, 7th edn. Thieme, New York
Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF (2008) Safety and accuracy of bedside external ventricular drain placement. Neurosurgery 63:ONS162–ONS166; discussion ONS166-167. https://doi.org/10.1227/01.neu.0000335031.23521.d0
Mansoor N, Madsbu MA, Mansoor NM, Tronnes AN, Fredriksli OA, Salvesen O, Jakola AS, Solheim O, Gulati S (2020) 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. Acta Neurochir 162:755–761. https://doi.org/10.1007/s00701-020-04247-3
Raabe C, Fichtner J, Beck J, Gralla J, Raabe A (2018) Revisiting the rules for freehand ventriculostomy: a virtual reality analysis. J Neurosurg 128:1250–1257. https://doi.org/10.3171/2016.11.JNS161765
Roach J, Gaastra B, Bulters D, Shtaya A (2019) Safety, accuracy, and cost effectiveness of bedside bolt external ventricular drains (EVDs) in comparison with tunneled EVDs inserted in theaters. World Neurosurg 125:e473–e478. https://doi.org/10.1016/j.wneu.2019.01.106
Schodel P, Proescholdt M, Brawanski A, Bele S, Schebesch KM (2012) Ventriculostomy for acute hydrocephalus in critically ill patients on the ICU--outcome analysis of two different procedures. Br J Neurosurg 26:227–230. https://doi.org/10.3109/02688697.2011.603853
Toma AK, Camp S, Watkins LD, Grieve J, Kitchen ND (2009) External ventricular drain insertion accuracy: is there a need for change in practice? Neurosurgery 65:1197–1200; discussion 1200-1191. https://doi.org/10.1227/01.NEU.0000356973.39913.0B
Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, Initiative S (2014) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Int J Surg 12:1500–1524. https://doi.org/10.1016/j.ijsu.2014.07.014
Yuen J, Selbi W, Muquit S, Berei T (2018) Complication rates of external ventricular drain insertion by surgeons of different experience. Ann R Coll Surg Engl 100:221–225. https://doi.org/10.1308/rcsann.2017.0221
Funding
No funding was received for this research. AKT’s research time was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Neurosurgical technique evaluation
Rights and permissions
About this article
Cite this article
Cabrilo, I., Craven, C.L., Dasgupta, D. et al. Accuracy of bolt external ventricular drain insertion by neurosurgeons of different experience. Acta Neurochir 163, 1121–1126 (2021). https://doi.org/10.1007/s00701-021-04712-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-021-04712-7