Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technica
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TECHNICAL NOTE - NEUROSURGICAL INTENSIVE CARE
Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note Ivan Cabrilo 1 & Claudia L. Craven 1 & Hazem Abuhusain 1 & Laura Pradini-Santos 1 & Hasan Asif 1 & Hani J. Marcus 1 & Ugan Reddy 2 & Laurence D. Watkins 1 & Ahmed K. Toma 1 Received: 16 September 2020 / Accepted: 23 October 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background The insertion of bolt external ventricular drains (EVD) on the intensive care unit (ICU) has enabled rapid cranial cerebrospinal fluid (CSF) diversion. However, bolt EVDs tend to be perceived as a more challenging technique, particularly when dealing with small ventricles or when there is midline shift distorting the ventricular morphology. Furthermore, if neuronavigation guidance is felt to be necessary, this usually assumes a transfer to an operating theatre. In this technical note, we describe the use of electromagnetic neuronavigation for bolt EVD insertion on the ICU and assess the protocol’s feasibility and accuracy. Methods Case series of neuronavigation-assisted bolt EVD insertion in ICU setting, using Medtronic Flat Emitter for StealthStation EM. Results Neuronavigation-guided bolt EVDs were placed at the bedside in n = 5 patients on ICU. Their widest frontal ventricular horn diameter in the coronal plane ranged from 11 to 20 mm. No procedural complications were encountered. Post-procedural CT confirmed the optimal placement of the EVDs. Conclusions Electromagnetic neuronavigation is feasible at the ICU bedside and can assist the insertion of bolt EVDs in this setting. The preference for a bolt EVD to be inserted in ICU—as is standard practice at this unit—should not prohibit patients from benefitting from image guidance if required. Keywords Bolt external ventricular drain . Electromagnetic neuronavigation . Intensive care unit . Ventriculostomy
Introduction Ivan Cabrilo and Claudia L. Craven contributed equally to this work. Portions of this work were presented in poster abstract form at EANS Conference, Dublin, in September 2019. This study was registered as a Service Improvement study with the University College London Hospitals NHS Foundation Trust Clinical Audit Committee, under the Registration number 28-202021-CA. This article is part of the Topical Collection on Neurosurgical intensive care * Ivan Cabrilo [email protected] 1
Neurosurgery Department, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals, London WC1N 3BG, UK
2
Neuro-intensive Care Department, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals, London WC1N 3BG, UK
The traditional technique for external ventricular drain (EVD) insertion is based on burr-hole trephination, typically using a compressed-air or electric drill in the operating theatre, through which the drain is introduced into the brain and then tunnelled subcutaneously to its point of exit at t
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