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Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note

  • Technical Note - Neurosurgical intensive care
  • Published:
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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.

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Author notes

  1. Ivan Cabrilo and Claudia L. Craven contributed equally to this work.

Authors and Affiliations

  1. Neurosurgery Department, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals, London, WC1N 3BG, UK

    Ivan Cabrilo, Claudia L. Craven, Hazem Abuhusain, Laura Pradini-Santos, Hasan Asif, Hani J. Marcus, Laurence D. Watkins & Ahmed K. Toma

  2. Neuro-intensive Care Department, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals, London, WC1N 3BG, UK

    Ugan Reddy

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  1. Ivan Cabrilo
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  2. Claudia L. Craven
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  3. Hazem Abuhusain
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  6. Hani J. Marcus
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Corresponding author

Correspondence to Ivan Cabrilo.

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Conflicts of interest

LD Watkins has received honoraria and served on advisory boards for Medtronic, Codman and B Braun. AK Toma’s research time was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. HJ Marcus is personally supported by the Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and NIHR BRC Neuro-oncology. The remaining 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.

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This article is part of the Topical Collection on Neurosurgical intensive care

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Cabrilo, I., Craven, C.L., Abuhusain, H. et al. Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note. Acta Neurochir 163, 1127–1133 (2021). https://doi.org/10.1007/s00701-020-04634-w

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  • DOI: https://doi.org/10.1007/s00701-020-04634-w

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