Freehand external ventricular drain insertion - is there a learning curve?

• Published in: Surgical neurology international Vol. 12; p. 193
• Main Authors: Jayasekera, B Ashan P, Al-Mousa, Alaa, Shtaya, Anan, Pereira, Erlick
• Format: Journal Article
• Language: English
• Published: United States Scientific Scholar 2021
• Subjects: Original; Training; Accuracy; Learning curve; Education; External ventricular drain; Ventriculostomy
• ISSN: 2229-5097; 2152-7806; 2152-7806
• DOI: 10.25259/SNI_151_2021

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. 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. 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 ( = 0.669), nor any difference in intraventricular catheter length ( = 0.697). There were no statistically significant differences between surgeons' accuracy at each grade. 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.