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

Cabrilo, I; Craven, CL; Abuhusain, H; Pradini-Santos, L; Asif, H; Marcus, HJ; Reddy, U; ... Toma, AK; + view all (2021) Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note. Acta Neurochirurgica , 163 pp. 1127-1133. 10.1007/s00701-020-04634-w. Green open access

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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.

Type: Article
Title: Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note
Location: Austria
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s00701-020-04634-w
Publisher version: https://doi.org/10.1007/s00701-020-04634-w
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Bolt external ventricular drain; electromagnetic neuronavigation; intensive care unit; ventriculostomy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation
URI: https://discovery.ucl.ac.uk/id/eprint/10116437
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