Innovations in Assist Devices to Improve External Ventricular Drain Placement: A Bibliometric Review of the Literature From 1985 to 2023

Placement of an external ventricular drain (EVD) involves navigating a catheter into a lateral ventricle of the brain, allowing drainage of cerebrospinal fluid. This can be a life-saving procedure in emergency situations. Ventricular cannulation is classically performed freehand, using landmarks on the skull to align the trajectory. However, this technique is vulnerable to misplacement and can lead to complications. New technologies have emerged to improve EVD placement accuracy and claim to reduce adverse effects. The objective of this report is to examine recent technology developed to improve EVD accuracy. A qualitative review of the literature was completed on publications collected from 6 databases: Pub Med, Medline, Web of Knowledge, Scopus, ClinicalTrials.Gov, and Google Scholar. The google scholar patent search was also used to query all patented devices. Relevant studies presented technology and innovations for EVD placement. The article and patent search returned 15 devices for EVD placement within 4 categories: ultrasound guidance, electromagnetic guidance, computed tomography-based guidance, and mechanical assist devices. The potential benefits of these devices range from real-time feedback for adjustments during insertion to reducing the number of passes and improving placement accuracy. Downsides include the cost of these devices and procedural changes that may increase the overall time of placement. A survey of neurosurgeons and residents found that 51.7% preferred image guidance, 41.6% preferred freehand technique, and 6.7% preferred the Ghajar guide in patients with slit ventricles. Although the freehand technique has been the traditional method for EVD insertion, a number of guidance technologies have been developed to improve placement accuracy. Image-guided procedures have become the preferred method in patients with complicated anatomy. However, changes in procedure time, device availability, and cost have limited the use of these technologies.