University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository





Purpose: The purpose of this article is to review the treatment options for EVD placement and preferred therapy type.

Method: A PubMed and Google Scholar literature search was conducted with search terms Freehand EVD placement and EVD placement with image guidance. This resulted in hundreds of results individually. To limit these results, I changed the search criteria to only utilize articles published after 2015, this limited the results to 68. I also attempted to narrow the search results by searching for articles that were inclusive of both freehand and image-guided.

Results:In situations where navigation can be utilized, studies such as those performed by Foreman et al have found “Using the navigation to guide EVD placement was associated with a significantly better accuracy and a lower number of passes.”5There is a variance among studies regarding the accuracy of placement between placement with and without navigation. The studies cited in this article found 83.1% accuracy with freehand vs 94.7% with image guidance.2,6Not only does placement accuracy improve with the use of image navigation, but there is also a statistically significant reduction in complications.

Conclusion: EVD placement is a common procedure performed in hospitals for many indications. Muralidharan discusses some of the indications for EVD insertion, “such as intracranial hemorrhage with intraventricular extension, subarachnoid hemorrhage, traumatic brain injury, and bacterial meningitis”.3When an EVD is to be placed with CT mapping and navigation, it requires additional resources such as radiographic imaging and must be performed in an operating room. Are the additional resources for image navigation improving patient outcomes and decreasing complications?

Keywords: Freehand EVD Placement, Image navigation EVD Placement, EVD Complications


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