BACKGROUND An external ventricular drain (EVD) is typically indicated in the presence of hydrocephalus and increased intracranial pressure (ICP). Procedural challenges have prompted the development of different methods to improve accuracy, safety, and logistics. OBJECTIVES EVD placement and complications rates were compared using two surgical techniques; the standard method (using a 14-mm trephine burrhole with the EVD tunnelated through the skin) was compared to a less invasive method (EVD placed through a 2.7-3.3-mm twist drill burrhole and fixed to the bone with a bolt system). METHODS Retrospective observational study in a single-centre setting between 2008 and 2018. EVD placement was assessed using the Kakarla scoring system. We registered postoperative complications, surgery duration and number of attempts to place the EVD. RESULTS Two hundred seventy-two patients received an EVD (61 bolt EVDs, 211 standard EVDs) in the study period. Significant differences between the bolt system and the standard method were observed in terms of revision surgeries (8.2% vs. 21.5%, p = 0.020), surgery duration (mean 16.5 vs. 28.8 min, 95% CI 7.64, 16.8, p < 0.001) and number of attempts to successfully place the first EVD (mean 1.72 ± 1.2 vs. 1.32 ± 0.8, p = 0.017). There were no differences in accuracy of placement or complication rates. CONCLUSIONS The two methods show similar accuracy and postoperative complication rates. Observed differences in both need for revisions and surgery duration favoured the bolt group. Slightly, more attempts were needed to place the initial EVD in the bolt group, perhaps reflecting lower flexibility for angle correction with a twist drill approach.

中文翻译：

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使用麻花钻和螺栓系统放置心室外引流管与标准环钻和隧道的准确性和并发症发生率：一项基于人群的回顾性研究。

背景外脑室引流（EVD）通常在存在脑积水和颅内压（ICP）增加的情况下指示。程序上的挑战促使开发不同的方法来提高准确性、安全性和物流。目的 使用两种手术技术比较 EVD 放置和并发症发生率；标准方法（使用 14 毫米环钻钻孔，EVD 穿过皮肤）与侵入性较小的方法（EVD 通过 2.7-3.3 毫米麻花钻钻孔放置并用螺栓系统固定到骨骼上）进行了比较。方法 2008 年至 2018 年在单中心环境中进行的回顾性观察研究。使用 Kakarla 评分系统评估埃博拉病毒病的安置。我们记录了术后并发症、手术持续时间和尝试放置 EVD 的次数。结果 在研究期间，272 名患者接受了 EVD（61 名螺栓 EVD，211 名标准 EVD）。在翻修手术（8.2% 对 21.5%，p = 0.020）、手术持续时间（平均 16.5 对 28.8 分钟，95% CI 7.64，16.8，p < 0.001）方面观察到螺栓系统和标准方法之间存在显着差异) 和成功放置第一个 EVD 的次数（平均 1.72 ± 1.2 与 1.32 ± 0.8，p = 0.017）。放置的准确性或并发症发生率没有差异。结论 这两种方法显示出相似的准确性和术后并发症发生率。观察到的翻修需求和手术持续时间的差异有利于螺栓组。稍微需要更多的尝试才能将初始 EVD 放置在螺栓组中，