External ventricular drain (EVD) is one of the most commonly performed neurosurgical procedures. EVD can be associated with high rates of complications like misplacement, iatrogenic hemorrhage, and CSF infection. Several modifications have been proposed in the EVD insertion techniques to decrease the risk of these complications. Bolt-connected EVD, one of these modifications which involves insertion of a bolt in the burr hole, has been proposed to have better chances of optimal placement of EVD tip, lesser risk of CSF infection, and accidental pullout. A comprehensive search of different databases was performed to retrieve studies comparing the bolt-connected EVD with tunneled EVD and meta-analysis was done. Seven studies met inclusion criteria and were included in the meta-analysis. Our analysis revealed that bolt-connected EVD is associated with significantly better chances of optimal placement than traditional tunneled EVD (MH OR—1.65, 95% CI 1.14 to 2.40, p = 0.008). We also observed that bolt-connected EVD is associated with significantly decreased risk of CSF infection (MH OR—0.60, 95% CI 0.39 to 0.94, p = 0.026), EVD malfunction (MH OR—0.31, 95% CI 0.16 to 0.58, p = 0.0003), and accidental disconnection (MH OR—0.09, 95% CI 0.03 to 0.26, p < 0.0001) as compared to traditional tunneled EVD. The difference between the two techniques was not statistically significant for complications, multiple punctures done for insertion of EVD, iatrogenic intracranial, and need of reoperation. Bolt-connected external ventricular drain is associated with significantly more chances of optimal placement and lesser chances of accidental discontinuation and CSF infection than tunneled EVD. There was no statistically significant difference noted between the two techniques for multiple punctures done for insertion of EVD, iatrogenic intracranial hemorrhage and need of reoperation. However, most of the included studies were retrospective. Thus, the results from the meta-analysis should be interpreted with caution as further prospective high-quality studies are needed.

脑室外引流 (EVD) 是最常用的神经外科手术之一。EVD 可能与错位、医源性出血和脑脊液感染等并发症的高发生率有关。已经在 EVD 插入技术中提出了一些修改，以降低这些并发症的风险。螺栓连接的 EVD 是这些修改之一，其中涉及在钻孔中插入螺栓，已被提议有更好的机会优化 EVD 尖端的放置，降低 CSF 感染和意外拔出的风险。对不同数据库进行了全面搜索，以检索比较螺栓连接 EVD 与隧道 EVD 的研究，并进行了荟萃分析。七项研究符合纳入标准并被纳入荟萃分析。p  = 0.008）。我们还观察到螺栓连接的 EVD 与 CSF 感染风险显着降低相关（MH OR-0.60，95% CI 0.39 至 0.94，p  = 0.026），EVD 故障（MH OR-0.31，95% CI 0.16 至 0.58，p  = 0.0003）和意外断开（MH OR-0.09, 95% CI 0.03 to 0.26, p < 0.0001) 与传统的隧道 EVD 相比。两种技术之间的并发症、EVD 插入的多次穿刺、医源性颅内和需要再次手术的差异无统计学意义。与隧道式 EVD 相比，螺栓连接的外部脑室引流管的最佳放置机会显着增加，意外停药和 CSF 感染的机会更少。对于为插入 EVD、医源性颅内出血和需要再次手术而进行的多次穿刺，两种技术之间没有统计学上的显着差异。然而，大多数纳入的研究都是回顾性的。因此，应谨慎解释荟萃分析的结果，因为需要进一步的前瞻性高质量研究。