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The first 25 slides, exactly as they appear. The full deck has 70 content slides.
Neuro Critical Care
1 External Ventricular Drain
Built from Jallo — Neurocritical Care Procedure Atlas
What’s inside
9 sections · 70 slides
Overview
- What you will learn
What Is an EVD?
- The big picture
- How the same tube measures AND controls pressure
- Schematic of an external ventricular drain
The Fluid the Drain Controls: CSF
- Where CSF is made
- The one-way path CSF travels
- Circulation of cerebrospinal fluid
- CSF by the numbers
- How the balance can break
- Obstructive hydrocephalus: a dam in the pipe
- Obstructive hydrocephalus from a tumor
- Nonobstructive hydrocephalus: clogged drains
- Arachnoid granulations in the sagittal sinus
Why Place an EVD? Three Jobs
- Three overlapping purposes
- ICP monitoring, in detail
- CSF diversion, in detail
- Intrathecal access, in detail
When to Pause: Contraindications
- Relative contraindications
- Special situations that demand extra care
Equipment: The Cranial Access Kit
- Prepackaged cranial access kit
- Core hardware and sharps
- Sterile drapes, sutures and dressings
- Antibiotic-impregnated catheters
Technique: Step by Step
- Preparation and planning
- Measuring ventricular depth on coronal CT
- Medications: prophylaxis and pressure control
- Medications: sedation and local anesthesia
- Positioning and room setup
- Finding Kocher's point (the standard entry)
- Locating Kocher's point
- Defining the insertion planes
- Trajectory planes seen from the operator's view
- Prepping, anesthetizing and draping
- Direction of scalp blood supply
- Elevating the head and placing the drape
- Making the incision and burr hole
- Stripping periosteum with a mosquito clamp
- Feeling the drill through the skull
- Burr-hole trephination with a twist drill
- Opening the dura and passing the catheter
- Confirming you are in the ventricle
- Tunneling and securing the catheter
- Tunneling and anchoring the catheter
- Finishing: dressing and drainage setup
- When Kocher's point cannot be used
- Alternative approaches
- Starting sites for Frazier's, Dandy's and Keen's points
Complications
- The main risks, by the numbers
- Infection: the most common serious problem
- Hemorrhage
- Upward herniation
- Aneurysm re-rupture
- Injury to the motor cortex or sagittal sinus
Expert Tips and Troubleshooting
- Controlling scalp bleeding
- Choosing the entry site
- Tunneling direction planned around future surgery
- More tunneling rules, and checking the skull
- Troubleshooting: the ventricle that collapses
- Key takeaways
- References
- Neuro ICU Procedure Atlas