Optimierung der Ventrikelkatheter-Anlage durch standardisiertes Training im Rahmen der neurochirurgischen Ausbildung

Abstract

Background and objectives: External ventricular drain (EVD) placement is a critical, lifesaving procedure in cranial neurosurgery, often performed manually using anatomical landmarks that vary between individuals. This study evaluates the efficacy of a 3-dimensional (3D)-printed EVD training model designed to improve the accuracy of this procedure.

Methods: Computed tomography scans from 3 patients were used to create 3D-printed head models with narrow, wide, and normal ventricles. Twenty-five neurosurgeons participated in a three-round training protocol: pre-training, training with neuronavigation and a standardized protocol, and post-training. The accuracy of EVD placement was measured using an optical navigation system, and participants' confidence levels were assessed through questionnaires.

Results: Training significantly enhanced EVD placement accuracy. Pre-training, only 55.3% of placements were intraventricular (Kakarla grade 1), which increased to 84.0% post-training ( P < .001). The distance to the ideal entry point improved from 5.8 mm (SD, ±3.7 mm) to 4.1 mm (SD, ±1.5 mm), and the distance to the target point improved from 12.6 mm (SD, ±5.8 mm) to 8.3 mm (SD, ±4.0 mm) ( P < .001 for both). The time to identify entry points and puncture the ventricles also improved significantly. Left-sided EVDs were more frequently misplaced. In addition, right-handed participants (n = 24) performed better when placing left-sided EVDs with their right hand. Participants with more than 6 years of experience were more likely to misplace the EVD and overestimate their placement accuracy compared with less experienced participants. Post-training, both experienced and less experienced neurosurgeons achieved similar success rates. Confidence in EVD placement and puncture direction significantly increased post-training.

Conclusion: A standardized training protocol using a 3D-printed model significantly improves the accuracy and confidence of neurosurgeons in EVD placement. Regular training is recommended to maintain high clinical performance, emphasizing the need for standardized procedures and the use of neuronavigation for complex cases.