ArticleInterventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences2025
The venous angle as an anatomical landmark to evaluate external ventricular catheter placement.
Article in Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BackgroundExternal ventricular drain (EVD) placement is a lifesaving procedure that accesses the ventricular system. It is typically performed freehand using external craniometric landmarks. Herein, we study the utility of digital subtraction angiograms (DSA) in determining the EVD location by comparing it to the deep venous system.MethodsA retrospective review was conducted at a single center from 2021 to 2024 to identify patients with EVD placement for communicating hydrocephalus secondary to a subarachnoid hemorrhage. Two independent reviewers assessed placement using Fargen's grade and a novel grading system. We analyzed inter-reviewer reliability.ResultsWe included 48 patients (mean age 60.3 ± 12.9) in this study. Most patients presented with a modified Fisher score of 4 (76.6%) and a Hunt-Hess grade of 4 (31.9%). Based on the computed tomography (CT) scan, 33 patients had good placement, 13 had contralateral placement, and two had suboptimal EVD placement. Inter-reviewer reliability between the Fargen CT and novel DSA grading systems demonstrated 85.4% overall agreement and Cohen's κ = 0.66 (95% CI, 0.41-0.90). The novel DSA grading system demonstrated moderate discrimination among the three CT-defined categories (one-vs-all AUCs: suboptimal 0.668, contralateral 0.847, good 0.841; multiclass AUC 0.700).ConclusionThis feasibility study suggests that EVD placement can efficiently be determined in the endovascular suite by visualizing the catheter's position in relation to the venous angle on DSA. While this may streamline emergency workflows and reduce reliance on immediate CT scans, subsequent verification with CT or magnetic resonance imaging remains essential. Prospective studies are needed to validate accuracy before wider adoption.
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