Clinical Scorecard: Evaluating the Efficacy of Augmented Reality versus Freehand Techniques for External Ventricular Drain Insertion: A Multicenter Randomized Controlled Crossover Study Using Phantom Models
Comparison of AR Head-Mounted Display (AR-HMD) assisted EVD placement versus conventional freehand technique using anatomically realistic phantoms
Target Population
Neurosurgeons and neurosurgical residents performing EVD insertion
Care Setting
Neurosurgical operating rooms and simulated clinical environments
Key Highlights
Freehand EVD insertion has a high misplacement rate (26-28%) leading to increased revision, hemorrhage (7%), and infection (5%) risks.
Neuronavigation reduces misplacement below 10% but is costly, complex, and limited in emergencies.
AR-HMD systems like Lumi provide stereoscopic 3-D visualization, flexible registration without external sensors, and integration with hospital PACS, potentially improving accuracy and workflow.
Guideline-Based Recommendations
Diagnosis
Use CT imaging to identify ventricular anatomy and plan EVD trajectory.
Select challenging cases with small or shifted ventricles for enhanced guidance.
Management
Consider AR-HMD assisted EVD placement to improve catheter insertion accuracy and reduce misplacement.
Use freehand technique guided by anatomical landmarks when AR or neuronavigation is unavailable.
Monitoring & Follow-up
Perform post-operative imaging to assess catheter placement accuracy.
Monitor for complications such as hemorrhage and infection following EVD insertion.
by Jesse A. M. van Doormaal, Elisa Colombo, Jasper M. van der Zee, Wouter D. Maathuis, Maarten Bot, Patrick O’Donnell, Bachtiar Burhani, Luca Regli, Pierre A. J. T. Robe, Eelco W. Hoving, Tristan P. C. van Doormaal
FOXC1 duplications were the second most common monogenic finding among genetically solved juvenile open-angle glaucoma cases in one registry, supporting the use of copy-number variant analysis in early-onset glaucoma testing.
