# Preventing What Matters: A Fast and Reliable Technique to Secure External Ventricular Drains and Avoid Dislodgement

## TL;DR

A new method for securing external ventricular drains in pediatric patients is shown to prevent dislodgement and reduce complications.

## Contribution

A novel two-step suturing technique for EVD fixation is introduced and evaluated for preventing dislodgement and accidental removal.

## Key findings

- No cases of EVD dislodgement, migration, leakage, or infection were observed in 62 pediatric patients.
- The technique eliminated the need for additional suturing after EVD removal, reducing patient discomfort.

## Abstract

Background

External ventricular drain (EVD) placement is a critical neurosurgical procedure for managing intracranial pressure and represents the most performed procedure in neurosurgery. However, complications such as dislodgement and accidental removal remain prevalent, often resulting in possible significant morbidities. While various fixation techniques exist, a standardized method to minimize these risks is lacking and remains institution-dependent. This study aims to introduce and evaluate a novel EVD fixation technique developed from clinical experience, aiming to reduce complications associated with EVD dislodgement and accidental removal.​

Methods

In this retrospective study, we evaluate a new suturing method for EVD fixation in all pediatric patients treated at our institution between 2020 and 2024 who underwent an EVD implantation due to various indications (n=62). All EVDs were placed at Kocher’s point. The two-step fixation technique was documented with detailed step-by-step photographs and was applied consistently across the cohort. All patients were monitored for EVD-related complications, including dislodgement, leakage, infection, and malfunction.

Results

Sixty-two pediatric patients were included in this study. Indications for EVD included posterior fossa tumor surgery (n=39), shunt infection and intracerebral or intraventricular hemorrhage (n=22), and intracerebral abscess (n=1). In three of 62 patients, the secondary fixation suture was inadvertently cut during EVD removal, requiring bedside re-suturing of the EVD exit point. In one patient, the primary fixation suture was applied too tightly, leading to reduced cerebrospinal fluid drainage and necessitating bedside re-fixation of the EVD. Importantly, no cases of EVD dislodgement, migration, leakage, or infection were observed in this cohort.

Conclusion

The presented EVD fixation technique demonstrated both safety and efficacy, providing excellent catheter stability with no observed cases of dislodgement or leakage. Notably, the method obviates the need for additional suturing of the exit point following EVD removal, thereby reducing procedural discomfort and avoiding unnecessary pain, which is particularly relevant in the pediatric population. These findings indicate that this technique may substantially lower the incidence of EVD-related complications and has the potential to serve as a standardized fixation approach. Further prospective studies with larger cohorts are needed to validate these preliminary results.