A written patient consent was not necessary. Local approval was obtained from the Ethics Board of Ruhr University Bochum (IBR number 18-6288-BR). Section snippets Study population and surgical procedure In three-dimensionally mapped pre- and postprocedural thin-layer CT scans we investigated whether the anatomical landmarks had been respected in choosing the entrance point onto the skull surface and to what extent a number of geometrical parameters influence the final catheter position. We aimed to transfer the findings of Raabe et al. examined, with the help of a grid, the issue of which entry points and trajectories offer the highest chance of successfully targeting the ipsilateral anterior horn of the lateral ventricle. In a virtual-reality analysis Raabe et al. In the last few decades, many groups have attempted to assess the accuracy of EVD placement, describing very different malposition rates ranging from 8% to 40%.

The reason for this lies in the fact that indications are often emergent in nature and do not allow a long preparation time.

In the course of nearly 100 years, the freehand placing of EVDs has not been supplanted by any other technique or assistive device in the majority of cases. Malposition rates of EVDs are still a frequently raised topic in clinical debate – as well as the need for technical devices that could increase the accuracy of EVD positioning. External ventricular drainage (EVD) application is one of the most frequently conducted neurosurgical procedures, and precise placement of the catheter tip is essential as it ensures adequate drainage of liquor in critically ill patients.

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