Introduction: External Ventricular Drain (EVD) placement is one of the most commonly performed procedures in neurosurgery, frequently by the junior neurosurgery resident (1,2). Simulators for EVD placement are often costly, time-intensive to create, and complicated to set up (3,4,5). In this presentation, we describe creation of a simulator that is inexpensive, time-efficient, and simple to set up.

Methods: This simulator involves printing a hollow head using a desktop 3D printer. This head is registered to a commercially available image guidance system. Eleven participants volunteered for this simulation module. EVD placement was assessed at baseline, after verbal teaching, and after live 3D view instruction.

Results: Accurate placement of an EVD on the right side at the foramen of Monro or the frontal horn of the lateral ventricle increased from 44% to 98% with training. Similarly, accurate placement on the left increased from 42% to 85% with training.

Conclusions: During participation in the simulation, accurate placement of EVDs increased significantly. All participants believed that they had a better understanding of ventricular anatomy and that this module would be useful as a teaching tool for neurosurgery interns.

Patient Care: This research describes the creation and evaluation of a 3-D printed EVD simulator that is inexpensive ($5 in materials for each participant) and easy to create. We show that practice with the simulator improves EVD accuracy with our 11 participants, who were either sub-interns or interns. Improved accuracy of EVD placement will result in fewer complications, including hemorrhage, paralysis, and death.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the current options available for EVD placement simulation 2) Identify the materials and equipment needed to create a 3D-printed EVD simulator at their home institution 3) Construct a simulation to teach their interns how to insert an EVD.

References: 1 Srinivasan VM, O’Neill BR, Jho D, Whiting DM, Oh, MY. The history of external ventricular drainage: historical vignette. J Neurosurg. 2014;120(1):228-236. 2 Sneldon NR, Origitano TC, Burchiel KJ, et al. A national fundamentals curriculum for neurosurgery PGY1 residents: the 2010 Society of Neurological Surgeons boot camp courses. Neurosurgery. 2012;70(4):971-981. 3 Banerjee PP, Luciano CJ, Lemole GM, Charbel FT, Oh MY. Accuracy of ventriculostomy catheter placement using a head- and hand-tracked high-resolution virtual reality simulator with haptic feedback. J Neurosurg. 2007:107(3):515-521. 4 Tai BL, Rooney D, Stephenson F, et al. Development of a 3D-printed external ventricular drain placement simulator: technical note. J Neurosurg. 2015;123(4):1070-1076 5 Hooten KG, Lister JR, Lombard G, et al. Mixed reality ventriculostomy simulation: experience in neurosurgical residency. Neurosurgery. 2014;10:576-581.