Anatomical Approaches for Insertion Sites of External Ventricular Drainage Catheters

External ventricular drains (EVDs) are widely used in neurosurgery to control intracranial pressure, divert cerebrospinal fluid (CSF), and facilitate monitoring in acute neurological and neurosurgical conditions. Accurate catheter placement is essential, as anatomical trajectory and insertion site directly influence efficacy and complication rates. This review summarizes the major anatomical entry points for EVD insertion, including Kocher’s, Frazier’s, Keen’s, occipital-parietal, and Dandy’s points, and discusses the rationale, advantages, and limitations associated with each approach. Commonly used techniques, such as freehand landmark-based placement, stereotactic guidance, neuronavigation, ultrasound-assisted insertion, and endoscopic methods, are reviewed in the context of accuracy and clinical applicability. Reported outcomes demonstrate high cannulation success with standard approaches, while complications such as infection, hemorrhage, catheter misplacement, and obstruction remain significant considerations. Key patient-, procedure-, and maintenance-related risk factors are highlighted, along with evidence-based recommendations to improve safety and reduce variability in clinical practice. As technological developments continue to advance catheter design and placement guidance, understanding anatomical strategies and standardized care protocols remains essential for optimizing EVD effectiveness. This review provides a comprehensive, practical overview intended to support neurosurgeons and critical care clinicians in selecting safe insertion sites and minimizing procedure-related complications.