Superior accuracy of external ventricular drain placement using electromagnetic navigation compared to freehand insertion: A retrospective cohort study

•EM-guidance significantly enhances the accuracy of EVD placements compared to freehand insertion.•EM-guidance was more frequently utilized in anatomically challenging cases characterized by significantly smaller ventricular systems and a higher frequency of midline shift.•EM-guidance was primarily used by less experienced neurosurgeons in training.•EM-guidance is recommended for routine neurosurgical practice, particularly in anatomically challenging cases.