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Background: External ventricular drainage (EVD) is an emergency process intended to reduce intracranial hypertension resulting from the obstruction of cerebrospinal fluid (CSF) flow. This creates a temporary situation to extract CSF that cannot pass through normally. Knowing the surface anatomy for EVD implantation is important to prevent its inadvertent complications. The external landmarks have been designed in this anatomic study to review the classical landmarks and come up with new landmarks to improve this simple but lifesaving procedure. Methods: From November 1998 to October 2012, we implanted 439 EVDs. Results: In the first years, we employed usual landmarks to implant 97 EVDs. Since 2002, we used modified anatomical landmarks to implant 342 EVDs directly in the third ventricle. Conclusion: Using effective landmarks for EVD implementation allows the catheter to be inserted in the third ventricle. In addition, it permits more precise accuracy to ensure a safer procedure with fewer complications. [ABSTRACT FROM AUTHOR]