External ventricular drain (EVD) placement is one of the most basic and common neurosurgical procedure which most was performed by young neurosurgical trainees. This study is conducted to determinate the safe and accuracy of EVD placement by freehand method. About 129 EVD placements were evaluated in this study. Eighty-three catheters (64.3%) were located in the ipsilateral frontal horn or third ventricle. The functional accuracy was 86%. Of eighteen misplaced catheters, only 4 (3.1%) catheters were nonfunctional, requiring a replacement or reposition. The higher misplaced rate was significantly observed in patients whose head CT scans revealed the lower hydrocephalus ratio (28.85%) and the smaller ventricular size (5.6 mm). Twenty-one (16.2%) new hemorrhages associated with EVD placements were observed. Using the freehand method, EVD placement is a safe and effective procedure in management of these emergent neurosurgical diseases.