[Placement of a ventricular catheter into narrow lateral ventricles. Popular navigation]

Neuronavigation device for stereotaxic external ventricular drainage insertion

Background:

The insertion of an external ventricular drainage (EVD) is one of the most frequently used neurosurgical procedures. It is performed to adjust intracranial hypertension in cases of severe craniocerebral injury, acute posthemorrhagic hydrocephalus, meningitis, and oncological diseases related to impaired circulation of cerebrospinal fluid circulation (CSF).

Methods:

In 2020, three patients with subarachnoid aneurysmal hemorrhage underwent insertion of an EVD navigation percutaneous stereotaxic device. Three cases introduced.

Results:

In all cases, satisfactory EVD functioning was noted during the surgery and during the early postoperative period. The EVD insertion procedure took an average of 10 min. The EVD insertion route calculations using the software took about 5–15 min. No cases showed any infection, hemorrhagic complications, or EVD dysfunction. According to the control brain computed tomography data, the catheter position was satisfactory and corresponded to the target coordinates in all cases.

Conclusion:

The use of the device, with its high accuracy and efficiency, can reduce the incidence of unsatisfactory EVD implantation cases in patients with neurosurgical pathology.

High accuracy of external ventricular drainage placement using anatomical landmarks

BACKGROUND

The conventional approach for external ventricular drainage (EVD) application is the freehand method. Technical devices can improve the accuracy of placement, but they have not yet replaced anatomical landmarks owing to the cost and effort that they entail. There is disagreement as to whether freehand EVD application is safe enough to be accepted as a standard technique. Many authors have investigated the final catheter position in retrospect. They describe variable rates of malpositioning. However, few studies have assessed in how far cranial surface anatomy has really been respected during burr-hole drilling and catheter insertion. The aim of this study was to investigate parameters that might play a part in determining the final intracranial catheter position.

METHODS

In all, 100 pre- and postprocedural thin-layer computed-tomography (CT) scans of EVD patients were analysed with the help of JiveX® and OsiriX Lite® software. A series of anatomical and catheter-related parameters, including inter alia intraventricular blood, midline shift, burr-hole location and catheter entrance angle, were correlated with the final catheter position.

RESULTS

A majority of EVDs show an optimal or nearly optimal position. Only the deviation of catheter entrance angle has a significant influence on catheter malpositioning. The burr-hole location can vary within an area of several centimetres around the coronary suture.

CONCLUSIONS

The freehand application of EVD is safe as long as the intracranial anatomy is not disfigured to a large extent, the surface measurements are carried out precisely and the puncturing is done perpendicularly to the skull.

The use of a smartphone-assisted ventricle catheter guide for Ommaya reservoir placement-experience of a retrospective bi-center study

BACKGROUND

For intraventricular chemotherapy (IVC) as part of many oncological treatment protocols, Ommaya reservoir is enabling repeated access to the cerebro-spinal fluid (CSF). The correct placement of the catheter in the ventricle is essential for correct application of drugs, which is enabled by sophisticated techniques such as neuronavigation.

OBJECTIVE

In a bi-center retrospective study, we reviewed our experience using a smartphone-assisted ventricle catheter guide as simple solution for correct Ommaya reservoir placement.

METHODS

Sixty Ommaya reservoirs have been placed in 60 patients between 2011 and 2017 with the smartphone-assisted ventricular catheter guidance technique. Patient characteristics, preoperative frontal and occipital horn ratio (FOHR), postoperative catheter position, and complications were assessed.

RESULTS

The majority of our patients (71.6%) have got narrow or slit-like ventricles (FOHR ≤ 0.4). All Ommaya reservoirs were placed successfully. Fifty-eight ventricular catheters (97%) were inserted at the first and 2 (3%) at the second attempt using the same technique. No immediate perioperative complications were observed. All catheters (100%) could be used for IVC. Postoperative imaging was available in 52 patients. Thirty-two (61.5%) of ventricular catheters were rated as grade I, 20 (38.5%) as grade II, and none (0%) as grade III. Four patients (6.7%) showed postoperative complications during a median follow-up of 8.5 months (hydrocephalus, n = 1; infection, n = 1; parenchymal cyst around catheter, n = 1; shunt revision, n = 1).

CONCLUSIONS

The smartphone-assisted guide offers decent accuracy of ventricle catheter placement with ease and simplicity for a small surgical intervention. We propose this technique as routine tool for Ommaya reservoir placement independent of lateral ventricular size to decrease the rate of ventricle catheter malposition as reasonable alternative to a neuronavigation system.