gms | German Medical Science

Objective: In a number of conditions, image guidance can facilitate placement of intracerebral catheters. However, the required preparation is time consuming. Therefore we investigated a novel technique for placement of image-guided catheters using preregistered stylets and a headband equipped with reference markers. We show preliminary data of a prospective study here, to optimize workflow in the operation room (OR) and intensive care unit (ICU).

Methods: 14 patients received an image-guided catheter either on the ICU or the OR. The time spans for preoperative transport and preparation, navigation planning, surgery and postoperative follow-up were assessed.

Results: 4 patients with intracerebral hemorrhage and 10 patients with elevated intracranial pressure and slit ventricles received catheter placement either into the hematoma for clot lysis or toin the ventricular system. In 11 cases (78.6%) the implanted catheter had an optimal, in 2 cases (14.3%) a functional but suboptimal position and in one (7.1%) re-operation was necessary. The average time for preoperative imaging and transport including preparation was 18.4 minutes, the average operation time was 26.8 minutes and the neuronavigation planning took 10.6 minutes. Perioperative management for procedures in the OR consumed 34 minutes on the average while on the ICU, it took 26 minutes (30% time-reduction).

Conclusions: Image-guided implantation of preregistered catheters was safe and accuracy corresponded to conventional image guiding techniques. Preregistered stylet in combination with the flexible headband equipped with reference markers allows the application of image guidance on the ICU as well. The latter resulted in faster procedures without loss of accuracy.