gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Non-assisted versus neuronavigated and real-time “tracked” ventricular catheter placement: a cadaver study

Meeting Abstract

  • P. Bijlenga - Service de Neurochirurgie, Hôpitaux Universitaire de Genève, Genèva, Suisse
  • M. Kotowski - Service de Neurochirurgie, Hôpitaux Universitaire de Genève, Genèva, Suisse
  • B. Schatlo - Service de Neurochirurgie, Hôpitaux Universitaire de Genève, Genèva, Suisse
  • L. Slegers - Philips Medical Systems
  • T. Gerken - BrainLab
  • B. Stimec - Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland
  • J. Fasel - Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland
  • K. Schaller - Service de Neurochirurgie, Hôpitaux Universitaire de Genève, Genèva, Suisse

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.15-01

DOI: 10.3205/09dgnc102, URN: urn:nbn:de:0183-09dgnc1024

Published: May 20, 2009

© 2009 Bijlenga et al.
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Outline

Text

Objective: Correct placement of the ventricular catheter for the treatment of acute or chronic hydrocephalus is an important issue especially if performed by our junior members. Drain insertion is associated with a risk of intracerebral hematoma with 1% mortality. Multiple attempts are often performed to reach the ventricles and increase the risk of hematoma. Fast and optimal positioning of the catheter at the first attempt should reduce mortality and morbidity associated with acute and chronic hydrocephalus treatment. The aim of this study was to compare two different drain insertion assistance tools with the traditional anatomical landmark method.

Methods: 10 cadaver heads were prepared by opening large bone windows centred on Kocher’s points on both sides preserving the bregma and the skin was closed. Twelve neurosurgeons, divided in 4 groups (junior trainees, senior trainees, junior board certified and senior board certified) performed catheters insertions. Optimal entry point was defined 2cm in front of the coronal suture on the mid pupillary line. The target for the ventricular drain tip was the foramen of Monroe. Each experiment required the surgeon to use 3 different methods for drain insertion: 1) by anatomical landmarks, 2) with neuronavigation, 3) with fluoroscopy guidance (real-time tracking). The number of ventricular hits, the distance of the catheter tip to target, A-P, lateral and cranio-caudal deviations from the optimal trajectory and size of catheter floating in the ventricles were measured and compared.

Results: Ventricles were missed in 29.6% of unassisted drain insertions, in 26.9% of neuronavigated insertions and in 11.5% of tracked insertions. The mean distance to target is 14.2±7.5mm when unassisted versus 10.9±7.2mm when neuronavigated (p=0.1) and 8.7±6.2mm when tracked (p=0.006). In particular, insertion tracking provided better control of the insertion depths (distance to target for tracking 3.7±3.7mm, neuronavigation 6.2±5.9mm, unassisted 7.3±5.9mm). The length of the catheter in the ventricles was larger for tracked insertion (17.2±9.2mm) than in the neuronavigated (12.8±9.5mm) or unassisted (11.2±9.6mm) groups.

Conclusions: The use of a navigating assistance improves accuracy of placement of ventricular drains.