Artikel
Real-time continuous ultrasound-guided placement of ventricular catheters
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Veröffentlicht: | 21. März 2014 |
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Gliederung
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Introduction: Placement of ventricular catheters is a common procedure. The freehand technique is mainly used, which relies on anatomical landmarks and general coordinates for burr hole and catheter trajectory. The rate of inaccurate placement reaches 25%, often leading to dysfunction. We thus evaluated real-time continuous ultrasound guidance, which allows for intraoperative visualization of anatomy, catheter trajectory and final position.
Material and methods: An Aloka burr hole probe (3.0-7.5mHz) was used. Ventricular size, midline shift and catheter position were assessed on CT or MRI. Ventricular size was quantified by frontal occipital horn ratio (FOHR). Ventricular catheter position was graded as I (= optimal), II (= catheter tip lying in contralateral ventricle or touching ventricular structures) or III (= misplaced).
Results: 21 patients were enrolled, with a mean age of 6.2 years (range 0-18 years). 18 CSF shunts and 3 EVD were inserted via either a frontal (n=14) or occipital (n=7) approach. Underlying pathology was posthemorrhagic hydrocephalus (n=9), occlusive hydrocephalus (n=3), acute hemorrhage or trauma (n=3), malformation (n=4) and other (n=2). Mean preoperative FOHR was 0.45 (range: 0.28–0.71). Grade I position was achieved in 7, grade II in 13 and grade III in 1 patient.
Conclusion: Real-time continuous ultrasound-guided placement of ventricular catheters significantly reduced the rate of misplacement to only 5%. Controlled trials are required to evaluate influence on outcome, e.g. shunt survival. However, ultrasound appears to dramatically increase precision of ventricular catheter placement compared to freehand technique.