gms | German Medical Science

131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

Real-time continuous ultrasound-guided placement of ventricular catheters

Meeting Abstract

  • Sevgi Sarikaya-Seiwert - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik, Düsseldorf
  • Thomas Beez - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik, Düsseldorf
  • Hans-Jakob Steiger - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik, Düsseldorf
  • Daniel Hänggi - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik, Düsseldorf

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch235

doi: 10.3205/14dgch235, urn:nbn:de:0183-14dgch2352

Veröffentlicht: 21. März 2014

© 2014 Sarikaya-Seiwert et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

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.