Artikel
Non-assisted versus neuronavigated and real-time “tracked” ventricular catheter placement: a cadaver study
Suche in Medline nach
Autoren
Veröffentlicht: | 20. Mai 2009 |
---|
Gliederung
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.