Artikel
The impact of real-time ultrasound guidance for ventricular catheter placement in cerebrospinal fluid shunts – a single center study
Suche in Medline nach
Autoren
-
Sevgi Sarikaya-Seiwert
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
-
Thomas Beez
- Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, United Kingdom
-
Ann Kristin Schmitz
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
-
Hans-Jakob Steiger
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
| Veröffentlicht: | 8. Juni 2016 |
|---|
Gliederung
Text
Objective: Misplacement of ventricular catheter in shunt surgery occurs in 40% with freehand technique and is a risk for early shunt failure resulting in additional morbidity. The goal of this retrospective, single center study was to analyze the impact of using real-time ultrasound guidance on central catheter positioning and early outcome of shunt survival.
Method: We analyzed retrospectively the charts and images of all patients who underwent ventriculo-peritoneal shunt surgery from 09/2011 to 08/2015 and compared the position of ventricular catheter by using the freehand technique or real-time ultrasound guidance. Central catheter position was graded as grade I (optimal), II (contact with ventricle structures or contralateral) and III (misplacement). For ultrasound guidance a burr hole probe was used (ProSound Alpha 6, Hitachi Aloka Medical Ltd., Tokyo, Japan).
Results: In 244 patients ventricular catheter placement was performed by real-time ultrasound guidance whereas in 506 patients the central catheter was placed by freehand technique. The mean age (54.3 in the study, 53.6 in the control group) and the preoperative frontal occipital horn ratio (FOHR; 0.47 versus 0.44) were almost equal in both groups. In the study group, grade I catheter position was achieved in 64%, grade II in 34% and grade III in 2%. The control group showed grade I position in 45%, grade II in 32% and grade III in 23% of cases (p<0.05). Early central catheter failure rate (within 5 days) was highest in grade III (100%) compared to 4% in grade I.
Conclusions: Our data demonstrates real-time ultrasound guidance lead to an improvement of catheter positioning in the ventricle. In consequence early cerebrospinal fluid shunt revisions decrease significantly. In the absence of additional burden or risks, this method should be used routinely for ventricular catheter placement.
