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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Virtual ventricular catheter placement using neuronavigation – a training tool for neurosurgeons-in-training

Virtuelle neuronavigierte Ventrikelkatheterplatzierung – eine Trainingsmethode für angehende Neurochirurgen

Meeting Abstract

  • presenting/speaker Julie Anne Etingold - Städtisches Klinikum Karlsruhe, Neurosurgery, Karlsruhe, Deutschland
  • Andrej von Schilling - Städtisches Klinikum Karlsruhe, Neurosurgery, Karlsruhe, Deutschland
  • Uwe Spetzger - Städtisches Klinikum Karlsruhe, Neurosurgery, Karlsruhe, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP087

doi: 10.3205/21dgnc375, urn:nbn:de:0183-21dgnc3751

Published: June 4, 2021

© 2021 Etingold et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: The aim of this prospective study is to evaluate practices, pitfalls and traceability in a realistic but virtual set-up for simulating ventricular drainage (VD) placement as a practicable training model. The influence of the level of neurosurgical knowledge and training level were of overall interest, especially in narrow ventricles.

Methods: In this ongoing study, we evaluate the accuracy to hit the target by repeated virtual freehand VD placement using anatomical landmarks by neurosurgeons-in-training and non-neurosurgical staff. The target was to place the VD into the anterior horn of the right lateral ventricle, assuming CSF drainage. Catheter placement was simulated using the pointer of the navigation system with variable tip extension simulating catheter length. The chosen target point was frozen and documented. Until then, the participant has no visual feedback via the navigation system. The results were directly evaluated on-screen, saved to the navigation system and thereafter evaluated in detail using iPlan Net (Brainlab) on the computer. Placement was assessed for the possibility of CSF-flow, injury of eloquent structures, catheter tip length, number of attempts and level of neurosurgical training.

Results: At present, 28 virtual freehand VD were placed into a proband with a narrow ventricular system by 17 participants. These were grouped into a high-knowledge group of 11 participants (neurosurgical training >1 year) and a low-knowledge group of 6 participants (no neurosurgical training or < 1 year). In total, 16 correct VD were performed. The high expertise group fared better with 14 successfully placed VD in 17 attempts than the low-expertise group with 2 successful VD in 11 attempts. Accurate VD placement correlated with neurosurgical experience. The overall low success rate was partially attributed to the narrow ventricles as well as to the fact that catheter length was pre-determined and not modified once CSF-flow is obtained as in reality.

Conclusion: The results emphasize the need for noninvasive training for catheter placement, especially in narrow ventricles and is correlated to the anatomical knowledge and the level of neurosurgical training. Navigation-guided virtual ventricular catheter placement is a perfect and unbloody training model and should be integrated as a simple, non-invasive, inexpensive training of neurosurgeons to improve placement trajectories and techniques in real-life scenarios.