A survey of surgical techniques for catheterising the cerebral lateral ventricles

Lind, Christopher R. P.; Correia, Jason; Law, Andrew; Kejriwal, Ritwik

doi:10.1016/j.jocn.2007.05.013

Cited by 33 publications

(19 citation statements)

References 13 publications

(13 reference statements)

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“…14,15,19,20,31,32 The frontal approach has the shortest intracerebral route 15 with more consistent anatomical landmarks. 15,33,34 However, ventricular catheter shortening and burr hole displacement with growth is more pronounced with this approach.…”

Section: Predictors Of Optimal Shunt Placementmentioning

confidence: 99%

“…34,37 Direct visualization of the catheter is not possible with freehand placement, which is associated with difficulty in gauging optimum catheter length and angle. 2,25,31 As a result, accurate catheter placement can be a challenge, especially in patients with small or abnormal ventricular anatomy. 17,24 In children, ongoing changes of ventricular size and shape can be substantial, adding to the difficulty.…”

Section: Future Directionsmentioning

confidence: 99%

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Factors affecting the accuracy of ventricular catheter placement

Wan

Toy

Wolfe

et al. 2011

Journal of Clinical Neuroscience

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Section: Predictors Of Optimal Shunt Placementmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

Factors affecting the accuracy of ventricular catheter placement

Wan

Toy

Wolfe

et al. 2011

Journal of Clinical Neuroscience

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“…The placement of ventricular catheters is a relatively easy and straight-forward procedure, for which the neurosurgeons are trained during their first years of residency [1]. It may be the most often performed procedure in neurosurgery, since it becomes necessary in patients with cerebrospinal fluid drainage blockage, as transient external drainage before larger tumor surgeries, for intracranial pressure monitoring, for example, in severe traumatic brain injury patients, and in hydrocephalus patients for cerebrospinal fluid (CSF) shunting [3,5].…”

Section: Discussionmentioning

confidence: 99%

“…The transcortical puncture of the ventricles is considered to be a simple neurosurgical procedure and is performed as one of the first procedures in neurosurgical training [1]. The ventricular catheter is considered as a lifelong functioning implant in the case of a shunting procedure; therefore special focus should be dedicated to the accurate positioning of the catheter as a correlation between catheter position and risk for proximal shunt obstruction is already described [2-7].…”

Section: Introductionmentioning

confidence: 99%

Guided Application of Ventricular Catheters (GAVCA) - multicentre study to compare the ventricular catheter position after use of a catheter guide versus freehand application: study protocol for a randomised trail

Schaumann

Thomale

2013

Trials

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BackgroundThe standard technique for the placement of ventricular catheters (VC) comprises a high proportion of malpositioning of the catheter (12.5 to 40%). Technical advances such as neuronavigation or ultrasound have been shown to increase the accuracy of the procedure. Since these means result in significant technical and time consuming efforts, they are used for selected cases only. In order to simplify the controlled placement of ventricular catheters a newly developed smartphone assisted guiding tool has been introduced. In this study the efficacy and safety of this guiding tool is determined.Methods/designThis study is a multicentre, randomised, controlled trial. A total of 144 patients planned for an elective shunting procedure will be enrolled throughout 10 study centres within two years. The primary objective of the trial is to show the superiority of the guided placement in comparison to the standard freehand technique of ventricular catheter application. Patients will be followed up for 30 days after the operation in regard to image-based evaluation of the catheter position as well as possible shunt dysfunction and complications.DiscussionThe Guided Application of Ventricular Catheters (GAVCA) trial compares the guided catheter positioning with the standard freehand technique of catheter placement in hydrocephalic patients. If superiority is shown, the standard technique may be changed with the advantage of a more reliable and safer positioning of the ventricular catheter with just a slight effort in time and pre-operative planning.Trial registrationThe GAVCA trial is registered at ClinicalTrials.gov under the number NCT01811589.

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“…Cannulation perpendicular to Kocher's point continues to predominate in clinical practice. [9][10][11]13,14,23 However, image guidance and frameless stereotaxy are increasingly being used to improve catheterization of the ipsilateral frontal horn. 2,4,11,17,21,22 While new image-guided methods prioritize accuracy of ventricle entry, little is known about the damage to cortical vasculature during ventriculostomy and whether iatrogenic hemorrhage can be prevented.…”

mentioning

confidence: 99%

Ventriculostomy-associated hemorrhage: a risk assessment by radiographic simulation

Robertson

Abd-El-Barr

Mukundan

et al. 2017

Journal of Neurosurgery

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OBJECTIVEVentriculostomy entry sites are commonly selected by freehand estimation of Kocher's point or approximations from skull landmarks and a trajectory toward the ipsilateral frontal horn of the lateral ventricles. A recognized ventriculostomy complication is intracranial hemorrhage from cortical vessel damage; reported rates range from 1% to 41%. In this report, the authors assess hemorrhagic risk by simulating traditional ventriculostomy trajectories and using CT angiography (CTA) with venography (CTV) data to identify potential complications, specifically from cortical draining veins.METHODSRadiographic analysis was completed on 50 consecutive dynamic CTA/CTV studies obtained at a tertiary-care academic neurosurgery department. Image sections were 0.5 mm thick, and analysis was performed on a venous phase that demonstrated high-quality opacification of the cortical veins and sagittal sinus. Virtual ventriculostomy trajectories were determined for right and left sides using medical diagnostic imaging software. Entry points were measured along the skull surface, 10 cm posteriorly from the nasion, and 3 cm laterally for both left and right sides. Cannulation was simulated perpendicular to the skull surface. Distances between the software-traced cortical vessels and the virtual catheter were measured. To approximate vessel injury by twist drill and ventricular catheter placement, veins within a 3-mm radius were considered a hemorrhage risk.RESULTSIn 100 virtual lines through Kocher's point toward the ipsilateral ventricle, 19% were predicted to cause cortical vein injury and suspected hemorrhage (radius ≤ 3 mm). Little difference existed between cerebral hemispheres (right 18%, left 20%). The average (± SD) distance from the trajectory line and a cortical vein was 7.23 ± 4.52 mm. In all 19 images that predicted vessel injury, a site of entry for an avascular zone near Kocher's point could be achieved by moving the trajectory less than 1.0 cm laterally and less than 1.0 cm along the anterior/posterior axis, suggesting that empirical measures are suboptimal, and that patient-specific coordinates based on preprocedural CTA/CVA imaging may optimize ventriculostomy in the future.CONCLUSIONSIn this institutional radiographic imaging analysis, traditional methods of ventriculostomy site selection predicted significant rates of cortical vein injury, matching described rates in the literature. CTA/CTV imaging potentiates identification of patient-specific cannulation sites and custom trajectories that avoid cortical vessels, which may lessen the risk of intracranial hemorrhage during ventriculostomy placement. Further development of this software is underway to facilitate stereotactic ventriculostomy and improve outcomes.

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A survey of surgical techniques for catheterising the cerebral lateral ventricles

Cited by 33 publications

References 13 publications

Factors affecting the accuracy of ventricular catheter placement

Factors affecting the accuracy of ventricular catheter placement

Guided Application of Ventricular Catheters (GAVCA) - multicentre study to compare the ventricular catheter position after use of a catheter guide versus freehand application: study protocol for a randomised trail

Ventriculostomy-associated hemorrhage: a risk assessment by radiographic simulation

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