Calvarial slope affecting accuracy of Ghajar Guide technique for ventricular catheter placement

Park, Jaechan; Son, Wonsoo; Park, Ki‐Su; Kim, Min Young; Lee, Joomi

doi:10.3171/2015.5.jns15226

Cited by 13 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The tripod keeps the probe holder perpendicular to the skull. Though this is true in a large percentage of patients, in a patient with an unusual slope to the cranial surface, the trajectory may not drop into the ventricle [13]. Furthermore, for the posterior approach, when the aim is to get the catheter tip into the frontal horn with minimal travel through the brain substance, this system will not provide optimal trajectory.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, tapping the lateral ventricle from the posterior approach can be a little more challenging than the anterior approach, especially if the desired tip-point is the frontal horn, because of the length of the passage to the frontal horn from the posterior approach [1,2]. Therefore, surgeons often have use navigation or guidance systems, ultrasound imaging, and ventricular guiding devices to tap the ventricles with a great degree of success [3][4][5][6][7][8][9][10][11][12][13]. In this paper, the authors present a simple device to tap the ventricle from the posterior approach using preoperative CT or MR images.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Stereotactic guide for posterior approach to lateral ventricle

Chand

Patil

et al. 2021

Egypt J Neurosurg

View full text Add to dashboard Cite

Background Free-hand tapping of the lateral ventricle through the posterior approach is a standard procedure. There are occasions, however, when more than one pass is needed. One way to make it easy and safe is to use a neuro-navigation approach. This requires extra setup. Therefore, the authors in this paper describe the use of a simple device to accurately place the catheter tip in the frontal horn. Main body The device is rectangular with two open arms with co-linear free ends. Based on axial CT or MR images, a trajectory that travels within the ventricle from the posterior to the anterior horn is chosen. The anterior and posterior points of the trajectory are marked on the scalp. A burr hole is placed at the posterior point. The anterior free end is then attached to the anterior trajectory point on the scalp using an EKG pad and to the posterior to a plug placed in the burr hole. The ventricle is tapped through a central hole in the burr hole plug. All 12 patients had accurate catheter placement at the first attempt using this system. Short conclusion This is a simple device that used CT or MR images and surface markings to accurately tap the ventricle.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stereotactic guide for posterior approach to lateral ventricle

Chand

Patil

et al. 2021

Egypt J Neurosurg

View full text Add to dashboard Cite

show abstract

“…The proposed adjustable Ghajar guide technique was developed based on a previous radiographic simulation study of catheter trajectories by the current authors 15) , which revealed that the accuracy of the original Ghajar guide technique is affected by the calvarial slope lateral to the sagittal midline with individual variation, making it suboptimal for guiding the ventricular catheter trajectory into the frontal horn of the lateral ventricle near the foramen of Monro. The radiographic simulation of orthogonal catheter placement resulted in 70.2% optimal catheter placement in the ipsilateral frontal horn and 29.8% suboptimal placement in the contralateral frontal horn.…”

Section: Discussionmentioning

confidence: 99%

“…The coronal adjustment angle from the orthogonal catheter trajectory at Kocher’s point is determined based on a radiographic simulation of the orthogonal catheter trajectory using coronal head images, as previously reported by the current authors 15) . This is simulated on coronal computed tomography (CT) images reconstructed from axial head imaging or coronal T2-weighted magnetic resonance image (MRI) using PiViewSTAR TM (INFINITT Co., Ltd., Seoul, Korea), a picture archiving and communication system (PACS) that integrates simple measurement tools (e.g., distance and angle measurements).…”

Section: Methodsmentioning

confidence: 99%

Adjustable Ghajar Guide Technique for Accurate Placement of Ventricular Catheters : A Pilot Study

Yoon

Kwak

Park

2017

J Korean Neurosurg Soc

Self Cite

View full text Add to dashboard Cite

ObjectiveAn adjustable Ghajar guide is presented to improve the accuracy of the original Ghajar guide technique. The accuracy of the adjustable Ghajar guide technique is also investigated.MethodsThe coronal adjustment angle from the orthogonal catheter trajectory at Kocher’s point is determined based on coronal head images using an electronic picture archiving and communication system. For the adjustable Ghajar guide, a protractor is mounted on a C-shaped basal plate that is placed in contact with the margin of a burrhole, keeping the central 0° line of the protractor orthogonal to the calvarial surface. A catheter guide, which is moved along the protractor and fixed at the pre-determined adjustment angle, is then used to guide the ventricular catheter into the frontal horn adjacent to the foramen of Monro. The adjustable Ghajar guide technique was applied to 20 patients, while a freehand technique based on the surface anatomy of the head was applied to another 47 patients. The accuracy of the ventricular catheter placement was then evaluated using postoperative computed tomography scans.ResultsFor the adjustable Ghajar guide technique (AGT) patients, the bicaudate index ranged from 0.23 to 0.33 (mean±standard deviation [SD]: 0.27±0.03) and the adjustment angle ranged from 0° to 10° (mean±SD: 5.2°±3.2°). All the AGT patients experienced successful cerebrospinal fluid diversion with only one pass of the catheter. Optimal placement of the ventricular catheter in the ipsilateral frontal horn approximating the foramen of Monro (grade 1) was achieved in 19 patients (95.0%), while a suboptimal trajectory into a lateral corner of the frontal horn passing along a lateral wall of the frontal horn (grade 3) occurred in 1 patient (5.0%). Thus, the AGT patients experienced a significantly higher incidence of optimal catheter placement than the freehand catheterized patients (95.0% vs. 68.3%, p=0.024). Moreover, none of the AGT patients experienced any tract hemorrhages along the catheter or procedure-related complications.ConclusionThe proposed adjustable Ghajar guide technique, using angular adjustment in the coronal plane from the orthogonal trajectory at Kocher’s point, facilitates accurate freehand placement of a ventricular catheter for hydrocephalic patients.

show abstract

“…[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

View full text Add to dashboard Cite

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.

show abstract

Calvarial slope affecting accuracy of Ghajar Guide technique for ventricular catheter placement

Cited by 13 publications

References 15 publications

Stereotactic guide for posterior approach to lateral ventricle

Stereotactic guide for posterior approach to lateral ventricle

Adjustable Ghajar Guide Technique for Accurate Placement of Ventricular Catheters : A Pilot Study

Ventriculostomy-associated hemorrhage: a risk assessment by radiographic simulation

Contact Info

Product

Resources

About