Common Trajectories for Freehand Frontal Ventriculostomy: A Systematic Review

Amoo, Michael; Henry, Jack; Javadpour, Mohsen

doi:10.1016/j.wneu.2020.11.065

Cited by 7 publications

(1 citation statement)

References 26 publications

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“…The misplacement rates reported in literature are high, probably due to the use of EVD also in patients affected by midline shift or slit ventricles and in procedures performed by non-neurosurgeons in remote areas with logistic difficulties. Numerous studies have already been published about the reduction of complication after EVD, which is currently a freehand procedure, performed only according to anatomical landmarks that help to introduce the catheter perpendicularly to the burr hole; the perpendicularity is a critical element for the correct positioning of the catheter ( Gil et al, 2002 ; Shimizu et al, 2004 ; Lee et al, 2008 , 2020 ; Mahan et al, 2013 ; Patil et al, 2013 ; Jakola et al, 2014 ; Siesjö, 2014 ; Shtaya et al, 2018 ; Thomale et al, 2018 ; Wilson et al, 2018 ; Fuller et al, 2020 ; Park et al, 2020 ; Sun et al, 2020 ; Amoo et al, 2021 ; Cabrilo et al, 2021 ; Pishjoo et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement

et al. 2021

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BackgroundExternal ventricular drain (EVD) placement is mandatory for several pathologies. The misplacement rate of the EVD varies widely in literature, ranging from 12.3 to 60%. The purpose of this simulation study is to provide preliminary data about the possibility of increasing the safety of one of the most common life-saving procedures in neurosurgery by testing a new device for EVD placement.MethodsWe used a novel guide for positioning the ventricular catheter (patent RM2014A000376). The trajectory was assessed using 25 anonymized head CT scans. The data sets were used to conduct three-dimensional computer-based and combined navigation and augmented reality-based simulations using plaster models. The data set inclusion criteria were volumetric head CT scan, without midline shift, of patients older than 18. Evans’ index was used to quantify the ventricle’s size. We excluded patients with slit ventricles, midline shift, skull fractures, or complex skull malformations. The proximal end of the device was tested on the cadaver.ResultsThe cadaveric tests proved that a surgeon could use the device without any external help. The multimodal simulation showed Kakarla grade 1 in all cases but one (grade 2) on both sides, after right and left EVD placement. The mean Evans’ index was 0.28. The geometric principles that explain the device’s efficacy can be summarized by studying the properties of circumference and chord. The contact occurs, for each section considered, at the extreme points of the chord. Its axis, perpendicular to the plane tangent to the spherical surface at the entry point, corresponds to the direction of entry of the catheter guided by the instrument.ConclusionAccording to our multimodal simulation on cadavers, 3D computer-based simulation, 3D plaster modeling, 3D neuronavigation, and augmented reality, the device promises to offer safer and effective EVD placement. Further validation in future clinical studies is recommended.

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