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

Abstract

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.

Brain Abscess: A Comparison of Surgical Outcomes between Conventional Burr Hole Aspiration and Endoscope-Assisted Evacuation

“…Bacterial brain abscesses can be diagnosed and treated with percutaneous aspiration under imaging modalities and neuronavigation systems. 9 Drainage of brain abscesses is carried out in most centers with contrast-enhanced CT scan, [10][11][12][13] even though magnetic resonance (MR) imaging is the gold standard. One major advantage of modern imaging techniques is the use of stereotaxis.…”

Detection of “Incidentalomas” on Brain and Body68Ga-DOTATOC-PET Scans: A Retrospective Study and Case Illustration

“…This could deeply revolutionize the editorial approach to scientific content. Mixed reality offers an immersive environment where images (18,19), videos, tables, text can be easily read, but the most important aspect is about transparency. The platform used to upload the whole manuscript may also contain the DICOM files, to give the opportunity to the scientific community to evaluate the entire dataset and not only the few images usually present in the papers.…”

Augmented reality–assisted craniofacial reconstruction in skull base lesions — an innovative technique for single-step resection and cranioplasty in neurosurgery

“…Phantom studies and cadaver simulations have also demonstrated promising applications of AR in cranial neurosurgery with techniques for cranial biopsy or accurate catheter placement. This raises the potential for very precise minimally invasive procedures, which could perspectively be applied bedside with minor efforts [ 33 , 36 ]. AR-assisted puncture of the gasserian ganglion for precise radiofrequency ablation in trigeminal neuralgia provides another interesting approach in minimally invasive interventional pain management [ 26 ].…”

“…As for intraoperative use, descriptions of AR-guided navigation can be found primarily for endoscopic procedures, including endoscopic transsphenoidal skull base surgery [ 9 , 25 , 29 ]. Several phantom studies also demonstrate potential applications for cranial biopsy or catheter placement [ 33 , 36 ].…”