Posterior ventricular catheter burr-hole localizer

Abstract

Proper ventricular catheter placements are associated with improved shunt performance. When placing ventricular catheters via the posterior approach, the surgeon must determine an optimum trajectory and then pass a catheter along that trajectory. The incidence of optimal posterior catheter placements is increased by using a posterior catheter guide (PCG); however, errors may still occur because of poor selection of a posterior burr-hole site. In this report an easy-to-use posterior burr-hole localizer (Localizer) is described that defines the optimum burr-hole location based on geometric relationships involving the ear and supraorbital rims. The basic design principle of the Localizer was formulated and tested by using neuronavigational imaging tools to examine normal adult ventricular anatomy in relation to surface landmarks and by reviewing imaging studies obtained in 50 adult patients with hydrocephalus. Subsequently, the Localizer was used in 28 consecutive patients scheduled to undergo shunt surgery performed by using the PCG. In all cases the catheter entered the ventricle on the first pass and postoperative imaging studies demonstrated successful placement in the ipsilateral anterior horn. There were no catheter-related complications. These early results indicate that the Localizer and PCG devices may be safe and effective when used in combination for placement of posterior ventricular catheters.

Ventricular catheter placement accuracy in non-stereotactic shunt surgery for hydrocephalus

“…The third is to use generic stereotactic guides. The use of at least one stereotactic guide achieves rapid, accurate targeting from the occipital approach, 17,18 although the universal accuracy of generic guides has been challenged. 16 The advent of catheter introducers for use with patient-specific frameless stereotaxy provides an elegant solution that should be formally trialled for routine placement of occipital ventricular catheters.…”

Manual Occipital Ventricular Puncture for Cerebrospinal Fluid Shunt Surgery: Can Aiming Be Standardized?

“…9,13) Investigation of a posterior ventricular catheter burr hole localizer employing the normally located superior orbital rim and superior attachment point of the ear as reference points showed that localization of the burr hole relative to the inion should not be applied because of the variations in this landmark. 9) The present retrospective analysis also showed that the described conventional standard occipital puncture might result in incorrect catheter emplacement and the ideal external aim points could not be standardized because of the wide varia- tion in the landmarks. We believe that the aim point should be decided based on preoperative individual radiological measurements, although this primitive process takes time.…”

A survey of surgical techniques for catheterising the cerebral lateral ventricles

“…9 Other stereotactic aids designed to reduce variability of measurements and trajectories based on generic landmarks have been developed and shown to be of some value, although the uptake of these techniques by other surgeons is unknown. [10][11][12] Patient-specific frameless, frame-based or real-time ultrasound stereotaxy based on preoperative or intraoperative imaging is likely to improve accuracy at the expense of time taken in scanning and registration of fiducials but has not been systematically studied to determine the risk-benefit profile of this innovation.…”