Literature

Highlights

A 10 question survey was sent to 2006 neurosurgeons and 1060 neurosurgery residents in the US. Demographic information and data regarding estimated success rates of ventriculostomies, the steps taken in failure and use of technological aids used were asked. 479 neurosurgeons and 108 residents responded. The authors concluded that both residents and neurosurgeons admit to multiple attempts and frequent catheter misplacement. In order to consider a change in practice, respondents cited an increase in available data about guidance systems and ability to accommodate abnormal ventricular anatomy as primary requirements.

Title

A US based survey on ventriculostomy practices

Authors

Tausif Rehmana, Atiqur Rehmanb, Amina Rehmanc, Hassaan H. Bashirc, Rushna Alid, Salima Ahmed Bhimani, Sidra Khan

Citation
Clinical Neurology and Neurosurgery 114 (2012) 651-654

Highlights

Pre operative and post operative computed tomography scans for 66 consecutive EVDs performed in 56 adult patients were retrospectively reviewed. Pre operative lateral ventricular volume, position of the burr hole, length of the catheter and its sagittal and coronal angular variations from a theoretical trajectory were measured. Only 50% of the EVDs in the coronal plane and 40% in the sagittal plane were placed with an angular variation of 5 to the target. The tip was placed outside of the ventricles in three cases; 13 catheters crossed the midline, and five intracranial minor hemorrhages were detected. The authors concluded that freehand placement of EVDs does not have sufficient accuracy and may lead to drainage dysfunction and the data suggests that a guidance system for EVD’s would be required.

Title

Accuracy of external ventricular drainage catheter placement

Authors

Mohammad Ghazi Abdoh, Olivier Bekaert, Jérôme Hodel, Salia Mamadou Diarra, Caroline Le Guerinel, Rémi Nseir, Sylvie Bastuji Garin, Philippe Decq

Citation
Acta Neurochir (2012) 154:153-159

Highlights

The objective of this study was to compare the accuracy of 3 methods of ventricular catheter placement during CSF shunt operations: freehand technique using surface anatomy, ultrasonic guidance, and stereotactic neuronavigation. There were 249 patients included in the study; 170 ventricular catheters were freehand passed, 51 were placed using stereotactic neuronavigation, and 28 were placed under intraoperative ultrasonic guidance. There was a statistically significant difference between freehand catheters and stereotactic guided catheters), as well as between freehand catheters and ultrasound guided catheters. The only risk factor for inaccurate placement identified in this study was use of the freehand technique. The use of stereotactic neuronavigation and ultrasonic guidance reduced proximal shunt failure rates in comparison with a freehand technique. The authors concluded that stereotactic and ultrasound guided ventricular catheter placements are significantly more accurate than freehand placement, and the use of these intraoperative guidance techniques reduced proximal shunt failure in this study.

Title

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Authors

Thomas J. Wilson, William R. Stettler Jr., Wajd N. Al-Holou, Stephen E. Sullivan

Citation
J. Neurosurgery 119: 66-70, 2013

Highlights

A total of 183 post EVD insertion scans were reviewed over a 2 year period for EVD tip location and intracranial catheter length. 73 EVD tips (39.9%) were in the ipsilateral frontal horn of the lateral ventricle (the desired target); of those, 18 (25%) required EVD revision/reinsertion. Of the others, 35 (19.1%) were in the third ventricle, 33 (18%) in the body of the lateral ventricle, 19 (10.4%) in the sub arachnoid space, 5 (2.7%) in the contralateral frontal horn, and 18 (9.8%) within the brain parenchyma. When the EVD tip was outside the desired target, 44 of the patients (40%) required EVD revision/reinsertion procedure. The authors concluded that free hand insertion of an EVD is an inaccurate procedure, and further studies are required to assess the accuracy and feasibility of the routine use of neuro navigation, ultrasonography, or other guidance techniques and the possible implication of the decreasing revision rate, complications, and length of hospital stay.

Title

External ventricular drain insertion accuracy: Is there a need for change in practice?

Authors

Ahmed Toma, Sophie Camp, Laurence Watkins, Joan Grieve, Neil Kitchen

Citation
Neurosurgery 65:1197-1201, 2009

Highlights

Retrospective evaluation of head computed tomography (CT) scans of 97 patients who underwent 98 freehand pass ventriculostomy catheter placements in an ICU setting. Using the post procedure CT scans of the patients, 3D measurements were made to calculate the accuracy of ventriculostomy catheter placement. The accuracy of freehand ventriculostomy catheterization typically required 2 passes per successful placement, and, when successful, was 1.6 cm from the Monro foramen. More importantly, 22.4% of these catheter tips were in non ventricular spaces. “Although many neurosurgeons believe that the current practice of ventriculostomy is good enough, the results of this study show that there is certainly much room for improvement.”

Title

Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans

Authors

David Huyette, Benjamin Turnbow, Christian Kaufman, Dale Vaslow, Benjamin Whiting, Michael Oh

Citation
J Neurosurg 108:88 91, 2008

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