A Radiographic Analysis of Ventricular Trajectories

Rehman, Tausif; Rehman, Atiq; Ali, Rushna; Rehman, Amina; Bashir, Hamid; Bhimani, Salima; Tran, Hoan; Khan, Sidra

doi:10.1016/j.wneu.2012.12.012

Cited by 35 publications

(26 citation statements)

References 5 publications

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“…The concept of "1 trajectory fits all" has been tested by accessing the ipsilateral anterior horn when using Kocher's point as the entry point 21 (which corresponds to the precoronal point in our study). Only a subset (67.5%) of the ventricular trajectories passed through the frontal horn, and as a result the study recommended small adjustments on a case-by-case basis.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of endoscopic third ventriculostomy trajectories in pediatric cases

Zádor

Coope

Kamaly-Asl

2015

PED

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E ndoscopic third ventriculostomy (ETV) has emerged as an alternative method of CSF diversion alongside the placement of ventriculoperitoneal shunts. [18][19][20] ETV has been primarily advocated as an aqueductal bypass procedure for obstructive hydrocephalus, 12 but its application has now expanded to treating hydrocephalus of nonobstructive etiologies 1,5,8 with an overall success rate ranging from 68.5% to 83% in large mixed series. 1,2,13,23 Parallel to these high success rates, a recent review demonstrates an overall complication rate of 8.5%, permanent morbidity of 2.4%, and mortality of 0.21% for ETVs.3 In addition to the conceptual advantage of hardware-free CSF diversion, ETV presents the option of acquiring tissue biopsy if needed. 15,16,25 ETV also benefits from a potentially better cost effectiveness 9,11,12 and shorter surgical time compared with the placement of ventriculoperitoneal shunts.A safe and successful ETV requires good surgical visualization and atraumatic neuroendoscope passage through OBJect Endoscopic third ventriculostomy (ETV) has become a widely used method for CSF diversion when treating obstructive hydrocephalus. There are multiple recommendations on the transcortical ETV entry points, and some are specifically designed to provide a trajectory that avoids displacement to the eloquent periventricular structures. However, the morphology of the ventricular system is highly variable in hydrocephalus, and therefore a single best ETV trajectory may not be applicable to all cases. In the current study, 3 frequently quoted ETV entry points are compared in a cohort of pediatric cases with different degrees of ventriculomegaly. methOdS The images of 30 consecutive pediatric patients with varying degrees of ventriculomegaly were reviewed. Three-dimensional models were created using radiological analysis of anatomical detail and preoperative MRI scans in order to simulate 3 frequently quoted ETV trajectories for rigid neuroendoscopes. These trajectories were characterized based on the frequency and depth of tissue displacement to structures such as the fornix, caudate nucleus, genu of the internal capsule, and thalamus. The results are stratified based on ventricle size using the frontal horn ratio (FHR). reSultS Eloquent areas were displaced in nearly all analyzed entry points (97%-100%). Stratifying the data based on ventricle size revealed that 1) lateral structures were more likely to be displaced in cases of intermediate ventriculomegaly (FHR < 0.4) using all 3 trajectories, whereas 2) the fornix was less likely to be displaced using more posteriorly placed trajectories for severe ventriculomegaly (FHR > 0.4). Allowing for minimal (2.4 mm) tissue displacement, a more posterior entry point was less traumatic for severe ventriculomegaly. cOncluSiOnS There is no single best ETV trajectory that fully avoids displacement of the eloquent periventricular structures. Larger ventricles require a more posteriorly placed entry point in order to reduce injury to the eloquent structures, and interme...

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Section: Discussionmentioning

confidence: 99%

Comparative analysis of endoscopic third ventriculostomy trajectories in pediatric cases

Zádor

Coope

Kamaly-Asl

2015

PED

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“…However, application of the technique is not always accurate, 9,11 and the difference from the ideal catheter trajectory had not been reported previously for patients with hydrocephalus.…”

Section: Discussionmentioning

confidence: 95%

“…A radiographic analysis of the ventricular catheter trajectory orthogonal to the skull was performed by Rehman et al 11 However, their study focused only on patients with a normal ventricular size and revealed a catheter trajectory in a nonventricular space in 10% of the patients. In our radiographic study, we analyzed patients with hydrocephalus with a bicaudate index of ≥ 0.15, and although the catheter trajectory passed through a ventricular space in every case, it passed into the contralateral lateral ventricle in 30% of the head sides.…”

Section: Discussionmentioning

confidence: 99%

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

Park

Son

Park

et al. 2016

JNS

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OBJECT The Ghajar Guide technique is used to direct a ventricular catheter at a 90° angle to the skull surface at Kocher’s point. However, the human calvaria is not completely spherical. Lateral to the sagittal midline, the calvaria slopes downward with individual variation and thereby affects the accuracy of ventricular catheter placement. Accordingly, the authors investigated the accuracy of the orthogonal catheter trajectory using radiographic simulation and examined the effect of the calvarial slope on this accuracy. METHODS A catheter trajectory orthogonal to the skull surface at Kocher’s point and the ideal catheter trajectory to the foramen of Monro were drawn bilaterally on coronal head images of 52 patients with hydrocephalus. The correction angle, the difference between the 2 catheter trajectories, was then measured. Meanwhile, the calvarial slope was measured around Kocher’s point by using a coronal head image. The correlation between the correction angle and factors such as the calvarial slope and bicaudate index was then assessed using a Pearson correlation analysis. RESULTS The ventricular catheter trajectory orthogonal to the skull at Kocher’s point in the patients with hydrocephalus led to a catheter trajectory into the ipsilateral (70.2%) or contralateral (29.8%) lateral ventricles. The correction angles ranged from −3.3° to 16.4° (mean ± SD 5.7° ± 3.7°). In 87 (83.7%) head sides, lateral deviation from the orthogonal trajectory was required to approximate the ideal trajectory, and the correction angle ranged from 2.0° to 16.4° (mean 6.7° ± 2.9°). The calvarial slope in the 104 head sides ranged from 15.6° to 32.5° (mean 24.2° ± 3.1°). Pearson correlation analysis revealed a strong positive correlation (r = 0.733) between the calvarial slope and the correction angle. CONCLUSIONS The accuracy of ventricular catheter placement using the Ghajar Guide technique is affected primarily by the calvarial slope around Kocher’s point. A radiographic analysis of a preoperative coronal head image can be used to estimate the accuracy of ventricular catheter placement and enable adjustment to approximate the ideal catheter trajectory.

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“…Mandel[4] utiliza el software OsiriX para planificar la cirugía en 3D de forma rápida y sencilla, disminuyendo el trauma quirúrgico sin necesidad de neuronavegación, inclusive en cirugías de urgencia. Otros autores, como Rehman,[8] describen y analizan la utilización del software OsiriX para la correcta y más precisa colocación de catéteres ventriculares. Miller[6] utiliza este software para visualizar la anatomía neurovascular en neuralgia trigeminal y planificar la cirugía, fusionando y reconstruyendo en 3D la angiografía por RM con secuencias de alta resolución.…”

Section: Discussiónunclassified

Planificación Neuroquirúrgica con Software Osirix Neurosurgical planning using osirix software

Jaimovich¹,

Guevara²,

Pampin³

et al. 2014

Surg Neurol Int

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Introducción:La individualidad anatómica es clave para reducir el trauma quirúrgico y obtener un mejor resultado. Actualmente, el avance en las neuroimágenes ha permitido objetivar esa individualidad anatómica, permitiendo planificar la intervención quirúrgica. Con este objetivo, presentamos nuestra experiencia con el software Osirix.Descripción de la técnica:Se presentan 3 casos ejemplificadores de 40 realizados. Caso 1: Paciente con meningioma de la convexidad parasagital izquierda en área premotora; Caso 2: Paciente con macroadenoma hipofisario, operada previamente por vía transeptoesfenoidal en otra institución con una resección parcial; Caso 3: Paciente con lesiones en pedúnculo cerebeloso medio bilateral. Se realizó la planificación prequirúrgica con el software OsiriX, fusionando y reconstruyendo en 3D las imágenes de TC e IRM, para analizar relaciones anatómicas, medir distancias, coordenadas y trayectorias, entre otras funciones.Discusión:El software OsiriX de acceso libre y gratuito permite al cirujano, mediante la fusión y reconstrucción en 3D de imágenes, analizar la anatomía individual del paciente y planificar de forma rápida, simple, segura y económica cirugías de alta complejidad. En el Caso 1 se pudo analizar las relaciones del tumor con las estructuras adyacentes para minimizar el abordaje. En el Caso 2 permitió comprender la anatomía post-operatoria previa del paciente, para determinar la trayectoria del abordaje transnasal endoscópico y la necesidad de ampliar su exposición, logrando la resección tumoral completa. En el Caso 3 permitió obtener las coordenadas estereotáxicas y trayectoria de una lesión sin representación tomográfica.Conclusión:En casos de no contar con costosos sistemas de neuronavegación o estereotáxia el software OsiriX es una alternativa a la hora de planificar la cirugía, con el objetivo de disminuir el trauma y la morbilidad operatoria.

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A Radiographic Analysis of Ventricular Trajectories

Cited by 35 publications

References 5 publications

Comparative analysis of endoscopic third ventriculostomy trajectories in pediatric cases

Comparative analysis of endoscopic third ventriculostomy trajectories in pediatric cases

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

Planificación Neuroquirúrgica con Software Osirix Neurosurgical planning using osirix software

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