Evaluation of minimally invasive percutaneous CT-controlled ventriculostomy in patients with severe head trauma

Abstract

Evaluation of percutaneous CT-controlled ventriculostomy (PCV) in patients with severe traumatic brain injury to measure intracranial pressure as a component of early clinical care. A consecutive series of 52 interventions with PCV was prospectively analyzed with regard to technical success, procedural time, time from the initial cranial computed tomography (CCT) until procedure and transfer to the intensive care unit (ICU). Additionally, the data was compared with a retrospective control group of 12 patients with 13 procedures of conventional burr-hole ventriculostomy (OP-ICP). The PCV was successful in all cases (52 of 52; 95% CI 94-100%). In 1 case a minor hemorrhage into the ipsilateral lateral ventricle was observed on CT scans due to an initially unsuccessful puncture (95% CI 0-6%). No infections occurred (95% CI 0-6%). In the control group with OP-ICP one catheter infection and one unsuccessful catheter placement occurred (each 8%, 95% CI 0-20%). The PCV led to a significant decrease of procedure time from 45 +/- 11 min (OP-ICP) to 20 +/- 12 min (PCV). The interval from the initial CCT until procedure (PCV 28 +/- 11 min, OP-ICP 78 +/- 33 min) and transfer to the ICU (PCV 69 +/- 34 min, OP-ICP 138 +/- 34 min) could also be significantly reduced (each with p<0.05, Mann-Whitney U-test). Percutaneous CT-controlled ventriculostomy is a safe and efficient method for ICP catheter placement during initial trauma room management. It significantly reduces the time of initial trauma room treatment.

Image guidance and improved accuracy of external ventricular drain tip position particularly in patients with small ventricles

“…The use of a Ghajar guide at Kocher's point and live CT guidance in placing EVD catheters have been described. 4,6,10,12 Image guidance has also been proposed to have a positive role in EVD placements; 11 however, there are few data comparing FH and IGS procedures. We have performed a timely analysis of the precision of EVD placement in consecutive cases using both conventional FH and image guidance techniques at a single busy neurosurgical unit.…”

Placement of External Ventricular Drain: Comparison of Two Methods

“…1 Based on these well-known complications, different techniques and devices for EVD insertion were developed and described to improve the success rate and accuracy of ventricular catheter placement. [12][13][14]18 O'Leary et al defined the foramen of Monro as a reference point for EVD placement. 22 In their study, they used the Ghajar guide, a device for EVD insertion.…”

“…1 Typical complications after insertion of an EVD are the occurrence of a new intracerebral or intraventricular hemorrhage (nICVH), infection, and malpositioning of the catheter. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The optimal position of the EVD is the frontal horn of the lateral ventricle, with its tip close to the foramen of Monro.…”

Utilizing preprocedural CT scans to identify patients at risk for suboptimal external ventricular drain placement with the freehand insertion technique

“…Several promising alternative EVD placement methods have been proposed in recent years including a guiding fixed tripod, 5 endoscopic and robotic procedures, 12,21 bedside neuronavigation procedures, 15 flat detector CT and live fluoroscopic guidance, 3 CT guidance, 10 and realtime ultrasound guidance through a single burr hole. 2,20 Concerns regarding efficiency, cost, availability, ease of use, and other modality-specific limitations have restricted widespread use of these alternative techniques.…”

“…veloped 2,3,5,10,12,15,20,22 that have been shown to increase the accuracy of placement. 4,6,11,13,15,20,21,24 However, alternatives to freehand insertion have inherent limitations, some of which can be particularly restrictive in the emergency setting.…”