External ventricular drainage in the management of pediatric patients with posterior fossa tumors and hydrocephalus: a retrospective cohort study

Verhey, Leonard H.; Maharaj, Arjuna; Patel, Nikunj; Manoranjan, Branavan; Ajani, Olufemi; Fleming, Adam; Farrokhyar, Forough; Singh, Sheila K.; Yarascavitch, Blake

doi:10.1007/s00381-022-05818-8

Cited by 7 publications

(10 citation statements)

References 28 publications

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“…Two weeks or more time is needed to relieve a hydrocephalus 32 . Cerebrospinal fluid diversion before resection reduces postoperative persistent hydrocephalus 22,29,33 . We believe that it is necessary to perform CSF diversion before resection for children with severe hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

“…A larger stoma size in ETV reduced closure of the stoma which may be the reason for this phenomenon, 5 as shown in Supplemental Table 3, Supplemental Digital Content 3, http://links.lww.com/SCS/F653. And EVD before resection effectively reduces the ICP and permits egress of debris and hemorrhage in the perioperative period 33 . Thus, we rarely perform a VPS before resection.…”

Section: Discussionmentioning

confidence: 99%

“…32 Cerebrospinal fluid diversion before resection reduces postoperative persistent hydrocephalus. 22,29,33 We believe that it is necessary to perform CSF diversion before resection for children with severe hydrocephalus. Emergent CSF diversion is always necessary to manage deteriorating hydrocephalus before resection in our center.…”

Section: Necessity Of Surgical Resection For Children With Pineal Reg...mentioning

confidence: 99%

“…And EVD before resection effectively reduces the ICP and permits egress of debris and hemorrhage in the perioperative period. 33 Thus, we rarely perform a VPS before resection. We prefer to perform an ETV or EVD before resection for children with severe hydrocephalus to reduce the risk of blockage.…”

Section: Necessity Of Surgical Resection For Children With Pineal Reg...mentioning

confidence: 99%

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Treatment of Pineal Region Lesions in Children

Huang,

Zhou,

Tong

2023

Journal of Craniofacial Surgery

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Background: Pineal region lesions are more common in children than adults; however, therapeutic strategies for pineal region lesions in children are controversial. Methods: A retrospective study involving 54 pediatric with pineal region lesions was conducted. The therapeutic strategies for lesions and hydrocephalus were classified and analyzed. Results: Radiotherapy of pineal region lesions was shown to result in better postoperative recovery and fewer complications in the short-term compared with lesion resection. Total resection was related to smaller lesion size, endoscopic procedures, and a better prognosis. Cerebrospinal fluid (CSF) diversion before the resection reduced hydrocephalus recurrences, whereas further lesion resection had a negative short-term influence on CSF diversion. Among the 4 therapeutic strategies to manage hydrocephalus, a third ventriculostomy (ETV) was reasonable and further resection did not have a negative impact on the ETV. The relief of hydrocephalus was also related to better postoperative recovery, a higher total resection rate, fewer complications, and a better prognosis. Logistical regression analysis indicated that lesion size and intracranial complications were predictors of outcome. Conclusions: For lesion treatment, total resection and radiotherapy are essential components in children. Total resection and CSF diversion before resection were beneficial, whereas further lesion resection had a negative impact on CSF diversion. For hydrocephalus treatment, ETV was shown to be the best therapeutic strategy for management of pediatric hydrocephalus. Total resection and better preoperative health status were associated with greater hydrocephalus relief. For the overall prognosis, a lack of hydrocephalus relief was associated with poor outcomes. Lesion size and intracranial complications may be the best predictors of outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Necessity Of Surgical Resection For Children With Pineal Reg...mentioning

confidence: 99%

Section: Necessity Of Surgical Resection For Children With Pineal Reg...mentioning

confidence: 99%

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Treatment of Pineal Region Lesions in Children

Huang,

Zhou,

Tong

2023

Journal of Craniofacial Surgery

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“…4 The entry point of choice is Kocher's point. [4][5][6][7] It is located 12 cm above the nasion and 2.5-3.5 cm lateral to the midline, by most definitions. 8 After opening the skull with a trephine drill, we ABBREVIATIONS EVD = external ventricular drain.…”

mentioning

confidence: 99%

IMAGINER: improving accuracy with a mixed reality navigation system during placement of external ventricular drains. A feasibility study

Grunert,

Winkler,

Wach

et al. 2024

Neurosurgical Focus

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OBJECTIVE The placement of a ventricular catheter, that is, an external ventricular drain (EVD), is a common and essential neurosurgical procedure. In addition, it is one of the first procedures performed by inexperienced neurosurgeons. With or without surgical experience, the placement of an EVD according to anatomical landmarks only can be difficult, with the potential risk for inaccurate catheter placement. Repeated corrections can lead to avoidable complications. The use of mixed reality could be a helpful guide and improve the accuracy of drain placement, especially in patients with acute pathology leading to the displacement of anatomical structures. Using a human cadaveric model in this feasibility study, the authors aimed to evaluate the accuracy of EVD placement by comparing two techniques: mixed reality and freehand placement. METHODS Twenty medical students performed the EVD placement procedure with a Cushing’s ventricular cannula on the right and left sides of the ventricular system. The cannula was placed according to landmarks on one side and with the assistance of mixed reality (Microsoft HoloLens 2) on the other side. With mixed reality, a planned trajectory was displayed in the field of view that guides the placement of the cannula. Subsequently, the actual position of the cannula was assessed with the help of a CT scan with a 1-mm slice thickness. The bony structure as well as the left and right cannula positions were registered to the CT scan with the planned target point before the placement procedure. CloudCompare software was applied for registration and evaluation of accuracy. RESULTS EVD placement using mixed reality was easily performed by all medical students. The predefined target point (inside the lateral ventricle) was reached with both techniques. However, the scattering radius of the target point reached through the use of mixed reality (12 mm) was reduced by more than 54% compared with the puncture without mixed reality (26 mm), which represents a doubling of the puncture accuracy. CONCLUSIONS This feasibility study specifically showed that the integration and use of mixed reality helps to achieve more than double the accuracy in the placement of ventricular catheters. Because of the easy availability of these new tools and their intuitive handling, we see great potential for mixed reality to improve accuracy.

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External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates

Atallah,

Krauss,

Hermann

2024

Childs Nerv Syst

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Purpose Placement of an external ventricular drainage (EVD) is one of the most frequent procedures in neurosurgery, but it has specific challenges and risks in the pediatric population. We here investigate the indications, management, and shunt conversion rates of an EVD. Methods We retrospectively analyzed the data of a consecutive series of pediatric patients who had an EVD placement in the Department of Neurosurgery at Hannover Medical School over a 12-year period. A bundle approach was introduced to reduce infections. Patients were categorized according to the underlying pathology in three groups: tumor, hemorrhage, and infection. Results A total of 126 patients were included in this study. Seventy-two were male, and 54 were female. The mean age at the time of EVD placement was 5.2 ± 5.0 years (range 0–17 years). The largest subgroup was the tumor group (n = 54, 42.9%), followed by the infection group (n = 47, 37.3%), including shunt infection (n = 36), infected Rickham reservoir (n = 4), and bacterial or viral cerebral infection (n = 7), and the hemorrhage group (n = 25, 19.8%). The overall complication rate was 19.8% (n = 25/126), and the total number of complications was 30. Complications during EVD placement were noted in 5/126 (4%) instances. Complications during drainage time were infection in 9.5% (12 patients), dysfunction in 7.1% (9 patients), and EVD dislocation in 3.2% (4 patients). The highest rate of complications was seen in the hemorrhage group. There were no long-term complications. Conversion rates into a permanent shunt system were 100% in previously shunt-dependent patients. Conversion rates were comparable in the tumor group (27.7%) and in the hemorrhage group (32.0%). Conclusion EVD placement in children is an overall safe and effective option in children. In order to make further progress, carefully planned prospective and if possible randomized studies are needed controlling for multivariable aspects.

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External ventricular drainage in the management of pediatric patients with posterior fossa tumors and hydrocephalus: a retrospective cohort study

Cited by 7 publications

References 28 publications

Treatment of Pineal Region Lesions in Children

Treatment of Pineal Region Lesions in Children

IMAGINER: improving accuracy with a mixed reality navigation system during placement of external ventricular drains. A feasibility study

External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates

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