Ommaya reservoir with ventricular catheter placement for chemotherapy with frameless and pinless electromagnetic surgical neuronavigation

Weiner, Gregory M.; Chivukula, Srinivas; Chen, Ching-Jen; Ding, Dale; Engh, Johnathan A.; Amankulor, Nduka

doi:10.1016/j.clineuro.2014.12.018

Cited by 27 publications

(13 citation statements)

References 38 publications

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“…5,6,18 Based on our data, and hypothesis that the real-time catheter assessment may account for the small advantage of fluoroscopy of frameless stereotaxy in our cohort, the use of electromagnetic technology may optimize frameless neuronavigation for this procedure. Paired with the increasing availability of intraoperative CT and MRI, an algorithm for ensuring safe and accurate placement can be developed using any of the existing or emerging technologies.…”

Section: Discussionmentioning

confidence: 72%

“…A freehand catheter technique was used initially, but over the years has been largely supplanted by various forms of image guidance as technology has improved and practitioners have recognized that freehand placement was associated with a high rate of failure. 5–10 Image guidance has been accomplished over the years by many modalities, including ultrasound, pneumoencephalogram with fluoroscopy, frame based and frameless stereotaxy. Each of these techniques has technical advantages and drawbacks, but comparison of the accuracy and safety of these techniques in the literature is sparse.…”

Section: Introductionmentioning

confidence: 99%

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Image Guidance for Placement of Ommaya Reservoirs: Comparison of Fluoroscopy and Frameless Stereotactic Navigation in 145 Patients

et al. 2016

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Objective Ommaya reservoirs are used for administration of intrathecal chemotherapy and cerebrospinal fluid (CSF) sampling. Ventricular catheter placement for these purposes requires a high degree of accuracy. Various options exist to optimize catheter placement. We analyze a cohort of patients receiving catheters utilizing two different technologies. Methods Retrospective chart review was performed on patients undergoing Ommaya reservoir placement between 2011 and 2014. Most procedures were assisted by either frameless stereotactic neuronavigation or fluoroscopic guidance with pneumoencephalogram. Catheter accuracy, revision rates, perioperative complications and operative time were measured. Pre-operative similarities and differences in diagnosis, demographics and ventricular size were also recorded to avoid a biased assessment of our results. Results One hundred forty-five patients were included, 57 using fluoroscopic guidance and 88 using frameless stereotaxy. Common diagnoses in both groups were lymphoma and leptomeningeal disease. Qualitative measures of catheter placement accuracy showed no significant difference between the two groups. Proximity to the foramen of Monro favored fluoroscopy by a small margin (8.6 mm vs. 10.2 mm, p=0.03). Overall revision rates were not significantly different between the groups (3.5% vs. 4.5%, p=1.00). Early surgical complications occurred in 6.8% of the frameless stereotaxy group and 1.8% of the fluoroscopy group (p=0.25). Conclusions Ommaya reservoirs can be placed accurately using different methods. Although there are slight differences between fluoroscopy and frameless stereotaxy in quantitative accuracy and procedure time, there is no significant advantage of method over the other when evaluating revision or complication rates. Technique familiarity and surgeon preference may dictate the preferred procedure.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Image Guidance for Placement of Ommaya Reservoirs: Comparison of Fluoroscopy and Frameless Stereotactic Navigation in 145 Patients

et al. 2016

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“…It obviates the need for sharp head fixation offering a good alternative to optoelectric techniques, there are no line-of-sight problems, the position of the patient can be changed during surgery, and it allows the use of flexible instruments [24,31,33]. While it was shown to be beneficial especially in the placement of ventricular catheters for different indications [23,24,31,33,43,44], its advantages have been demonstrated also for many other neurosurgical procedures [22,25,26,27,34,45,46,47]. Studies on the accuracy of EM navigation have shown that it is comparable to optoelectric navigation ranging between 0.71-3.51 mm [48] and 0.7-4.4 mm [49].…”

Section: Discussionmentioning

confidence: 99%

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Hermann¹,

Polemikos²,

Heissler³

et al. 2017

Stereotact Funct Neurosurg

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Background: Idiopathic intracranial hypertension (IIH) is characterized by increased cerebrospinal fluid (CSF) pressure and normal or slit ventricles. Lumboperitoneal shunting had been favored by many investigators for CSF diversion in IIH for decades; however, it has been associated with various side effects. Because of the small ventricular size adequate positioning of a ventricular catheter is challenging. Objectives: Here, we investigated the usefulness of electromagnetic (EM)-guided ventricular catheter placement for ventriculoperitoneal shunting in IIH. Methods: Eighteen patients with IIH were included in this study. The age of patients ranged from 5 to 58 years at the time of surgery (mean age: 31.8 years; median: 29 years). There were 2 children (5 and 11 years old) and 16 adults. Inclusion criteria for the study were an established clinical diagnosis of IIH, lack of improvement with medication, and the presence of small ventricles. In all patients EM-navigated placement of the ventricular catheter was performed using real-time tracking of the catheter tip for exact positioning close to the foramen of Monro. Postoperative CT scans were correlated with intraoperative screen shots to validate the position of the catheter. Results: In all patients EM-navigated ventricular catheter placement was achieved with a single pass. There were no intraoperative or postoperative complications. Postoperative imaging confirmed satisfactory positioning of the ventricular catheter. No proximal shunt failure was observed during the follow-up at a mean of 41.5 months (range: 7-90 months, median: 40.5 months). Conclusions: EM-navigated ventricular catheter placement in shunting for IIH is a safe and straightforward technique. It obviates the need for sharp head fixation, the head of the patient can be moved during surgery, and it may reduce the revision rate during follow-up.

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“…The widening applications of EM surgery include now neuroendoscopy [24], aneurysm surgery [12], placement of Ommaya reservoirs for chemotherapy [28] and of external ventricular drains in the intensive care unit [16]. Accuracy of EM navigation has been shown to be comparable with that of opto-electric navigation ranging between 0.71 to 3.51 mm [23] and 0.7 to 4.4 mm [3].…”

Section: Em Navigationmentioning

confidence: 99%

Electromagnetic navigation-guided surgery in the semi-sitting position for posterior fossa tumours: a safety and feasibility study

et al. 2015

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Ommaya reservoir with ventricular catheter placement for chemotherapy with frameless and pinless electromagnetic surgical neuronavigation

Cited by 27 publications

References 38 publications

Image Guidance for Placement of Ommaya Reservoirs: Comparison of Fluoroscopy and Frameless Stereotactic Navigation in 145 Patients

Image Guidance for Placement of Ommaya Reservoirs: Comparison of Fluoroscopy and Frameless Stereotactic Navigation in 145 Patients

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Electromagnetic navigation-guided surgery in the semi-sitting position for posterior fossa tumours: a safety and feasibility study

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