Trajectories for frontal external ventricular drain placement: virtual cannulation of adults with acute hydrocephalus

Muirhead, William; Basu, Surajit

doi:10.3109/02688697.2012.671973

Cited by 29 publications

(20 citation statements)

References 7 publications

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“…This finding is consistent with a previous retrospective analysis of imaging in which superiority of the PTS and CMC/EAM trajectories over the IMC/EAM trajectory was also demonstrated. 11 Performance did not vary significantly according to the number of ventriculostomies performed previously by our participants, supporting the notion that the differences in performance observed were solely due to the trajectories used and not the expertise of the person performing the ventriculostomy. To elaborate, one would not expect experience or expertise to influence performance in ventriculostomy with a prefashioned bur hole and prespecified trajectory, although one would if the participant would be allowed to perform the ventriculostomy without prior instructions.…”

Section: Discussionsupporting

confidence: 76%

“…3,9 Previous studies assessing the relative merits of different trajectories for ventriculostomy have largely focused on the retrospective analysis of imaging data alone. 11,14 The advent of neuronavigation has facilitated the ability to observe ventriculostomy trajectory objectively in real time. To this end, the aim of the present study was to prospectively evaluate the relative performance of 3 recognized trajectories for frontal ventriculostomy in real time using metrics derived from imaging using the StealthStation S7 Surgical Navigation System (Medtronic).…”

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confidence: 99%

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The relative efficacy of 3 different freehand frontal ventriculostomy trajectories: a prospective neuronavigation-assisted simulation study

Kirkman

Muirhead

Sevdalis

2017

JNS

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OBJECTIVE Ventriculostomy is a relatively common neurosurgical procedure, often performed in the setting of acute hydrocephalus. Accurate positioning of the catheter is vital to minimize morbidity and mortality, and several anatomical landmarks are currently used. The aim of this study was to prospectively evaluate the relative performance of 3 recognized trajectories for frontal ventriculostomy using imaging-derived metrics: perpendicular to skull (PTS), contralateral medial canthus/external auditory meatus (CMC/EAM), and ipsilateral medial canthus/external auditory meatus (IMC/EAM). METHODS Participants completed 9 simulated ventriculostomy attempts (3 of each trajectory) on a model head with Medtronic StealthStation coregistered imaging. Performance measures were distance of the ventricular catheter tip to the foramen of Monro (FoM) and presence of the catheter tip in a lateral ventricle. RESULTS Thirty-one individuals of varying seniority and prior ventriculostomy experience performed a total of 279 simulated freehand frontal ventriculostomies. The PTS and CMC/EAM trajectories were found to be significantly more likely to result in both the catheter tip being closer to the FoM and in a lateral ventricle compared with the IMC/EAM trajectory. These findings were not influenced by the prior ventriculostomy experience of the participant, corroborating the significance of these results. CONCLUSIONS The PTS and CMC/EAM trajectories were superior to the IMC/EAM trajectories during freehand frontal ventriculostomy in this study, and further data from studies incorporating varying ventricular sizes and bur hole locations are required to facilitate a change in clinical practice. In addition, neuronavigation and other guidance techniques for ventriculostomy are becoming increasingly popular and may be superior to freehand techniques, necessitating further prospective data evaluating their safety, efficacy, and feasibility for routine clinical use.

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Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 99%

The relative efficacy of 3 different freehand frontal ventriculostomy trajectories: a prospective neuronavigation-assisted simulation study

Kirkman

Muirhead

Sevdalis

2017

JNS

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“…In addition to the general complications of EVD implantation as hemorrhage and obstruction, the most common misplaced catheters are basal ganglion, thalamus, internal capsula, corpus callosum, and frontal lobe. [123456891011121314151617181920]…”

Section: Discussionmentioning

confidence: 99%

Surface anatomy for implantation of external ventricular drainage: Some surgical remarks

Mostofi¹,

Khouzani

2016

Surg Neurol Int

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Background:External ventricular drainage (EVD) is an emergency process intended to reduce intracranial hypertension resulting from the obstruction of cerebrospinal fluid (CSF) flow. This creates a temporary situation to extract CSF that cannot pass through normally. Knowing the surface anatomy for EVD implantation is important to prevent its inadvertent complications. The external landmarks have been designed in this anatomic study to review the classical landmarks and come up with new landmarks to improve this simple but lifesaving procedure.Methods:From November 1998 to October 2012, we implanted 439 EVDs.Results:In the first years, we employed usual landmarks to implant 97 EVDs. Since 2002, we used modified anatomical landmarks to implant 342 EVDs directly in the third ventricle.Conclusion:Using effective landmarks for EVD implementation allows the catheter to be inserted in the third ventricle. In addition, it permits more precise accuracy to ensure a safer procedure with fewer complications.

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“…The procedure is done using the established landmarks to the frontal horn especially cannulating the ventricle with a trajectory that is perpendicular to the skull. [ 5 ] The feeding tube is advanced up to 5–6 cm from the dura and the tube is tunneled to about 5–7 cm away from the burr hole point to reduce the chances of infection. CSF is diverted through an infusion set into a sterile collection bag and allowed to drain without a vacuum attached.…”

Section: Methodsmentioning

confidence: 99%

Improvised external ventricular drain in neurosurgery: A Nigerian tertiary hospital experience

Ojo

Asha

Bankole

et al. 2015

Journal of Neurosciences in Rural Practice

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Background:The most common type of hydrocephalus in developing countries is post infective hydrocephalus. Infected cerebrospinal fluid (CSF) however cannot be shunted for the reason that it will block the chamber of the ventriculo-peritoneal (VP) shunt due to its high protein content. In centers where standard external ventricular drain (EVD) sets are not available, improvised feeding tube can be used.Aim:The main focus of this study is to encourage the use of improvised feeding tube catheters for EVD when standard sets are not available to improve patients’ survival.Methodology:This was a prospective study. Consecutive patients with hydrocephalus that cannot be shunted immediately for high chances of shunt failure or signs of increasing intracranial pressure were recruited into the study. Other inclusion criteria were preoperative brain tumor with possibility of blocked CSF pathway and massive intraventricular hemorrhage necessitating ventricular drainage as a salvage procedure. Standard EVD set is not readily available and too expensive for most of the parents to afford. Improvised feeding tube is used to drain/divert CSF using the standard documented procedure for EVD insertion. Outcome is measured and recorded.Results:A total of 28 patients were recruited into the study over a time frame of 2 years. There were 19 (67.9%) male and 9 (32.1%) females with a ratio of about 2:1. Age ranges varied from as low as 7 days to 66 years. The median age of the study sample was 6.5 months while the mean was 173.8 months. Duration of EVD varied from 2 days to 11 days with a median of 7 while the average was 6 days. Eventual outcome following the procedure of EVD showed that 19 (67.9%) survived and were discharged either to go home or to have VP shunt afterwards while 8 (28.6%) of the patients died.Conclusions:External ventricular drain can and should be done when it is necessary. Potential mortalities could be reduced by the improvised drainage using a standard feeding tube as described.

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Trajectories for frontal external ventricular drain placement: virtual cannulation of adults with acute hydrocephalus

Abstract: Despite its widespread use, the IMC trajectory performed poorly; PTS and CMC trajectories are more reliable ways of targeting the FILV when placing an EVD.

Cited by 29 publications

References 7 publications

The relative efficacy of 3 different freehand frontal ventriculostomy trajectories: a prospective neuronavigation-assisted simulation study

The relative efficacy of 3 different freehand frontal ventriculostomy trajectories: a prospective neuronavigation-assisted simulation study

Surface anatomy for implantation of external ventricular drainage: Some surgical remarks

Improvised external ventricular drain in neurosurgery: A Nigerian tertiary hospital experience

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