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ventricular_catheter_misplacement

Ventricular catheter misplacement

Catheter malpositioning is one of the most frequent causes of ventriculoperitoneal shunt dysfunction and revision surgery. Most intraoperative tools used to improve the accuracy of catheter insertion are time consuming and expensive or do not display the final position.

Coluccia et al evaluate the usefulness of intraoperative fluoroscopy to decrease catheter malpositioning, and define radiological landmarks to identify the correct localization.

A total of 104 patients undergoing ventriculoperitoneal shunt placement were analyzed for shunt position, revision surgery and outcome. The results for patients operated on using intraoperative biplanar fluoroscopic assessment of catheter location (X-ray group, n = 57) were compared with a control group operated without intraoperative radiography (control, n = 47). In order to generate a surgical reference map for intraoperative validation of shunt location, different ventricular system landmarks were defined on three-dimensional computed tomography reconstructions of hydrocephalic patients (n = 60) and exported to a two-dimensional layer of the skull.

The use of intraoperative X-ray imaging correlated with a significant increase of optimal catheter positions (X-ray group, n = 45, 79%; control group, n = 23, 49%; P = 0.0018). The sensitivity and positive predictive value for estimating an optimal shunt catheter position on biplanar imaging was 96% (95% confidence interval, 87%-99%). The specificity and negative predictive value were both 92% (95% confidence interval, 78%-98%).

Intraoperative fluoroscopy is easy to perform and is a reliable method to assess correct catheter positioning. Based on its predictive value, corrections of malpositioned ventricular catheters can be performed during the same procedure. The use of intraoperative fluoroscopy decreases early surgical revisions in ventriculoperitoneal shunt treatment 1).


To avoid shunt dysfunction, it is essential to place the ventricular catheter tip above the foramen of Monro. But the free-hand technique for ventricular catheter passage is not consistent.

Supposing that a convex of skull matches to a sphere, in which the foramen of Monro is the center, a perpendicular direction from the surface of the sphere to inside always directs toward the center. The authors identified the range of skull where corresponded to the sphere by magnetic resonance imaging assessment and utilized tripod to achieve exactly perpendicular insertion of ventricular catheter. And an optimal length of catheter insertion was investigated by navigation system.

The anterior-posterior range of the spherical portion was from coronal suture to 20mm anterior, and the lateral range of it was between 15 and 35mm lateral from sagittal suture. The optimal catheter length for insertion was between 55 and 58mm from the brain surface. Ideal placement of a ventricular catheter tip was achieved in more than 90% of cases (31/34) with this technique 2).

Ventricular catheter misplacement occurs in 40 % with freehand technique and is a risk factor for shunt failure.

A analysis demonstrated an improvement of catheter positioning with ultrasound guidance. In the absence of additional burden or risks, this method should be favored over freehand technique. It remains to be demonstrated in a randomized controlled fashion to what extent improved catheter position translates into improved outcome 3).

Unclassified

1: Wanderer S, Coluccia D, Añon J, Fandino J, Berkmann S. Intraoperative Computed Tomography Versus Fluoroscopy for Ventriculoperitoneal Shunt Placement. World Neurosurg. 2019 Jan 11. pii: S1878-8750(19)30034-8. doi: 10.1016/j.wneu.2019.01.002. [Epub ahead of print] PubMed PMID: 30639491.

2: Techataweewan N, Dudzik B, Kitkhuandee A, Duangthongphon P, Tayles N. Gender and Population Variation in Craniometry and Freehand Pass Ventriculostomy. World Neurosurg. 2018 Sep;117:e194-e203. doi: 10.1016/j.wneu.2018.05.240. Epub 2018 Jun 8. PubMed PMID: 29890273.

3: Manfield JH, Yu KKH. Real-time ultrasound-guided external ventricular drain placement: technical note. Neurosurg Focus. 2017 Nov;43(5):E5. doi: 10.3171/2017.7.FOCUS17148. PubMed PMID: 29088955.

4: AlAzri A, Mok K, Chankowsky J, Mullah M, Marcoux J. Placement accuracy of external ventricular drain when comparing freehand insertion to neuronavigation guidance in severe traumatic brain injury. Acta Neurochir (Wien). 2017 Aug;159(8):1399-1411. doi: 10.1007/s00701-017-3201-5. Epub 2017 May 29. PubMed PMID: 28555269.

5: Raabe C, Fichtner J, Beck J, Gralla J, Raabe A. Revisiting the rules for freehand ventriculostomy: a virtual reality analysis. J Neurosurg. 2018 Apr;128(4):1250-1257. doi: 10.3171/2016.11.JNS161765. Epub 2017 May 19. PubMed PMID: 28524798.

7: Rehman T, Rehman Au, Ali R, Rehman A, Bashir H, Ahmed Bhimani S, Tran H, Khan S. A radiographic analysis of ventricular trajectories. World Neurosurg. 2013 Jul-Aug;80(1-2):173-8. doi: 10.1016/j.wneu.2012.12.012. Epub 2012 Dec 12. PubMed PMID: 23246631.

8: Rehman T, Rehman AU, Rehman A, Bashir HH, Ali R, Bhimani SA, Khan S. A US-based survey on ventriculostomy practices. Clin Neurol Neurosurg. 2012 Jul;114(6):651-4. doi: 10.1016/j.clineuro.2011.12.040. Epub 2012 Jan 16. PubMed PMID: 22257519.

9: Schödel P, Proescholdt M, Ullrich OW, Brawanski A, Schebesch KM. An outcome analysis of two different procedures of burr-hole trephine and external ventricular drainage in acute hydrocephalus. J Clin Neurosci. 2012 Feb;19(2):267-70. doi: 10.1016/j.jocn.2011.04.026. Epub 2011 Oct 29. PubMed PMID: 22041131.

10: Giesemann AM, Capelle HH, Winter R, Krauss JK. Bilateral trochlear nerve palsy subsequent to ventriculoperitoneal shunting of normal pressure hydrocephalus. Br J Neurosurg. 2012 Feb;26(1):110-2. doi: 10.3109/02688697.2011.593644. Epub 2011 Aug 4. PubMed PMID: 21815738.

11: Hsieh CT, Chen GJ, Ma HI, Chang CF, Cheng CM, Su YH, Ju DT, Hsia CC, Chen YH, Wu HY, Liu MY. The misplacement of external ventricular drain by freehand method in emergent neurosurgery. Acta Neurol Belg. 2011 Mar;111(1):22-8. PubMed PMID: 21510229.

12: Shamir RR, Joskowicz L, Spektor S, Shoshan Y. Target and trajectory clinical application accuracy in neuronavigation. Neurosurgery. 2011 Mar;68(1 Suppl Operative):95-101; discussion 101-2. doi: 10.1227/NEU.0b013e31820828d9. PubMed PMID: 21206305.

13: Ngo QN, Ranger A, Singh RN, Kornecki A, Seabrook JA, Fraser DD. External ventricular drains in pediatric patients. Pediatr Crit Care Med. 2009 May;10(3):346-51. doi: 10.1097/PCC.0b013e3181a320cd. PubMed PMID: 19325503.

14: Hashiguchi K, Morioka T, Samura K, Miyagi Y, Yoshida F, Nagata S, Sasaki T. Medial temporal lobe epilepsy associated with misplacement of a ventricular shunting catheter. J Clin Neurosci. 2008 Aug;15(8):939-42. doi: 10.1016/j.jocn.2007.02.094. Epub 2008 May 27. PubMed PMID: 18502644.

15: Rodt T, Köppen G, Lorenz M, Majdani O, Leinung M, Bartling S, Kaminsky J, Krauss JK. Placement of intraventricular catheters using flexible electromagnetic navigation and a dynamic reference frame: a new technique. Stereotact Funct Neurosurg. 2007;85(5):243-8. Epub 2007 May 25. PubMed PMID: 17534137.

16: Rosen KR, Sinz EH. Simulation Case Library: The Case of the Coiled Cardiac Catheter. J Educ Perioper Med. 2002 May 1;4(2):E022. eCollection 2002 Jul-Dec. PubMed PMID: 27175416; PubMed Central PMCID: PMC4803422.

17: Piek J, Raes P. Pressure-controlled drainage of cerebrospinal fluid: clinical experience with a new type of ventricular catheter (Ventcontrol MTC)and an integrated Piezo-resistive sensor at its tip: technical note. Neurosurgery. 1996 Jan;38(1):216-8. PubMed PMID: 8747976.

18: Paramore CG, Turner DA. Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien). 1994;127(1-2):79-84. PubMed PMID: 7942188.

19: Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus–evaluation of risk factors. Neurosurgery. 1992 Nov;31(5):898-903; discussion 903-4. PubMed PMID: 1436414.

1)
Coluccia D, Anon J, Rossi F, Marbacher S, Fandino J, Berkmann S. Intraoperative Fluoroscopy for Ventriculoperitoneal Shunt Placement. World Neurosurg. 2016 Feb;86:71-8. doi: 10.1016/j.wneu.2015.08.072. Epub 2015 Sep 4. PubMed PMID: 26344633.
2)
Yamada SM, Yamada S, Goto Y, Nakaguchi H, Murakami M, Hoya K, Matsuno A. A simple and consistent technique for ventricular catheter insertion using a tripod. Clin Neurol Neurosurg. 2012 Jul;114(6):622-6. doi: 10.1016/j.clineuro.2011.12.025. Epub 2012 Jan 11. PubMed PMID: 22244253.
3)
Beez T, Sarikaya-Seiwert S, Steiger HJ, Hänggi D. Real-time ultrasound guidance for ventricular catheter placement in pediatric cerebrospinal fluid shunts. Childs Nerv Syst. 2015 Feb;31(2):235-41. doi: 10.1007/s00381-014-2611-4. Epub 2015 Jan 7. PubMed PMID: 25564197.
ventricular_catheter_misplacement.txt · Last modified: 2019/12/04 19:34 by administrador