Free-hand stereotactic ventricular catheter insertion technique based on radio-anatomical landmarks. How I do it
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HOW I DO IT - CSF CIRCULATION
Free-hand stereotactic ventricular catheter insertion technique based on radio-anatomical landmarks. How I do it Michaël Bruneau 1
&
Julien Spitaels 1 & Matteo Riva 1,2
Received: 18 April 2020 / Accepted: 24 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Accurate ventricular catheter (VC) placement plays an important role in reducing the risk of ventriculoperitoneal shunt failure. Free-hand VC insertion is associated with a significant misplacement rate. Consequently, several expensive alternative methods that are unfortunately not available worldwide have been used. To overcome these limitations, we developed a simple surgical technique based on radio-anatomical landmarks aimed at reducing VC’s misplacements. Method We reproduce the preoperative imaging on the patient’s head using common anatomical landmarks. This allows defining stereotactic VC coordinates to be followed during the surgical procedure. Conclusion This simple and cost-effective method improves VC insertion accuracy. Keywords Hydrocephalus . Surgical technique . Ventriculoperitoneal shunt
Abbreviations 2D Two-dimensional 3D Three-dimensional CP Catheter plane CSF Cerebrospinal fluid CT Computed tomography EAC External auditory canal Ep Entry point FOM Foramen of Monro Fp Frontal point IBO Inferior border of the orbit MPR Multi-planar reconstruction MRI Magnetic resonance imaging OP Oblique plane RP Reference plane This article is part of the Topical Collection on CSF Circulation Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04549-6) contains supplementary material, which is available to authorized users. * Michaël Bruneau [email protected] 1
Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070 Brussels, Belgium
2
Department of Neurosurgery, Mont-Godinne Hospital, UCL Namur, Yvoir, Belgium
Tp VC VPS Ep-x Ep-x’ Ep-y Fp-x
Target point Ventricular catheter Ventriculoperitoneal shunt x coordinate for the entry point x’ coordinate for the entry point y coordinate for the entry point x coordinate for the frontal point
Introduction Ventriculoperitoneal shunt (VPS) function depends on the correct position of the ventricular catheter (VC) in the ventricles. To decrease the reported 12-month 40% VPS failure rate, most commonly due to proximal obstruction, all drains must be ideally inserted with all holes surrounded by cerebrospinal fluid (CSF), at distance from the choroid plexus and ventricular walls [1].
Relevant surgical anatomy By a parietal approach, an ideally placed VC passes through the ipsilateral ventricle and reaches the frontal horn at the foramen of Monro (FOM) level; nevertheless, attempting to reach this target point (Tp) with a free-hand technique is associated with a significant misplacement risk [7, 10].
Acta Neurochir
R Fig. 1
Preoperative planning of a right parietal ventricular catheter (VC) insertion based on 3D CT scan with multi-planar reconstruction (a, b) and
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