Modified Puncture Needle for Percutaneous Needle Trepehination
Besides the classical burr hole trephination and external drainage with a plastic catheter for treatment of acute hydrocephalus, hematocephalus and of shunt complications as well as for venticular pressure measurements, spinal needles are used being inser
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Modified Puncture Needle for Percutaneous Needle Trepehination Werner
HASSLER
and Josef
ZENTNER
Department of Neurosurgery, Medical School, University of Tuebingen, Tuebingen, FRG
Besides the classical burr hole trephination and external drainage with a plastic catheter for treatment of acute hydrocephalus, hematocephalus and of shunt complications as weIl as for venticular pressure measurements, spinal needles are used being inserted through a small trephine performed either by a hand or battery-driven drill. The major advantage of percutaneous needle trephination is its convenience. However, disadvantage of conventional spinal needles is that a sharp instrument penetrates the brain or remains within the ventricles with the risk of subsequent bleeding complications. Furthermore, depth of desired penetration cannot be exactly defined , as there are no markings on the needle. The modified needle as presented (Figure) provides for convenience with percutaneous needle trephination, but compensates for its shortcomings. As the guide is withdrawn after penetration of the dura no sharp instrument touch es the brain or remains within the ventricles. A set screw allows exact definition of the desired depth of penetration and contributes to better stabilization of the needle. Moreover, perforations at the distal end of the needle allow sufficient drainage even when the central distal aperture is obstructed by a clot or parts of the chorioid plexus . To date, we have used this modified needle in 85 patients for treatment of acute and chronic hydrocephalus, hematocephalus and shunt sepsis as weIl as for ventricular pressure measurement. Trephination for puncture of the anterior horn of the lateral ventricle was performed with a hand or battery-driven drill 1 cm in front ofthe coronal suture and 2.5 cm lateral to the midline, usually on the right side . The diameter of the drill was 1.5 mm, only slightly larger than the diameter of the needle (1.2 mm) . The needle was inserted in the direction of the nasion and the external auditory meatus.
---Figure. Modified needle (produced by Fehling, 8757 Karlstein, F.R.G.). above: needle prepared for puncture with the sharp guide and set screw fixed at a distance of 6 cmfromthe tip. below: bluntneedlewiththe screw.
S. Matsumoto et al. (eds.), Annual Review of Hydrocephalus © Springer-Verlag Berlin Heidelberg 1990
Therapeutic Procedures
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After insertion, the needle was bent at 90 degrees above the screw and then fixed with a pIaster cast. The position of the needle was controlled by X-rays. The overall complication rate was 2.4% in our series including two patients with an infection after drainage of an occlusive hydrocephalus for 9 and 15 days, respectively. In our opinion, ventricular puncture with this device is a simple and safe method, especially in emergency cases. (Acta Neurochir (Wien) 94: 93-95 , 1988) Key words: External CSF drainage, CSF pressure measurement
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