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

View More View Less
  • 1 Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London;
  • 2 Department of Surgery and Cancer, Imperial College London, St Mary's Campus, London; and
  • 3 Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

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.

ABBREVIATIONSCMC = contralateral medial canthus; EAM = external auditory meatus; EVD = external ventricular drain; FoM = foramen of Monro; IMC = ipsilateral medial canthus; PTS = perpendicular to skull.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

INCLUDE WHEN CITING Published online April 15, 2016; DOI: 10.3171/2016.1.JNS152263.

Correspondence Matthew A. Kirkman, Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom. email: matthew.kirkman@gmail.com.
  • 1

    Abdoh MG, Bekaert O, Hodel J, Diarra SM, Le Guerinel C, Nseir R, : Accuracy of external ventricular drainage catheter placement. Acta Neurochir (Wien) 154:153159, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Crowley RW, Dumont AS, Asthagiri AR, Torner JC, Medel R, Jane JA Jr, : Intraoperative ultrasound guidance for the placement of permanent ventricular cerebrospinal fluid shunt catheters: a single-center historical cohort study. World Neurosurg 81:397403, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Ghajar JB: A guide for ventricular catheter placement. Technical note. J Neurosurg 63:985986, 1985

  • 4

    Hayhurst C, Beems T, Jenkinson MD, Byrne P, Clark S, Kandasamy J, : Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study. J Neurosurg 113:12731278, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Huyette DR, Turnbow BJ, Kaufman C, Vaslow DF, Whiting BB, Oh MY: Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans. J Neurosurg 108:8891, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Janson CG, Romanova LG, Rudser KD, Haines SJ: Improvement in clinical outcomes following optimal targeting of brain ventricular catheters with intraoperative imaging. J Neurosurg 120:684696, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Kirkman MA, Ahmed M, Albert AF, Wilson MH, Nandi D, Sevdalis N: The use of simulation in neurosurgical education and training. A systematic review. J Neurosurg 121:228246, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Kirkman MA, Muirhead W, Sevdalis N, Nandi D: Simulated ventriculostomy training with conventional neuronavigational equipment used clinically in the operating room: prospective validation study. J Surg Educ 72:704716, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Lind CRP, Correia JA, Law AJJ, Kejriwal R: A survey of surgical techniques for catheterising the cerebral lateral ventricles. J Clin Neurosci 15:886890, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Mahan M, Spetzler RF, Nakaji P: Electromagnetic stereotactic navigation for external ventricular drain placement in the intensive care unit. J Clin Neurosci 20:17181722, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Muirhead WR, Basu S: Trajectories for frontal external ventricular drain placement: virtual cannulation of adults with acute hydrocephalus. Br J Neurosurg 26:710716, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    O'Leary ST, Kole MK, Hoover DA, Hysell SE, Thomas A, Shaffrey CI: Efficacy of the Ghajar Guide revisited: a prospective study. J Neurosurg 92:801803, 2000

  • 13

    Paramore CG, Turner DA: Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien) 127:7984, 1994

  • 14

    Rehman T, Rehman AU, Ali R, Rehman A, Bashir H, Ahmed Bhimani S, : A radiographic analysis of ventricular trajectories. World Neurosurg 80:173178, 2013

  • 15

    Sarrafzadeh A, Smoll N, Schaller K: Guided (VENTRI-GUIDE) versus freehand ventriculostomy: study protocol for a randomized controlled trial. Trials 15:478, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Schaumann A, Thomale UW: Guided Application of Ventricular Catheters (GAVCA)—multicentre study to compare the ventricular catheter position after use of a catheter guide versus freehand application: study protocol for a randomised trail. Trials 14:428, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Toma AK, Camp S, Watkins LD, Grieve J, Kitchen ND: External ventricular drain insertion accuracy: is there a need for change in practice?. Neurosurgery 65:11972009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Wilson TJ, Stetler WR Jr, Al-Holou WN, Sullivan SE: Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation. J Neurosurg 119:6670, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 754 266 18
PDF Downloads 352 82 8
EPUB Downloads 0 0 0