A guide to placement of parietooccipital ventricular catheters

Technical note

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✓ Accurate placement of parietooccipital ventricular catheters can be difficult and frustrating. To minimize the morbidity of the procedure and lengthen the duration of shunt function, the catheter tip should lie in the ipsilateral frontal horn. The authors describe a posterior ventricular guide (PVG) for placement of parietooccipital catheters that operates by mechanically coupling the posterior burr hole to the anterior target point. In a series of 38 patients who underwent ventriculoperitoneal shunting with the assistance of the guide, postoperative computerized tomography (CT) scanning revealed that 35 (92.0%) had accurate catheter placement. In comparison, a retrospective review of free-hand posterior catheter placement revealed good catheter position in only 22 of 43 patients (51.1%). The use of the guide added less than 5 minutes to the entire procedure, and there were no complications related to its use. The PVG is a simple and useful tool that aids in the placement of parietooccipital ventricular catheters.

Article Information

Address reprint requests to: Matthew A. Howard III, M.D., Department of Surgery, Division of Neurosurgery, 200 Hawkins Drive, Iowa City, Iowa 52242–1061.

© AANS, except where prohibited by US copyright law.

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Figures

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    A and B: Photographs depicting elements of the posterior ventricular guide (PVG). The adjustable catheter guide tube is inserted into the main assembly and secured by tightening the guide screw, and the modified square cautery cleaning pad is secured to the frontal target site. During catheter placement, the conical nosepiece of the main assembly rests on the frontal target site (A). The adjustable catheter guide tube is in position and a ventricular catheter has been passed through the tube using a metal stylet. The catheter follows a straight trajectory toward the frontal target site (B). C and D: Schematic drawings showing the guide technique. The PVG is positioned for right occipital catheter placement, and the adjustable guide tube positioned close to the burr hole so that the catheter is visible as it exits the guide tube and enters the brain (C). The surgeon has passed the stylet and catheter through the tube and into the ipsilateral lateral ventricle. Note the straight trajectory of the ventricular catheter toward the frontal target site (D).

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    Graphs demonstrating how an error in trajectory angle has a greater effect with increasing distance. The distance the catheter has been passed is represented in the x-axis and the error angle is calculated from this axis. The y-axis represents the error in distance from target point for a given angle of error.

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