Preliminary Results of Emergency Computed Tomography-Guided Ventricular Drain Placement-Precision for the Most Difficult Cases.
- Nowacki A Department of Neurosurgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
- Wagner F University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
- Söll N Department of Neurosurgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
- Hakim A University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
- Beck J Department of Neurosurgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
- Raabe A Department of Neurosurgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
- Z'Graggen WJ Department of Neurosurgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland. Electronic address: werner.zgraggen@insel.ch.
- 2018-04-08
Published in:
- World neurosurgery. - 2018
Accuracy
Computed tomography
External ventricular drains
Adult
Aged
Case-Control Studies
Catheterization
Drainage
Emergency Medical Services
Female
Humans
Intraoperative Neurophysiological Monitoring
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed
Ventriculostomy
English
BACKGROUND
External ventricular drainage (EVD) catheter placement is one of the most commonly performed neurosurgical procedures. The study's objective was to compare a computed tomography (CT) bolt scan-guided approach for the placement of EVDs with conventional landmark-based insertion.
METHODS
In this retrospective case-control study, we analyzed patients undergoing bolt-kit EVD catheter placement, either CT-guided or landmark-based, between 2013 and 2016. The CT bolt scan-guided approach was based on a dose-reduced CT scan after bolt fixation with immediate image reconstruction along the axis of the bolt to evaluate the putative insertion axis. If needed, angulation of the bolt was corrected and the procedure repeated before the catheter was inserted. Primary endpoint was the accuracy of insertion. Secondary endpoints were the overall number of attempts, duration of intervention, complication rates, and cumulative radiation dose.
RESULTS
In total, 34 patients were included in the final analysis. In the group undergoing CT-guided placement, the average ventricle width was significantly smaller (P = 0.04) and average midline shift significantly more pronounced (P = 0.01). CT-guided placement resulted in correct positioning of the catheter in the ipsilateral frontal horn in all 100% of the cases compared with landmark-guided insertion (63%; P = 0.01). Application of the CT-guided approach increased the number of total CT scans (3.6 ± 1.9) and the overall radiation dose (3.34 ± 1.61 mSv) compared with the freehand insertion group (1.84 ± 2.0 mSv and 1.55 ± 1.66 mSv). No differences were found for the other secondary outcome parameters.
CONCLUSIONS
CT-guided bolt-kit EVD catheter placement is feasible and accurate in the most difficult cases.
External ventricular drainage (EVD) catheter placement is one of the most commonly performed neurosurgical procedures. The study's objective was to compare a computed tomography (CT) bolt scan-guided approach for the placement of EVDs with conventional landmark-based insertion.
METHODS
In this retrospective case-control study, we analyzed patients undergoing bolt-kit EVD catheter placement, either CT-guided or landmark-based, between 2013 and 2016. The CT bolt scan-guided approach was based on a dose-reduced CT scan after bolt fixation with immediate image reconstruction along the axis of the bolt to evaluate the putative insertion axis. If needed, angulation of the bolt was corrected and the procedure repeated before the catheter was inserted. Primary endpoint was the accuracy of insertion. Secondary endpoints were the overall number of attempts, duration of intervention, complication rates, and cumulative radiation dose.
RESULTS
In total, 34 patients were included in the final analysis. In the group undergoing CT-guided placement, the average ventricle width was significantly smaller (P = 0.04) and average midline shift significantly more pronounced (P = 0.01). CT-guided placement resulted in correct positioning of the catheter in the ipsilateral frontal horn in all 100% of the cases compared with landmark-guided insertion (63%; P = 0.01). Application of the CT-guided approach increased the number of total CT scans (3.6 ± 1.9) and the overall radiation dose (3.34 ± 1.61 mSv) compared with the freehand insertion group (1.84 ± 2.0 mSv and 1.55 ± 1.66 mSv). No differences were found for the other secondary outcome parameters.
CONCLUSIONS
CT-guided bolt-kit EVD catheter placement is feasible and accurate in the most difficult cases.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.wneu.2018.03.199
- PMID 29626681
- Persistent URL
- https://susi.usi.ch/global/documents/178144
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