O'Leary S T, Kole M K, Hoover D A, Hysell S E, Thomas A, Shaffrey C I
Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan 48202, USA.
J Neurosurg. 2000 May;92(5):801-3. doi: 10.3171/jns.2000.92.5.0801.
The goal of this study was to compare the freehand technique of catheter placement using external landmarks with the technique of using the Ghajar Guide for this procedure. The placement of a ventricular catheter can be a lifesaving procedure, and it is commonly performed by all neurosurgeons. Various methods have been described to cannulate the ventricular system, including the modified Friedman tunnel technique in which a soft polymeric tube is inserted through a burr hole. Paramore, et al., have noted that two thirds of noninfectious complications have been related to incorrect positioning of the catheter.
Forty-nine consecutive patients were randomized between either freehand or Ghajar Guide-assisted catheter placement. The target was the foramen of Monro, and the course was through the anterior horn of the lateral ventricle approximately 10 cm above the nasion, 3 cm from the midline, to a depth of 5.5 cm from the inner table of the skull. In all cases, the number of passes was recorded for successful cannulation, and pre- and postplacement computerized tomography scans were obtained. Calculations were performed to determine the bicaudate index and the distance from the catheter tip to the target point.
Successful cannulation was achieved using either technique; however, the catheters placed using the Ghajar Guide were closer to the target.
本研究的目的是比较使用外部标志的徒手放置导管技术与使用加贾尔引导器进行该操作的技术。放置脑室导管可能是一种挽救生命的操作，并且所有神经外科医生通常都会进行。已经描述了多种插入脑室系统的方法，包括改良的弗里德曼隧道技术，即通过钻孔插入一根柔软的聚合物管。帕拉莫尔等人指出，三分之二的非感染性并发症与导管位置不正确有关。
49例连续患者被随机分为徒手放置导管组或加贾尔引导器辅助放置导管组。目标是Monro孔，路径是通过侧脑室前角，在鼻根上方约10厘米处，距中线3厘米，至距颅骨内板5.5厘米深处。在所有病例中，记录成功插管的穿刺次数，并在放置前后进行计算机断层扫描。进行计算以确定双尾状核指数以及导管尖端到目标点的距离。
两种技术均成功实现了插管；然而，使用加贾尔引导器放置的导管更接近目标。
