Huyette David R, Turnbow Benjamin J, Kaufman Christian, Vaslow Dale F, Whiting Benjamin B, Oh Michael Y
Department of Radiology, University of Missouri Health Care, Columbia, USA.
J Neurosurg. 2008 Jan;108(1):88-91. doi: 10.3171/JNS/2008/108/01/0088.
The standard method of ventriculostomy catheter placement is a freehand pass technique using surface anatomical landmarks. This study was undertaken to determine the accuracy of successful ventriculostomy procedures performed at a single institution's intensive care unit (ICU). The authors hypothesized that use of surface anatomical landmarks alone with successful results frequently do not correlate with desirable catheter tip placement.
Retrospective evaluation was performed on the head computed tomography (CT) scans of 97 patients who underwent 98 freehand pass ventriculostomy catheter placements in an ICU setting. Using the postprocedure CT scans of the patients, 3D measurements were made to calculate the accuracy of ventriculostomy catheter placement.
The mean distance (+/- standard deviation [SD]) from the catheter tip to the Monro foramen was 16 +/- 9.6 mm. The mean distance (+/- SD) from the catheter tip to the center of the bur hole was 87.4 +/- 14.0 mm. Regarding accurate catheter tip placement, 56.1% of the catheter tips were in the ipsilateral lateral ventricle, 7.1% were in the contralateral lateral ventricle, 8.2% were in the third ventricle, 6.1% were within the interhemispheric fissure, and 22.4% were within extraventricular spaces.
The accuracy of freehand ventriculostomy catheterization at the authors' institution typically required 2 passes per successful placement, and, when successful, was 1.6 cm from the Monro foramen. More importantly, 22.4% of these catheter tips were in nonventricular spaces. Although many neurosurgeons believe that the current practice of ventriculostomy is good enough, the results of this study show that there is certainly much room for improvement.
脑室造瘘导管置入的标准方法是使用体表解剖标志的徒手穿刺技术。本研究旨在确定在单一机构的重症监护病房（ICU）进行的成功脑室造瘘手术的准确性。作者推测，仅使用体表解剖标志且结果成功时，往往与理想的导管尖端位置不相关。
对在ICU环境中接受98次徒手穿刺脑室造瘘导管置入的97例患者的头部计算机断层扫描（CT）进行回顾性评估。利用患者术后的CT扫描进行三维测量，以计算脑室造瘘导管置入的准确性。
导管尖端到室间孔的平均距离（±标准差[SD]）为16±9.6mm。导管尖端到钻孔中心的平均距离（±SD）为87.4±14.0mm。关于导管尖端的准确位置，56.1%的导管尖端位于同侧侧脑室，7.1%位于对侧侧脑室，8.2%位于第三脑室，6.1%位于大脑半球间裂内，22.4%位于脑室外间隙。
在作者所在机构，徒手脑室造瘘置管的准确性通常是每次成功置管需要穿刺2次，成功时距室间孔1.6cm。更重要的是，这些导管尖端中有22.4%位于非脑室空间。尽管许多神经外科医生认为目前的脑室造瘘做法已经足够好，但本研究结果表明仍有很大的改进空间。
