Lind Christopher R P, Tsai Amy M C, Law Andrew J J, Lau Hui, Muthiah Kavitha
Department of Neurosurgery, Auckland City Hospital, University of Auckland, Auckland City, New Zealand.
J Neurosurg. 2008 May;108(5):930-3. doi: 10.3171/JNS/2008/108/5/0930.
The purpose of this study was to compare the margins of error of different shunt catheter approaches to the lateral ventricle and assess surface anatomical aiming landmarks for free-hand ventricular catheter insertion in adult patients with hydrocephalus.
Four adults who had undergone stereotactic brain magnetic resonance (MR) imaging and had normal ventricles, and 7 prospectively recruited adult patients with acute hydrocephalus were selected for inclusion in this study. Reconstructed MR images obtained prior to surgical intervention were geometrically analyzed with regard to frontal, parietal, and parietooccipital (occipital) approaches in both hemispheres.
The ventricular target zones were as follows: the frontal horn for frontal and occipital approaches, and the atrium/posterior horn for parietal approaches. The range of possible angles for successful catheter insertion was smallest for the occipital approach (8 degrees in the sagittal plane and 11 degrees in the coronal plane), greater for parietal catheters (23 and 36 degrees ), and greatest for the frontal approach in models of hydrocephalic brains (42 and 30 degrees; p < 0.001 for all comparisons except frontal vs parietal, which did not reach statistical significance). There was no single landmark for aiming occipital or parietal catheters that achieved ventricular target cannulation in every case. Success was achieved in only 86% of procedures using occipital trajectories and in 66% of those using parietal trajectories.
The occipital approach to ventricular catheter insertion provides the narrowest margin of error with regard to trajectory but has less aiming point variability than the parietal approach. The use of patient-specific stereotaxy rather than generic guides is required for totally reliable, first-pass ventricular catheterization via a posterior approach to shunt placement surgery in adults.
本研究旨在比较不同侧脑室分流导管置入方法的误差范围，并评估成人脑积水患者徒手脑室导管置入的表面解剖定位标志。
选取4例接受过立体定向脑磁共振成像且脑室正常的成人，以及7例前瞻性招募的急性脑积水成年患者纳入本研究。对手术干预前获得的重建磁共振图像，针对双侧半球的额部、顶部和顶枕部（枕部）入路进行几何分析。
脑室目标区域如下：额部和枕部入路为额角，顶部入路为房部/后角。在脑积水模型中，成功插入导管的可能角度范围，枕部入路最小（矢状面8度，冠状面11度），顶部导管较大（23度和36度），额部入路最大（42度和30度；除额部与顶部比较未达到统计学意义外，所有比较p<0.001）。没有单一的定位标志能在每种情况下都实现枕部或顶部导管插入脑室目标。使用枕部轨迹的操作中只有86%成功，使用顶部轨迹的操作中只有66%成功。
脑室导管插入的枕部入路在轨迹方面误差范围最窄，但瞄准点变异性比顶部入路小。对于成人分流置管手术通过后入路进行完全可靠的首次脑室导管插入，需要使用针对患者的立体定向技术而非通用导向装置。
