Levitt Michael R, O'Neill Brent R, Ishak Gisele E, Khanna Paritosh C, Temkin Nancy R, Ellenbogen Richard G, Ojemann Jeffrey G, Browd Samuel R
Seattle Children's Hospital, Department of Neurological Surgery, 4800 Sand Point Way NE, Seattle, Washington 98105, USA.
J Neurosurg Pediatr. 2012 Aug;10(2):112-7. doi: 10.3171/2012.3.PEDS122. Epub 2012 Jun 29.
Cerebrospinal fluid shunt placement has a high failure rate, especially in patients with small ventricles. Frameless stereotactic electromagnetic image guidance can assist ventricular catheter placement. The authors studied the effects of image guidance on catheter accuracy and shunt survival in children.
Pediatric patients who underwent placement or revision of a frontal ventricular CSF shunt were retrospectively evaluated. Catheters were placed using either anatomical landmarks or image guidance. Preoperative ventricular size and postoperative catheter accuracy were quantified. Outcomes of standard and image-guided groups were compared.
Eighty-nine patients underwent 102 shunt surgeries (58 initial, 44 revision). Image guidance was used in the placement of 56 shunts and the standard technique in 46. Shunt failure rates were not significantly different between the standard (22%) and image-guided (25%) techniques (p = 0.21, log-rank test). Ventricular size was significantly smaller in patients in the image-guided group (p < 0.02, Student t-test) and in the surgery revision group (p < 0.01). Small ventricular size did not affect shunt failure rate, even when controlling for shunt insertion technique. Despite smaller average ventricular size, the accuracy of catheter placement was significantly improved with image guidance (p < 0.01). Shunt accuracy did not affect shunt survival.
The use of image guidance improved catheter tip accuracy compared with a standard technique, despite smaller ventricular size. Failure rates were not dependent on shunt insertion technique, but an observed selection bias toward using image guidance for more at-risk catheter placements showed failure rates similar to initial surgeries.
脑脊液分流管置入术的失败率很高，尤其是在脑室较小的患者中。无框架立体定向电磁图像引导可辅助脑室导管置入。作者研究了图像引导对儿童导管准确性和分流管存活情况的影响。
对接受额部脑室脑脊液分流管置入或翻修术的儿科患者进行回顾性评估。导管置入采用解剖标志法或图像引导法。对术前脑室大小和术后导管准确性进行量化。比较标准组和图像引导组的结果。
89例患者接受了102次分流管手术（58例初次手术，44例翻修手术）。56例分流管置入采用图像引导技术，46例采用标准技术。标准技术组（22%）和图像引导技术组（25%）的分流管失败率无显著差异（p = 0.21，对数秩检验）。图像引导组患者的脑室大小明显较小（p < 0.02，学生t检验），手术翻修组患者的脑室大小也明显较小（p < 0.01）。即使在控制分流管插入技术的情况下，较小的脑室大小也不影响分流管失败率。尽管平均脑室大小较小，但图像引导显著提高了导管置入的准确性（p < 0.01）。分流管的准确性不影响分流管的存活情况。
与标准技术相比，尽管脑室较小，但使用图像引导提高了导管尖端的准确性。失败率不取决于分流管插入技术，但观察到的在更多高风险导管置入中使用图像引导的选择偏倚显示失败率与初次手术相似。
