Thomale U W, Knitter T, Schaumann A, Ahmadi S A, Ziegler P, Schulz M, Miethke C
Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Childs Nerv Syst. 2013 Jan;29(1):131-9. doi: 10.1007/s00381-012-1943-1. Epub 2012 Oct 23.
Freehand placement of ventricular catheters (VC) is reported to be inaccurate in 10-40 %. Endoscopy, ultrasound, or neuronavigation are used in selected cases with significant technical and time-consuming efforts. We suggest a smartphone-assisted guiding tool for the placement of VC.
Measurements of relevant parameters in 3D-MRI datasets in a patient cohort with narrow ventricles for a frontal precoronal VC placement were performed. In this context, a guiding tool was developed to apply the respective measures for VC placement. The guiding tool was tested in a phantom followed by CT imaging to quantify placement precision. A smartphone application was designed to assist the relevant measurements. The guide was applied in 35 patients for VC placement.
MRI measurements revealed the rectangular approach in the sagittal plane and the individual angle towards the tangent in the coronal section as relevant parameter for a frontal approach. The latter angle ranged from medial (91.96° ± 2.75°) to lateral margins (99.56° ± 4.14°) of the ventricle, which was similar in laterally shifted (±5 mm) entry points. The subsequently developed guiding tool revealed precision measurements in an agarose model with 1.1° ± 0.7° angle deviation. Using the smartphone-assisted guide in patients with narrow ventricles (frontal occipital horn ratio, 0.38 ± 0.05), a primary puncture of the ventricles was possible in all cases. No VC failure was observed during follow-up (9.1 ± 5.3 months).
VC placement in narrow ventricles requires accurate placement with simple means in an every-case routine. The suggested smartphone-assisted guide meets these criteria. Further data are planned to be collected in a prospective randomized study.
据报道，徒手放置脑室导管（VC）的误差率为10%至40%。在某些情况下会使用内镜、超声或神经导航，但这些方法技术要求高且耗时。我们提出一种用于VC放置的智能手机辅助导向工具。
对一组脑室狭窄患者的三维磁共振成像（3D-MRI）数据集进行相关参数测量，以用于额前冠状位VC放置。在此基础上，开发了一种导向工具，以应用VC放置的相应测量方法。该导向工具在模型中进行测试，随后进行CT成像以量化放置精度。设计了一款智能手机应用程序来辅助相关测量。该导向工具应用于35例患者进行VC放置。
MRI测量显示，矢状面的矩形入路以及冠状面中与切线的个体角度是额部入路的相关参数。后一个角度范围从脑室内侧（91.96°±2.75°）到外侧边缘（99.56°±4.14°），在侧方移位（±5mm）的穿刺点中相似。随后开发的导向工具在琼脂糖模型中的精度测量显示角度偏差为1.1°±0.7°。在脑室狭窄患者（额枕角比，0.38±0.05）中使用智能手机辅助导向，所有病例均能一次成功穿刺脑室。随访期间（9.1±5.3个月）未观察到VC失败。
在狭窄脑室中放置VC需要在日常病例中以简单方法进行精确放置。所建议的智能手机辅助导向工具符合这些标准。计划在前瞻性随机研究中收集更多数据。
