Fiorella David, Peeling Lissa, Denice Christine M, Sarmiento Marily, Woo Henry H
Department of Neurological Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
J Neurointerv Surg. 2014 Jul;6(6):457-60. doi: 10.1136/neurintsurg-2013-010856. Epub 2013 Jul 26.
To demonstrate the feasibility of the application of integrated flat detector (FD) CT and fluoroscopic guidance (iGuide) for the placement of external ventricular drains (EVD) within the neuroangiography suite.
A retrospective review of a prospectively maintained endovascular database identified six patients who underwent EVD placement using iGuide. Patient characteristics, operator, number of passes, accuracy of placement, immediate and delayed periprocedural complications and radiation exposure were assessed.
Five patients with subarachnoid hemorrhage and one patient with a large cerebellar infarct (average age 45.5 years (range 39-53), four women) underwent EVD placement within the angiography suite using iGuide. Four procedures were performed by a neuroradiologist and two by a neurosurgeon. All catheters were placed with a single pass and all terminated within the frontal horn of the ipsilateral lateral ventricle. No parenchymal or intraventricular hemorrhages were encountered after catheter placement. No patients experienced any immediate or delayed periprocedural complications. Radiation exposure related to the FD CTs required for placement was 593.7 mGy (range 539-673).
EVD placement under combined CT and fluoroscopic control within the neuroangiography suite is feasible. The technique predictably allows optimized EVD catheter placement with a single pass. We propose that this technique could improve the accuracy, and potentially reduce the complications, of EVD insertion in cerebrovascular patients.
证明在神经血管造影套件中应用集成平板探测器（FD）CT和透视引导（iGuide）进行脑室外引流管（EVD）置入的可行性。
对前瞻性维护的血管内数据库进行回顾性分析，确定了6例使用iGuide进行EVD置入的患者。评估了患者特征、操作者、穿刺次数、置入准确性、围手术期即时和延迟并发症以及辐射暴露情况。
5例蛛网膜下腔出血患者和1例小脑大面积梗死患者（平均年龄45.5岁（范围39 - 53岁），4名女性）在血管造影套件中使用iGuide进行了EVD置入。4例手术由神经放射科医生进行，2例由神经外科医生进行。所有导管均一次穿刺成功，且均终止于同侧侧脑室额角内。置管后未发生实质内或脑室内出血。所有患者均未出现围手术期即时或延迟并发症。与置入所需的FD CT相关的辐射暴露为593.7 mGy（范围539 - 673）。
在神经血管造影套件中，在CT和透视联合控制下进行EVD置入是可行的。该技术可预测地允许单次穿刺实现优化的EVD导管置入。我们认为该技术可提高脑血管疾病患者EVD置入的准确性，并可能减少并发症。
