Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London.
Department of Surgery and Cancer, Imperial College London, St Mary's Campus, London; and.
J Neurosurg. 2017 Jan;126(1):304-311. doi: 10.3171/2016.1.JNS152263. Epub 2016 Apr 15.
OBJECTIVE Ventriculostomy is a relatively common neurosurgical procedure, often performed in the setting of acute hydrocephalus. Accurate positioning of the catheter is vital to minimize morbidity and mortality, and several anatomical landmarks are currently used. The aim of this study was to prospectively evaluate the relative performance of 3 recognized trajectories for frontal ventriculostomy using imaging-derived metrics: perpendicular to skull (PTS), contralateral medial canthus/external auditory meatus (CMC/EAM), and ipsilateral medial canthus/external auditory meatus (IMC/EAM). METHODS Participants completed 9 simulated ventriculostomy attempts (3 of each trajectory) on a model head with Medtronic StealthStation coregistered imaging. Performance measures were distance of the ventricular catheter tip to the foramen of Monro (FoM) and presence of the catheter tip in a lateral ventricle. RESULTS Thirty-one individuals of varying seniority and prior ventriculostomy experience performed a total of 279 simulated freehand frontal ventriculostomies. The PTS and CMC/EAM trajectories were found to be significantly more likely to result in both the catheter tip being closer to the FoM and in a lateral ventricle compared with the IMC/EAM trajectory. These findings were not influenced by the prior ventriculostomy experience of the participant, corroborating the significance of these results. CONCLUSIONS The PTS and CMC/EAM trajectories were superior to the IMC/EAM trajectories during freehand frontal ventriculostomy in this study, and further data from studies incorporating varying ventricular sizes and bur hole locations are required to facilitate a change in clinical practice. In addition, neuronavigation and other guidance techniques for ventriculostomy are becoming increasingly popular and may be superior to freehand techniques, necessitating further prospective data evaluating their safety, efficacy, and feasibility for routine clinical use.
目的
脑室造口术是一种相对常见的神经外科手术，通常在急性脑积水的情况下进行。为了将发病率和死亡率降至最低，导管的准确定位至关重要，目前使用了几种解剖学标志。本研究旨在前瞻性评估使用成像衍生指标的 3 种公认的额脑室造口术轨迹的相对性能：垂直于颅骨（PTS）、对侧内眦/外耳门（CMC/EAM）和同侧内眦/外耳门（IMC/EAM）。
方法
参与者在 Medtronic StealthStation 配准成像的模型头上完成了 9 次模拟脑室造口术尝试（每种轨迹 3 次）。性能指标包括脑室导管尖端到 Monro 孔（FoM）的距离和导管尖端是否在侧脑室中。
结果
31 名不同资历和先前脑室造口术经验的个体总共进行了 279 次模拟徒手额脑室造口术。与 IMC/EAM 轨迹相比，PTS 和 CMC/EAM 轨迹更有可能导致导管尖端更靠近 FoM 并进入侧脑室。这些发现不受参与者先前脑室造口术经验的影响，证实了这些结果的重要性。
结论
在这项研究中，与 IMC/EAM 轨迹相比，PTS 和 CMC/EAM 轨迹在徒手额脑室造口术中表现更为优越，需要进一步研究纳入不同大小的脑室和钻孔位置的数据，以促进临床实践的改变。此外，脑室造口术的神经导航和其他引导技术越来越受欢迎，可能优于徒手技术，因此需要进一步前瞻性数据评估其用于常规临床应用的安全性、有效性和可行性。
