Wilson Thomas J, McCoy Kathleen E, Al-Holou Wajd N, Molina Sergio L, Smyth Matthew D, Sullivan Stephen E
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and.
Department of Neurosurgery, Washington University in St. Louis, Missouri.
Neurosurg Focus. 2016 Sep;41(3):E10. doi: 10.3171/2016.5.FOCUS16159.
OBJECTIVE The aim of this paper is to compare the accuracy of the freehand technique versus the use of intraoperative guidance (either ultrasound guidance or frameless stereotaxy) for placement of parietooccipital ventricular catheters and to determine factors associated with reduced proximal shunt failure. METHODS This retrospective cohort study included all patients from 2 institutions who underwent a ventricular cerebrospinal fluid (CSF) shunting procedure in which a new parietooccipital ventricular catheter was placed between January 2005 and December 2013. Data abstracted for each patient included age, sex, method of ventricular catheter placement, side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic studies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision. Standard statistical methods were used for analysis. RESULTS A total of 257 patients were included in the study: 134 from the University of Michigan and 123 from Washington University in St. Louis. Accurate ventricular catheter placement was achieved in 81.2% of cases in which intraoperative guidance was used versus 67.3% when the freehand technique was used. Increasing age reduced the likelihood of accurate catheter placement (OR 0.983, 95% CI 0.971-0.995; p = 0.005), while the use of intraoperative guidance significantly increased the likelihood (OR 2.809, 95% CI 1.406-5.618; p = 0.016). During the study period, 108 patients (42.0%) experienced shunt failure, 79 patients (30.7%) had failure involving the proximal catheter, and 53 patients (20.6%) had distal failure (valve or distal catheter). Increasing age reduced the likelihood of being free from proximal shunt failure (OR 0.983, 95% CI 0.970-0.995; p = 0.008), while both the use of intraoperative guidance (OR 2.385, 95% CI 1.227-5.032; p = 0.011), and accurate ventricular catheter placement (OR 3.424, 95% CI 1.796-6.524; p = 0.009) increased the likelihood. CONCLUSIONS The use of intraoperative guidance during parietooccipital ventricular catheter placement as part of a CSF shunt system significantly increases the likelihood of accurate catheter placement and subsequently reduces the rate of proximal shunt failure.
目的 本文旨在比较徒手技术与术中引导（超声引导或无框架立体定向）用于顶枕部脑室导管置入的准确性，并确定与近端分流失败率降低相关的因素。方法 这项回顾性队列研究纳入了2家机构在2005年1月至2013年12月期间接受脑室脑脊液（CSF）分流手术且置入新的顶枕部脑室导管的所有患者。为每位患者提取的数据包括年龄、性别、脑室导管置入方法、脑室导管置入侧、埃文斯比率和双额叶脑室跨度。回顾术后影像学研究以评估脑室导管置入的准确性。还查阅病历以寻找需要翻修的分流失败证据。采用标准统计方法进行分析。结果 本研究共纳入257例患者：密歇根大学134例，圣路易斯华盛顿大学123例。术中引导组的脑室导管准确置入率为81.2%，徒手技术组为67.3%。年龄增加会降低导管准确置入的可能性（比值比[OR]0.983，95%置信区间[CI]0.971 - 0.995；p = 0.005），而术中引导的使用显著增加了这种可能性（OR 2.809，95% CI 1.406 - 5.618；p = 0.016）。在研究期间，108例患者（42.0%）出现分流失败，79例患者（30.7%）近端导管失败，53例患者（20.6%）远端失败（阀门或远端导管）。年龄增加会降低无近端分流失败的可能性（OR 0.983，95% CI 0.970 - 0.995；p = 0.008），而术中引导的使用（OR 2.385，95% CI 1.227 - 5.032；p = 0.011）和脑室导管准确置入（OR 3.424，95% CI 1.796 - 6.524；p = 0.009）均增加了这种可能性。结论 在作为脑脊液分流系统一部分的顶枕部脑室导管置入过程中使用术中引导，可显著提高导管准确置入的可能性，并随后降低近端分流失败率。
