Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Brussels, Belgium.
Department of Neurosurgery, Mont-Godinne Hospital, UCL Namur, Yvoir, Belgium.
Acta Neurochir (Wien). 2021 Apr;163(4):1103-1112. doi: 10.1007/s00701-020-04702-1. Epub 2021 Feb 15.
The accurate placement of the ventricular catheter (VC) is critical in reducing the incidence of proximal failure of ventriculoperitoneal shunts (VPSs). The standard freehand technique is based on validated external anatomical landmarks but remains associated with a relatively high rate of VC malposition. Already proposed alternative methods have all their specific limitations. Herein, we evaluate the accuracy of our adapted freehand technique based on an individualized radio-anatomical approach. Reproducing the preoperative imaging on the patient's head using common anatomical landmarks allows to define stereotactic VC coordinates to be followed at surgery.
Fifty-five consecutive patients treated with 56 VPS between 11/2005 and 02/2020 fulfilled the inclusion criteria of this retrospective study. Burr hole coordinates, VC trajectory, and length were determined in all cases on preoperative computed tomography (CT) scan and were accurately reported on patients' head. The primary endpoint was to evaluate VC placement accuracy. The secondary endpoint was to evaluate the rate and nature of postoperative VC-related complications.
Our new technique was applicable in all patients and no VC-related complications were observed. Postoperative imaging showed VC optimally placed in 85.7% and sub-optimally placed in 14.3% of cases. In all procedures, all the holes on the VC tip were found in the ventricular system.
This simple individualized technique improves the freehand VC placement in VPS surgery, making its accuracy comparable to that of more sophisticated and expensive techniques. Further randomized controlled studies are required to compare our results with those of the other available techniques.
准确放置脑室导管（VC）对于降低脑室-腹腔分流术（VPS）近端故障的发生率至关重要。标准的徒手技术基于已验证的外部解剖学标志，但仍与 VC 位置不当的相对较高发生率相关。已经提出的替代方法都有其特定的局限性。在此，我们评估了基于个体化放射解剖方法的改良徒手技术的准确性。使用常见的解剖学标志在患者头部重现术前成像，可以定义在手术中要遵循的立体 VC 坐标。
2005 年 11 月至 2020 年 2 月期间，55 例连续接受 56 例 VPS 治疗的患者符合本回顾性研究的纳入标准。在所有病例中，均在术前 CT 扫描上确定了颅钻坐标、VC 轨迹和长度，并准确报告在患者头部。主要终点是评估 VC 放置的准确性。次要终点是评估术后与 VC 相关并发症的发生率和性质。
我们的新技术适用于所有患者，未观察到与 VC 相关的并发症。术后影像学显示 VC 最佳位置占 85.7%，次优位置占 14.3%。在所有手术中，均在 VC 尖端的所有孔均位于脑室系统中。
这种简单的个体化技术可提高 VPS 手术中徒手 VC 的放置准确性，使其准确性可与更复杂和昂贵的技术相媲美。需要进一步的随机对照研究来比较我们的结果与其他可用技术的结果。
