Department of Neurological Surgery, Stanford University, Palo Alto, CA, USA; The Stanford Neurosurgical Training and Innovation Center, Stanford University, Palo Alto, CA, USA; Neurosurgery Unit, Ferrara University Hospital, Department of Morphology Surgery and Experimental Medicine, Ferrara, Italy.
Neurosurgery Unit, Ferrara University Hospital, Department of Morphology Surgery and Experimental Medicine, Ferrara, Italy.
Clin Neurol Neurosurg. 2022 Jun;217:107264. doi: 10.1016/j.clineuro.2022.107264. Epub 2022 Apr 26.
Several techniques have been described to improve the accuracy of the freehand procedure for frontal ventriculostomy and reduce complications due to suboptimal placement or misplacement of the catheter tip. To date, none of the available studies have found a reliable, low cost and consistent technique. We aimed to provide a standardized protocol for freehand frontal ventriculostomy.
In the first part of the radiological study, 125 CT scans were used to measure the length of the catheter using 2 right-sided entry points. In the second part, a grid of 24 entry points on the frontal bone was used in 50 CT scans to record the distance from the cranial surface to the Foramen of Monro (FM). Ventriculostomy was performed on six cadaveric heads using a grid of 9 entry points, comparing a 5 ml syringe with the freehand technique to reach the target.
The first part of the radiological study showed a length from the cranial surface to the FM was overall 67,38 ± 1,03 mm. For the second part, the mean length of the 24 selected points was 68,54 ± 2,73 mm without statistical difference. In the anatomical study, the FM was reached 8 times (14.8%) with the syringe vs 31 times (57.4%) with the freehand technique, and the ventricles 43 (79.6%) vs 37 (68.5%). The mean lengths from the skull to the FM were 71.33 ± 4.21 mm.
In this study, we showed the optimal length of a frontal ventricular catheter. We have also demonstrated that the portion of the frontal bone above the superior temporal lines matches a sphere in which the center is the FM.
已经描述了几种技术来提高徒手额角脑室造瘘术的准确性，并减少由于导管尖端位置不佳或放置不当而导致的并发症。迄今为止，尚无可用的研究发现一种可靠、低成本且一致的技术。我们旨在为徒手额角脑室造瘘术提供一个标准化的方案。
在放射学研究的第一部分中，使用 125 次 CT 扫描测量使用 2 个右侧入路的导管长度。在第二部分中，在 50 次 CT 扫描中使用额骨上的 24 个入点网格记录从颅表面到 Monro 孔（FM）的距离。使用 9 个入点网格在 6 个尸体头上进行脑室造瘘术，将 5ml 注射器与徒手技术进行比较以达到目标。
放射学研究的第一部分显示从颅表面到 FM 的总长度为 67.38 ± 1.03mm。对于第二部分，24 个选定点的平均长度为 68.54 ± 2.73mm，无统计学差异。在解剖学研究中，FM 用注射器到达 8 次（14.8%），徒手技术到达 31 次（57.4%），脑室用注射器到达 43 次（79.6%），徒手技术到达 37 次（68.5%）。从颅骨到 FM 的平均长度为 71.33 ± 4.21mm。
在这项研究中，我们展示了额角脑室导管的最佳长度。我们还表明，颞上线以上的额骨部分与 FM 为中心的球体相匹配。
