Stahl Robert, D'Anastasi Melvin, Forbrig Robert, Liebig Thomas, Katzendobler Sophie, Weller Jonathan, Trumm Christoph G
Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta.
Diagnostics (Basel). 2023 Aug 30;13(17):2805. doi: 10.3390/diagnostics13172805.
To assess accuracy, the frequency of hemorrhagic complications and computed tomography (CT) radiation dose parameters in pediatric patients undergoing landmark-guided external ventricular drain (EVD) placement in an emergency setting.
Retrospective analysis comprised 36 EVD placements with subsequent CT control scans in 29 patients (aged 0 to 17 years) in our university hospital from 2008 to 2022. The position of the EVD as well as the presence and extension of bleeding were classified according to previously established grading schemes. Dose length product (DLP), volume-weighted CT dose index (CTDI) and scan length were extracted from the radiation dose reports and compared to the diagnostic reference values (DRLs) issued by the German Federal Office for Radiation Protection.
After the initial EVD placement, optimal positioning of the catheter tip into the ipsilateral frontal horn or third ventricle (Grade I), or a functional positioning in the contralateral lateral ventricle or the non-eloquent cortex (Grade II), was achieved in 28 and 8 cases, respectively. In 32 of 36 procedures, no evidence of hemorrhage was present in the control CT scan. Grade 1 (<1 mL) and Grade 2 (≥1 to 15 mL) bleedings were detected after 3 and 1 placement(s), respectively. For control scans after EVD placements, CTDI (median [25%; 75% quartile]) was 39.92 [30.80; 45.55] mGy, DLP yielded 475.50 [375.00; 624.75] mGy*cm and the scan length result was 136 [120; 166] mm. Exceedances of the DRL values were observed in 14.5% for CTDI, 12.7% for DLP and 65.6% for the scan length. None of these values was in the range requiring a report to the national authorities.
Landmark-based emergency EVD placement in pediatric patients yielded an optimal position in most cases already after the initial insertion. Complications in terms of secondary hemorrhages are rare. CT dose levels associated with the intervention are below the reportable threshold of the national DRLs in Germany.
评估在紧急情况下接受地标引导下外置脑室引流（EVD）置入术的儿科患者中，EVD置入的准确性、出血并发症的发生率以及计算机断层扫描（CT）辐射剂量参数。
回顾性分析了2008年至2022年在我们大学医院对29例年龄在0至17岁的患者进行的36次EVD置入及随后的CT对照扫描。根据先前制定的分级方案对EVD的位置以及出血的存在和范围进行分类。从辐射剂量报告中提取剂量长度乘积（DLP）、体积加权CT剂量指数（CTDI）和扫描长度，并与德国联邦辐射防护办公室发布的诊断参考值（DRLs）进行比较。
在初次EVD置入后，导管尖端分别在28例和8例中最佳定位到同侧额角或第三脑室（I级），或功能性定位到对侧侧脑室或非功能区皮质（II级）。在36例手术中的32例中，对照CT扫描未发现出血迹象。分别在3次和1次置管后检测到1级（<1 mL）和2级（≥1至15 mL）出血。对于EVD置入后的对照扫描，CTDI（中位数[25%；75%四分位数]）为39.92 [30.80；45.55] mGy，DLP为475.50 [375.00；624.75] mGy*cm，扫描长度结果为136 [120；166] mm。CTDI超过DRL值的比例为14.5%，DLP为12.7%，扫描长度为65.6%。这些值均未达到需要向国家当局报告的范围。
在儿科患者中基于地标进行的紧急EVD置入在大多数情况下初次插入后即可获得最佳位置。继发性出血方面的并发症很少见。与该干预相关的CT剂量水平低于德国国家DRLs的可报告阈值。
