Sano Noritaka, Torikoshi Sadaharu, Kitahara Takahiro, Nakajima Yusuke, Hayase Makoto, Nishimura Masaki
1Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui; and.
2Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Neurosurg. 2025 Apr 4;143(1):127-134. doi: 10.3171/2024.12.JNS241625. Print 2025 Jul 1.
The traditional freehand insertion of a ventricular catheter using surface anatomical landmarks is a basic procedure for neurosurgeons. However, this procedure involves considerable uncertainty and frequently requires multiple placement attempts. This also periodically results in improper positioning of the catheter tip. The aim of this study was to evaluate the accuracy of ventricular catheter insertion using real-time ultrasound images acquired with a burr hole-compatible transducer and to compare it with freehand insertion.
This retrospective cohort study included all patients at a single institution who underwent a ventricular catheter insertion operation, including external ventricular drainage, ventriculoperitoneal shunt placement, and Ommaya reservoir insertion through a new burr hole, between January 2015 and March 2022. The data collected for each patient included age, sex, diagnosis, antiplatelet or anticoagulant use within 24 hours before or after the procedure, use of intraoperative real-time ultrasound with a burr hole-compatible transducer, site and side of the ventricular catheter placement, number of attempts required to achieve successful insertion, postoperative parenchymal bleeding, and symptomatic complications related to inaccurate catheter insertion. The Evans index was acquired from preoperative CT images, and the accuracy of ventricular catheter placement was evaluated using postoperative CT.
A total of 136 procedures were included in this study; 81 ventricular catheters were inserted using the freehand technique, and 55 were inserted using the real-time ultrasound technique. The number of catheter placement attempts was significantly lower using the real-time ultrasound technique than the freehand technique (p < 0.001), and the accuracy of the real-time ultrasound technique was significantly higher (p < 0.001). The difference in accuracy between the ultrasound and freehand techniques was augmented in posterior horn punctures (100% and 74.1%, respectively, p = 0.01).
The real-time ultrasound-guided ventricular catheter insertion technique is significantly more accurate than the traditional surface anatomical landmark-based freehand technique and results in a reduced number of puncture attempts.
使用体表解剖标志徒手插入脑室导管是神经外科医生的一项基本操作。然而，该操作存在相当大的不确定性，并且常常需要多次尝试放置。这也会周期性地导致导管尖端定位不当。本研究的目的是评估使用与骨孔兼容的换能器获取的实时超声图像进行脑室导管插入的准确性，并将其与徒手插入进行比较。
这项回顾性队列研究纳入了2015年1月至2022年3月期间在单一机构接受脑室导管插入手术的所有患者，包括脑室外引流、脑室腹腔分流术置管以及通过新的骨孔插入奥马亚贮液器。为每位患者收集的数据包括年龄、性别、诊断、手术前后24小时内使用抗血小板或抗凝药物的情况、术中使用与骨孔兼容的换能器进行实时超声检查的情况、脑室导管放置的部位和侧别、成功插入所需的尝试次数、术后实质内出血以及与导管插入不准确相关的症状性并发症。从术前CT图像获取埃文斯指数，并使用术后CT评估脑室导管放置的准确性。
本研究共纳入136例手术；81根脑室导管采用徒手技术插入，55根采用实时超声技术插入。实时超声技术的导管放置尝试次数显著低于徒手技术（p < 0.001），实时超声技术的准确性显著更高（p < 0.001）。超声和徒手技术之间的准确性差异在后角穿刺中增大（分别为100%和74.1%，p = 0.01）。
实时超声引导下的脑室导管插入技术比传统的基于体表解剖标志的徒手技术显著更准确，且穿刺尝试次数减少。
