科研之友
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摘要
BACKGROUND: The prevalent method of ventriculostomy placement is via freehand insertion to cannulate the ventricle at a 90 degrees angle to the skull to get ideal placement. Our goal was to test the validity of this practice in patients without midline shift and with normal ventricular size. %26lt;br%26gt;METHODS: This study was a virtual radiographic analysis of 3-dimensional data of skull and ventricular anatomy. Data were collected using thin-cut (1-mm) computed tomography scans of 101 randomly selected patients with normal ventricular anatomy. Virtual ventriculostomy trajectories were determined for entry from the right and left sides separately, going in at a 90 degrees angle to the skull. Three-dimensional multiplanar reconstructions were performed using Osirix software to see where the catheter would end up within the brain. %26lt;br%26gt;RESULTS: In our patient population, the mean bicaudate index was 0.14. Of the 202 perpendicular lines created from Kocher%26apos;s point into the brain, 67.8% (137) of the virtual lines passed through the ipsilateral frontal horn of the lateral ventricle, 20.8% (42) passed through the contralateral ventricle, and 10.4% (21) did not pass through a ventricular space. A lower bicaudate index also leads to a greater misplacement even with a perpendicular trajectory. Pushing a catheter beyond an entry length of 6.5 cm if no cerebrospinal fluid flow has been obtained will not result in ipsilateral ventricular catheterization. %26lt;br%26gt;CONCLUSIONS: Our study concludes that not all catheters passed through Kocher%26apos;s point using a perpendicular trajectory will end up in the ipsilateral frontal horn, and almost 10% of these catheters will be in a nonventricular space. In the instance in which a freehand pass fails to cannulate a ventricle, the safest alternative would be to make only minor adjustments to the perpendicular angle.
- 出版日期2013-8
