scholarly journals P.183 Accuracy of External Ventricular Drain Freehand Placement in patients with Traumatic Brain injury. A 5-year single-institution experience

2021 ◽  
Vol 48 (s3) ◽  
pp. S72-S73
Author(s):  
A Alsahlawi ◽  
J Marcoux ◽  
R Saluja
Keyword(s):  
Intensive Care Unit ◽  
Trauma Registry ◽  
External Ventricular Drain ◽  
Optimal Placement ◽  
Grading System ◽  
Single Institution ◽  
Image Guided ◽  
Freehand Technique ◽  
Improve Accuracy ◽  
Grade 3

Background: Placement of an external ventricular drain is considered a simple yet fundamental procedure. Despite its wide practice, an inaccuracy rate of around 50% has been reported. In the trauma setting, targeting the ventricles with a blind freehand technique is challenging due to distorted anatomy. Failure to cannulate lead to multiple passes with a higher risk of complications. Methods: A retrospective study from a single institution was conducted using a trauma registry between March-2014 and March-2019 were included. Accuracy of EVD placement was determined using the Kakarla grading system Results: 224 TBI patients with total of 241 EVDs were performed, 211 met our criteria. Among them, Grade-1 (optimal placement) was achieved in 39.3%, Grade-2 (suboptimal in non-eloquent tissue) in 21.8% and Grade-3 (suboptimal in eloquent tissue) in 38.9%. A total of 74 EVDs were inserted in the intensive care unit, while 137 EVDs were inserted in the operating room. Our accuracy for ICU insertions was 50%, 25.7%, 24.3% for Grades1,2 and3 respectively, while our OR insertion accuracy was 33.6%,19.7%,and46.7% Conclusions: EVD is commonly performed, yet a substantial rate of inaccuracy is reported. This highly suggests the need to improve accuracy, possibly with the adjunct of image-guided techniques, to further optimize catheter placement

Safety and Accuracy of Bedside External Ventricular Drain Placement

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS162-ONS167 ◽  
Author(s):  
Udaya K. Kakarla ◽  
Louis J. Kim ◽  
Steven W. Chang ◽  
Nicholas Theodore ◽  
Robert F. Spetzler
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Third Ventricle ◽  
Optimal Placement ◽  
Grading System ◽  
Midline Shift ◽  
Training Experience ◽  
Frontal Horn ◽  
Grade 3

Abstract Objective: To study the safety and accuracy of ventriculostomy by neurosurgical trainees. Methods: Initial computed tomographic studies of 346 consecutive patients who underwent bedside ventriculostomy were reviewed retrospectively. Diagnosis, catheter tip location, midline shift, and procedural complications were tabulated. To analyze catheter placement, we used a new grading system: Grade 1, optimal placement in the ipsilateral frontal horn or third ventricle; Grade 2, functional placement in the contralateral lateral ventricle or noneloquent cortex; and Grade 3, suboptimal placement in the eloquent cortex or nontarget cerebrospinal fluid space, with or without functional drainage. Statistical analysis was performed using Fisher's exact test and a weighted k coefficient. Results: Diagnoses included the following: subarachnoid hemorrhage, n = 153 (44%); trauma, n = 64 (18%); intracerebral hemorrhage/intraventricular hemorrhage, n = 63 (18%); and other, n = 66 (20%). There were 266 (77%) Grade 1, 34 (10%) Grade 2, and 46 (13%) Grade 3 catheter placements. Hemorrhagic complications occurred in 17 (5%). Four patients (1.2%) were symptomatic, with two (0.6%) requiring surgery. Interand intraobserver agreement was almost perfect (k = 0.846 and 0.922, respectively) as applied to our grading system. Rates of suboptimal placement were highest in patients with midline shift (P = 0.059) and trauma (P = 0.0001). Rates of optimal placement were highest in patients with subarachnoid hemorrhage (P = 0.003) and when the catheter was placed ipsilateral to the side of midline shift (P = 0.063). Neither the resident's training experience nor the side of placement seemed to affect accuracy. Conclusion: Bedside ventriculostomy is a safe and accurate procedure for intracranial pressure monitoring and cerebrospinal fluid drainage.

The Use of Staples for External Ventricular Drain Catheter Fixation: A Single Institution Case Series

2021 ◽  
pp. 106761
Author(s):  
Mohamed M. Salem ◽  
Luis C. Ascanio ◽  
Alejandro Enriquez-Marulanda ◽  
Santiago Gomez-Paz ◽  
Charles E. Mackel ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Case Series ◽  
Single Institution

scholarly journals Use of FOLFIRINOX or Nab-Paclitaxel Plus Gemcitabine for the Treatment of Locally Advanced Pancreatic Adenocarcinoma: A Single Institution Observational Study

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4939
Author(s):  
Alberto Servetto ◽  
Antonio Santaniello ◽  
Fabiana Napolitano ◽  
Francesca Foschini ◽  
Roberta Marciano ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Ductal Adenocarcinoma ◽  
Controlled Clinical Trials ◽  
Single Institution ◽  
Locally Advanced Pancreatic Adenocarcinoma ◽  
Grade 3 ◽  
Advanced Pancreatic Adenocarcinoma

Patients with locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) do not present distant metastases but are not eligible for surgery upfront. Chemotherapy regimens, such as FOLFIRINOX (FFN) or nab-paclitaxel plus gemcitabine (GemNab) in combination with loco-regional treatments are generally used in this setting. However, the best treatment choice is unknown. We retrospectively analyzed the information of 225 patients with stage II–III PDAC treated at our institution between October 2011 and December 2020. A total of 94 patients with LA PDAC who are non-eligible for surgery upfront received neoadjuvant FFN or GemNab. Of the 67 patients receiving FFN, 28 (41.8%) underwent surgery after neoadjuvant therapy. Of the 27 patients treated with GemNab, 6 (22.2%) became eligible for resection. The median overall survival (OS) was 85.1 weeks and 54.3 weeks in the FFN and GemNab groups, respectively (HR = 0.54, p = 0.0109). The median OS was 189.7 weeks and 76.4 weeks in the resected and unresected cohorts, respectively (HR = 0.25, p < 0.0001). Neutropenia (37.3%), anemia (6.0%), and diarrhea (6.0%) in the FFN group and neutropenia (22.2%) and thrombocytopenia (18.5%) in the GemNab groups were the most frequent grade 3–4 side effects. Higher rates of thrombocytosis (p < 0.0001) and peripheral edema (p < 0.0001) were observed in the GemNab group. Our results suggest that the use of FFN is associated with more favorable clinical outcomes than GemNab for patients with LA PDAC. Future randomized and controlled clinical trials are needed to further elucidate the role of these regimens and loco-regional treatments in this setting.

Observer variability in grading patients with subarachnoid hemorrhage

1982 ◽  
Vol 56 (5) ◽  
pp. 628-633 ◽  
Author(s):  
Kenneth W. Lindsay ◽  
Graham Teasdale ◽  
Robin P. Knill-Jones ◽  
Lilian Murray
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Condition ◽  
Systemic Disease ◽  
Observer Variation ◽  
Observer Agreement ◽  
Grading System ◽  
Kappa Statistics ◽  
Observer Variability ◽  
Content Type ◽  
Grade 3

✓ The management of individual patients with subarachnoid hemorrhage depends greatly on assessment of the patient's clinical condition. Difficulty in applying current grading systems prompted the authors to conduct studies of observer variability and to attempt to identify sources of inconsistency. Observers graded 15 patients by both the Hunt and Hess and Nishioka systems. Considerable observer variability was found, with up to four different grades being selected for the same patient. Kappa statistics were used to evaluate the data. This method determines observer agreement occurring in excess of chance. Kappa values for each grading system showed observer agreement to be significantly better than chance, yet revealed marked observer variation. Most variation occurred when Grade 3 was selected, irrespective of the system used. In a further study where observers graded clinical summaries, similar variation occurred; therefore, inconsistency was due mainly to difficulty in matching patients with levels described in the grading system, rather than to fluctuation in the patients' clinical condition or difference in the observers' examination technique. Variability was high when patients with systemic disease or vasospasm on angiography were graded with the Hunt and Hess system. The studies show that a simpler and more reliable grading system is required, and emphasize the need for caution when interpreting the results from different published series.

P109 Experience of tunnelled vs. bolt EVDs on the intensive care unit

2019 ◽  
Vol 90 (3) ◽  
pp. e50.4-e51
Author(s):  
H Asif ◽  
CL Craven ◽  
U Reddy ◽  
LD Watkins ◽  
AK Toma
Keyword(s):  
Intensive Care Unit ◽  
External Ventricular Drain ◽  
Complication Rates ◽  
Single Centre ◽  
Acute Hydrocephalus ◽  
Clinical Notes ◽  
Before And After ◽  
Csf Diversion ◽  
Neurosurgical Operation ◽  
Mean Time

ObjectivesThe placement of an external ventricular drain (EVD) is a common neurosurgical operation that carries great benefit in acute hydrocephalus but is not without risk. In our centre, bolt EVDs (B-EVD) are being placed in favour of tunnelled EVDs (T-EVD). The former has allowed for urgent CSF diversion in ITU. We compared EVD survival and complication rates between the two types of EVDs.DesignSingle centre prospective case-cohort.SubjectsTwenty-five patients with B-EVDs and thirty-four patients with T-EVDs.MethodsClinical notes and radiographic reports were collected before and after the placement of EVDs for patients in ITU between January 2017 and June 2018.ResultsFourteen of the 25 B-EVDs were placed on ITU, of which 2 were under stealth guidance. All 34 T-EVDs were placed in theatre. Mean time to CSF access after decision for diversion was 134 min in the B-EVD group and 227 min in the T-EVD group (p<0.05). Mean survival was 35 days for B-EVDs and 29 days for T-EVDs (p<0.05). Eight T-EVDs went onto be replaced as B-EVDs due to retraction or infection. Complications including infection, detachment or retraction were higher in the T-EVD group at 32% compared to 20% in the B-EVD group.ConclusionsBolt EVDs have a lower frequency of complications and higher survival compared to tunnelled EVDs. Since B-EVDs require fewer resources they can be placed faster and on ITU.

scholarly journals Supratentorial and Infratentorial Ependymomas in Adult Population - A 10-year single institution case series

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv19-iv19
Author(s):  
Shami Acharya ◽  
Athanasius Ishak ◽  
Priya Sekhon ◽  
Jose Pedro Lavrador ◽  
Asfand Malik ◽  
...  
Keyword(s):  
Adult Population ◽  
Case Series ◽  
Poor Response ◽  
Extent Of Resection ◽  
Good Prognosis ◽  
Single Institution ◽  
Single Centre ◽  
Who Grade ◽  
Oncological Treatment ◽  
Grade 3

Abstract Objectives Analyse clinical characteristics and treatment provided to an adult population diagnosed with intracranial ependymomas between 2009–2018. Methods Single centre retrospective cohort study. Variables reviewed: demographics, extent of resection, adjuvant oncological treatment and molecular genetics. Results 17 patients were included (6 females, 11 males). Average age at presentation was 51.3 yrs (range 19-74yrs). 4 supratentorial (2 intraventricular, 1 temporal lobe and 1 frontal lobe) and 13 infratentorial lesions were identified. In the supratentorial subgroup the following treatment was performed: GTR (1 patient), STR (1 patient) and Biopsy (2 patients); 2 patients underwent post-operative radiotherapy. 3 patients had a WHO grade 2 tumour (1 patient - insufficient tissue for grading). 3 recurrences were identified and 2 patients had re-debulking. 2 patients had postoperative hemiparesis, 1 patient died during treatment and 3 are currently being followed up. In the infratentorial subgroup the following treatment was performed: GTR (5 patients), STR (7 patients) and biopsy (1 patient). 3 patients underwent post-operative radiotherapy. 1 patient was WHO grade 1, 11 patients were WHO grade 2 and 1 patient was WHO grade 3. 2 patients had tumour recurrences of which 1 was re-operated. 7 patients develop new post-operative deficits after surgery; 1 patient died and the rest are currently being followed up. Conclusion Even though this case series supports the good prognosis in terms of overall survival in adults with intracranial ependymomas, they represent a challenge to manage given the morbidity of optimal surgical resection and their poor response to adjuvant treatment.

scholarly journals Efficacy of combination-chemotherapy with pirarubicin, ifosfamide, and etoposide for soft tissue sarcoma: a single-institution retrospective analysis

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shiro Saito ◽  
Hisaki Aiba ◽  
Satoshi Yamada ◽  
Hideki Okamoto ◽  
Katsuhiro Hayashi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Adverse Events ◽  
Combination Chemotherapy ◽  
Progressive Disease ◽  
Treatment Phase ◽  
Hematological Toxicity ◽  
Single Institution ◽  
Grade 3

Abstract Background The standard chemotherapy regimens for soft tissue sarcoma are doxorubicin-based. This retrospective study aimed to assess the efficacy and safety of pirarubicin, ifosfamide, and etoposide combination therapy for patients with this disease. Methods Between 2008 and 2017, 25 patients with soft tissue sarcoma were treated with pirarubicin (30 mg/m2, 2 days), ifosfamide (2 g/m2, 5 days), and etoposide (100 mg/m2, 3 days) every 3 weeks. The primary endpoint was overall response, and the secondary endpoint was adverse events of this regimen. Results Responses to this regimen according to RECIST criteria were partial response (n = 9, 36%), stable disease (n = 9, 36%) and progressive disease (n = 7, 28%). During the treatment phase, frequent grade 3 or worse adverse events were hematological toxicities including white blood cell decreases (96%), febrile neutropenia (68%), anemia (68%), and platelet count decreases (48%). No long-term adverse events were reported during the study period. Conclusion This regimen was comparable to previously published doxorubicin-based combination chemotherapy in terms of response rate. Although there were no long-lasting adverse events, based on our results, severe hematological toxicity should be considered.

Optimal Fiducial Configuration in Image-Guided Neurosurgery Using a Genetic Algorithm

2010 ◽  
Vol 4 (4) ◽  
Author(s):  
Laura Gastaldi ◽  
Alessandro Battezzato ◽  
Claudio Bernucci ◽  
Marco Mannino ◽  
Stefano Pastorelli
Keyword(s):  
Genetic Algorithm ◽  
Image Guidance ◽  
3D Model ◽  
Magnetic Resonance Images ◽  
Optimal Placement ◽  
Fiducial Markers ◽  
Virtual Spaces ◽  
Target Registration Error ◽  
Image Guided ◽  
Localize Lesion

Image-guided neurosurgery allows surgeons to navigate and localize lesion through the patient’s cranium with a 3D image guidance. The model of the head is reconstructed using preoperative computed tomography or magnetic resonance images and real and virtual spaces are aligned by means of fiducial markers placed on the patient. In this paper, a new method for the optimal placement of the fiducial markers in order to reduce misalignment is presented. Using routine diagnostic images, a customized 3D model of the patient’s cranium is reconstructed. A genetic algorithm calculates optimal positions of the marker in order to minimize the target registration error. The fiducial set is shown to the surgeons on the 3D model to help him/her in placement of them.

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