P102 Shunting slit ventricles: a comparison of the parieto-occipital vs frontal approach

2019 ◽  
Vol 90 (3) ◽  
pp. e49.2-e49
Author(s):  
CL Craven ◽  
L D’Antona ◽  
S Thompson ◽  
J Ramos ◽  
S Sennik ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Retrospective Cohort ◽  
Catheter Insertion ◽  
Burr Hole ◽  
Congenital Hydrocephalus ◽  
Shunt Placement ◽  
Kaplan Meier ◽  
Frontal Horn ◽  
Catheter Tip ◽  
Shunt Survival

ObjectivesSlit ventricles can be a challenging target during shunt catheter insertion. Traditionally, the frontal approach has been considered optimal. At this centre, routine use of electromagnetic (EM) stereotatic guidance (StealthTM, Medtronic) has enabled a parieto-occipital burr hole approach to the frontal horns. We compare shunt placement and revisions required for patients with slit ventricles who had shunts inserted via a parieto-occipital (P-O) approach vs. frontal shunt.DesignRetrospective cohort.SubjectsPatients with slit ventricles and a ventricular shunt inserted using EM guidance between 2012–2018.MethodsSlit ventricles were defined as <3 mm (widest). Outcome measures included placement accuary and survival using Kaplan-Meier curve.Results82 patients (77F:5M) aged 34.9±10.8 years (mean ±SD) had shunts inserted for IIH (n=63), chiari/syrinx (n=8), congenital hydrocephalus (n=10), pseudomeningocoele (n=1). 35 had primary P-O shunts and 46 had frontal shunts. Overall, 94% of cases had the catheter tip sitting in the frontal horn. The P-O approach was just as accurate as the frontal approach. Eight P-O shunts and 9 frontal shunts required revision over a 60 month periods. There was no significant different in shunt survival between the two approaches (p=0.99).ConclusionsEM guided placement has enabled the P-O approach to be as safe and with equivalent survival to frontal approach. The accuracy of shunt placement between the two approaches was equivocal.

No significant improvement in the rate of accurate ventricular catheter location using ultrasound-guided CSF shunt insertion: a prospective, controlled study by the Hydrocephalus Clinical Research Network

2013 ◽  
Vol 12 (6) ◽  
pp. 565-574 ◽  
Author(s):  
William E. Whitehead ◽  
Jay Riva-Cambrin ◽  
John C. Wellons ◽  
Abhaya V. Kulkarni ◽  
Richard Holubkov ◽  
...  
Keyword(s):  
Ultrasound Image ◽  
Intraoperative Ultrasound ◽  
Research Network ◽  
Ventricular Catheter ◽  
Ultrasound Guided ◽  
Shunt Insertion ◽  
Frontal Horn ◽  
Catheter Tip ◽  
Shunt Survival ◽  
Catheter Location

Object Cerebrospinal fluid shunt ventricular catheters inserted into the frontal horn or trigone are associated with prolonged shunt survival. Developing surgical techniques for accurate catheter insertion could, therefore, be beneficial to patients. This study was conducted to determine if the rate of accurate catheter location with intraoperative ultrasound guidance could exceed 80%. Methods The authors conducted a prospective, multicenter study of children (< 18 years) requiring first-time treatment for hydrocephalus with a ventriculoperitoneal shunt. Using intraoperative ultrasound, surgeons were required to target the frontal horn or trigone for catheter tip placement. An intraoperative ultrasound image was obtained at the time of catheter insertion. Ventricular catheter location, the primary outcome measure, was determined from the first postoperative image. A control group of patients treated by nonultrasound surgeons (conventional surgeons) were enrolled using the same study criteria. Conventional shunt surgeons also agreed to target the frontal horn or trigone for all catheter insertions. Patients were triaged to participating surgeons based on call schedules at each center. A pediatric neuroradiologist blinded to method of insertion, center, and surgeon determined ventricular catheter tip location. Results Eleven surgeons enrolled as ultrasound surgeons and 6 as conventional surgeons. Between February 2009 and February 2010, 121 patients were enrolled at 4 Hydrocephalus Clinical Research Network centers. Experienced ultrasound surgeons (> 15 cases prior to study) operated on 67 patients; conventional surgeons operated on 52 patients. Experienced ultrasound surgeons achieved accurate catheter location in 39 (59%) of 66 patients, 95% CI (46%–71%). Intraoperative ultrasound images were compared with postoperative scans. In 32.7% of cases, the catheter tip moved from an accurate location on the intraoperative ultrasound image to an inaccurate location on the postoperative study. This was the most significant factor affecting accuracy. In comparison, conventional surgeons achieved accurate location in 24 (49.0%) of 49 cases (95% CI [34%–64%]). The shunt survival rate at 1 year was 70.8% in the experienced ultrasound group and 66.9% in the conventional group (p = 0.66). Ultrasound surgeons had more catheters surrounded by CSF (30.8% vs 6.1%, p = 0.0012) and away from the choroid plexus (72.3% vs 58.3%, p = 0.12), and fewer catheters in the brain (3% vs 22.4%, p = 0.0011) and crossing the midline (4.5% vs 34.7%, p < 0.001), but they had a higher proportion of postoperative pseudomeningocele (10.1% vs 3.8%, p = 0.30), wound dehiscence (5.8% vs 0%, p = 0.13), CSF leak (10.1% vs 1.9%, p = 0.14), and shunt infection (11.6% vs 5.8%, p = 0.35). Conclusions Ultrasound-guided shunt insertion as performed in this study was unable to consistently place catheters into the frontal horn or trigone. The technique is safe and achieves outcomes similar to other conventional shunt insertion techniques. Further efforts to improve accurate catheter location should focus on prevention of catheter migration that occurs between intraoperative placement and postoperative imaging. Clinical trial registration no.: NCT01007786 (ClinicalTrials.gov).

Freehand Insertion of External Ventricular Drainage Catheter–Evaluation of Accuracy in a Single Centre

Neurosurgery ◽  
2019 ◽  
Vol 84 (5) ◽  
pp. E271-E271 ◽  
Author(s):  
Keng Siang Lee ◽  
Tseng Tsai Yeo ◽  
Ning Chou ◽  
Prof Sein Lwin ◽  
Kejia Teo ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
External Ventricular Drainage ◽  
Burr Hole ◽  
Anatomical Landmarks ◽  
Midline Shift ◽  
Frontal Horn ◽  
Significant Difference ◽  
Catheter Tip ◽  
Procedural Complications ◽  
Interhemispheric Fissure

Abstract INTRODUCTION External ventricular drain (EVD) placement is the gold standard for managing acute hydrocephalus. Freehand EVD, using surface anatomical landmarks is performed for ventricular cannulation due to its simplicity and efficiency. This study evaluates accuracy and reason(s) for misplacements as few studies have analyzed the accuracy of freehand EVD insertion. METHODS Preoperative and postoperative computed tomography (CT) scans of patients who underwent EVD insertion in 2014 were retrospectively reviewed. Diagnosis, Evan's ratio, midline shift, position of burr hole, length of the catheter and procedural complications were tabulated. The procedures were classified as satisfactory (catheter tip in the frontal horn ipsilateral lateral ventricle) and unsatisfactory. Unsatisfactory cases were further analyzed in relation to position of burr hole from midline and length of the catheter. RESULTS A total of 77 EVD placements in 70 patients were evaluated. Mean age of the patients was 57.5 yr. About 83.1% were satisfactory placements and 11.7% were unsatisfactory in the contralateral ventricle, corpus callosum and interhemispheric fissure. About 5.2% were in extra ventricular locations. About 2.6% EVD placements were complicated by hemorrhage and 1 catheter was reinserted. Suboptimal placements were significantly associated with longer intracranial catheter length. The mean length was 66.54 ± 10.1 mm in unsatisfactory placements compared to 58.32 ± 4.85 mm in satisfactory placements. Between the 2 groups, no significant difference was observed in Evan's ratio, midline shift, surgeon's experience, distance of burr hole from midline and coronal suture. CONCLUSION Freehand EVD insertion is safe and accurate. In small number of cases, unsatisfactory placement is related to longer catheter length.

scholarly journals Stereotactic guide for posterior approach to lateral ventricle

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Aatman Chand ◽  
Ashis K. Chand ◽  
Arun Angelo Patil ◽  
Manmeet Singh Chhabra
Keyword(s):  
Lateral Ventricle ◽  
Posterior Approach ◽  
Standard Procedure ◽  
Burr Hole ◽  
Simple Device ◽  
Main Body ◽  
Mr Images ◽  
Frontal Horn ◽  
Hand Tapping ◽  
Catheter Tip

Abstract Background Free-hand tapping of the lateral ventricle through the posterior approach is a standard procedure. There are occasions, however, when more than one pass is needed. One way to make it easy and safe is to use a neuro-navigation approach. This requires extra setup. Therefore, the authors in this paper describe the use of a simple device to accurately place the catheter tip in the frontal horn. Main body The device is rectangular with two open arms with co-linear free ends. Based on axial CT or MR images, a trajectory that travels within the ventricle from the posterior to the anterior horn is chosen. The anterior and posterior points of the trajectory are marked on the scalp. A burr hole is placed at the posterior point. The anterior free end is then attached to the anterior trajectory point on the scalp using an EKG pad and to the posterior to a plug placed in the burr hole. The ventricle is tapped through a central hole in the burr hole plug. All 12 patients had accurate catheter placement at the first attempt using this system. Short conclusion This is a simple device that used CT or MR images and surface markings to accurately tap the ventricle.

scholarly journals Optimizing ventriculoperitoneal shunt placement in the treatment of idiopathic intracranial hypertension: an analysis of neuroendoscopy, frameless stereotaxy, and intraoperative CT

2016 ◽  
Vol 40 (3) ◽  
pp. E12 ◽  
Author(s):  
Benjamin Yim ◽  
M. Reid Gooch ◽  
John C. Dalfino ◽  
Matthew A. Adamo ◽  
Tyler J. Kenning
Keyword(s):  
Intracranial Hypertension ◽  
Ventriculoperitoneal Shunt ◽  
Idiopathic Intracranial Hypertension ◽  
Catheter Placement ◽  
Frameless Stereotaxy ◽  
Ventricular Catheter ◽  
Intraoperative Ct ◽  
Shunt Placement ◽  
Frontal Horn ◽  
Catheter Tip

OBJECTIVE Cerebrospinal fluid shunting can effectively lower intracranial pressure and improve the symptoms of idiopathic intracranial hypertension (IIH). Placement of ventriculoperitoneal (VP) shunts in this patient population can often be difficult due to the small size of the ventricular system. Intraoperative adjuvant techniques can be used to improve the accuracy and safety of VP shunts for these patients. The purpose of this study was to analyze the efficacy of some of these techniques, including the use of intraoperative CT (iCT) and frameless stereotaxy, in optimizing postoperative ventricular catheter placement. METHODS The authors conducted a retrospective review of 49 patients undergoing initial ventriculoperitoneal shunt placement for the treatment of IIH. The use of the NeuroPEN Neuroendoscope, intraoperative neuronavigation, and iCT was examined. To analyze ventricular catheter placement on postoperative CT imaging, the authors developed a new grading system: Grade 1, catheter tip terminates optimally in the ipsilateral frontal horn or third ventricle; Grade 2, catheter tip terminates in the contralateral frontal horn; Grade 3, catheter terminates in a nontarget CSF space; and Grade 4, catheter tip terminates in brain parenchyma. All shunts had spontaneous CSF flow upon completion of the procedure. RESULTS The average body mass index among all patients was 37.6 ± 10.9 kg/m2. The NeuroPEN Neuroendoscope was used in 44 of 49 patients. Intraoperative CT scans were obtained in 24 patients, and neuronavigation was used in 32 patients. Grade 1 or 2 final postoperative shunt placement was achieved in 90% of patients (44 of 49). In terms of achieving optimal postoperative ventricular catheter placement, the use of iCT was as effective as neuronavigation. Two patients had their ventricular catheter placement modified based on an iCT study. The use of neuronavigation significantly increased time in the operating room (223.4 ± 46.5 vs 190.8 ± 31.7 minutes, p = 0.01). There were no shunt infections in this study. CONCLUSIONS The use of iCT appears to be equivalent to the use of neuronavigation in optimizing ventricular shunt placement in IIH. Additionally, it may shorten operating room time and limit overall costs.

An Analysis of Dental Implants Survival and Success

2018 ◽  
Vol 69 (9) ◽  
pp. 2465-2466
Author(s):  
Iustin Olariu ◽  
Roxana Radu ◽  
Teodora Olariu ◽  
Andrada Christine Serafim ◽  
Ramona Amina Popovici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Medical History ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Demographic Data ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

A guide to placement of parietooccipital ventricular catheters

1995 ◽  
Vol 82 (2) ◽  
pp. 300-304 ◽  
Author(s):  
Matthew A. Howard ◽  
Jayashree Srinivasan ◽  
Carl G. Bevering ◽  
H. Richard Winn ◽  
M. Sean Grady
Keyword(s):  
Ct Scanning ◽  
Catheter Placement ◽  
Target Point ◽  
Catheter Position ◽  
Content Type ◽  
Ventriculoperitoneal Shunting ◽  
Frontal Horn ◽  
Catheter Tip ◽  
Ventricular Catheters ◽  
Entire Procedure

✓ Accurate placement of parietooccipital ventricular catheters can be difficult and frustrating. To minimize the morbidity of the procedure and lengthen the duration of shunt function, the catheter tip should lie in the ipsilateral frontal horn. The authors describe a posterior ventricular guide (PVG) for placement of parietooccipital catheters that operates by mechanically coupling the posterior burr hole to the anterior target point. In a series of 38 patients who underwent ventriculoperitoneal shunting with the assistance of the guide, postoperative computerized tomography (CT) scanning revealed that 35 (92.0%) had accurate catheter placement. In comparison, a retrospective review of free-hand posterior catheter placement revealed good catheter position in only 22 of 43 patients (51.1%). The use of the guide added less than 5 minutes to the entire procedure, and there were no complications related to its use. The PVG is a simple and useful tool that aids in the placement of parietooccipital ventricular catheters.

scholarly journals Fuchs endothelial corneal dystrophy and small eyes

2020 ◽  
Vol 17 (1) ◽  
pp. 35-40
Author(s):  
Nicole Shao-Yuen Lim ◽  
John Males
Keyword(s):  
Cohort Study ◽  
Outcome Measures ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Strong Association ◽  
Corneal Thickness ◽  
Anterior Chamber Depth ◽  
Corneal Dystrophy ◽  
T Test ◽  
Corneal Decompensation

Aim: To determine whether there is an association between Fuchs endothelial corneal dystrophy (FECD) and shorter axial length (AL), shallower anterior chamber depth (ACD) and higher spherical equivalent (SE). In addition, to evaluate whether there is a correlation between AL and severity of corneal decompensation in FECD, using corneal thickness as a proxy. Design: Retrospective cohort study. Methods: This was a single-centre study conducted in a cornea clinic in Sydney, Australia. Detailed clinical measurements of 91 eyes of 50 FECD patients were compared with 110 eyes of 55 controls. Main outcome measures included AL, ACD and SE. Other outcome measures included central corneal thickness, visual acuity, intraocular pressure and keratometry. Results: Mean AL of FECD patients was 23.6 mm (standard deviation [SD] ±0.9 mm), compared with 24.7 mm (SD ±1.8 mm) for controls (1.1 mm difference [95% confidence interval [CI] 0.5-1.6], p < 0.001, independent sample t-test); corresponding means for ACD were 3.0 and 3.3 mm (0.32 mm difference [95%CI 0.2-0.5], p < 0.001, independent t-test). Eleven out of the 22 FECD patients with available refraction data had hypermetropic refraction compared with 16 out of 36 controls (p = 0.68, chi-squared test). The mean SE of FECD patients (+0.10D) was higher than controls (−1.33D) (1.4D difference [0.1-2.8], p = 0.04, independent t-test). No statistically significant correlation was found between AL and corneal thickness (p = 0.28, linear regression). Conclusion: In this retrospective cohort study, a strong association was established between FECD and small eyes, with shorter AL and shallower ACD, compared with controls. These results have important implications for surgical planning, as shorter AL and ACD in FECD patients likely contribute to their high risk of corneal decompensation following cataract surgery.

scholarly journals Incidence of Secondary Microorganism Infections Following Utilization of Tocilizumab for the Treatment of COVID‑19 - A Matched Retrospective Cohort Study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Joanna L. Moore ◽  
Stephanie J. Stroever ◽  
Patricia E. Rondain ◽  
Robyn N. Scatena
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secondary Infection ◽  
World Health ◽  
Quantitative Relation ◽  
Secondary Outcome ◽  
Healthcare Associated Infection ◽  
Kaplan Meier ◽  
Healthcare Associated

Introduction: immunological disorder agent’s area unit theorized to focus on the protein storm syndrome in COVID‑19. However, the downstream effects concerning susceptibilities to secondary infection risk stay unknown. This study seeks to work out risk variations for secondary infections among COVID‑19 patients World Health Organization did and failed to receive tocilizumab. Methods: we have a tendency to conducted a matched retrospective cohort study from 2 giants, acute care hospitals in Western Connecticut from March 1 to May 31, 2020. we have a tendency to collected variables exploitation manual case history abstraction. the first exposure variable was any dose of tocilizumab. the first outcome was any healthcare‑associated microorganism or mycosis as outlined by the National Care Safety Network. we have a tendency to performed a Kaplan–Meier analysis to assess the crude distinction within the additive likelihood of healthcare‑associated infection (HAI) across exposure teams. we have a tendency to conjointly performed a multivariable Cox multivariate analysis to work out the hazard quantitative relation for HAI by exposure group whereas dominant for potential confounders. Results: The Kaplan–Meier analysis incontestable no distinction within the additive likelihood of HAI across teams. The adjusted hazard of HAI for patients given tocilizumab was zero.85 times that of patients not given tocilizumab (95% confidence interval = zero.29, 2.52, P = 0.780) once dominant for relevant confounders. Conclusions: Tocilizumab failed to increase the incidence of secondary infection among COVID‑19 patients. Larger, irregular trials ought to valuate infection as a secondary outcome to validate this finding.

Abstract 201: Gemfibrozil In Combination With Statin Is Associated With Reduction In All Cause Mortality: A Retrospective Cohort Study

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Sudeep R Aryal ◽  
William Newman
Keyword(s):  
Coronary Artery ◽  
Retrospective Cohort ◽  
Bypass Graft ◽  
Outcome Variable ◽  
Combination Group ◽  
Proportional Hazard ◽  
Significant Group ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
All Cause Mortality

Objective: Statins and gemfibrozil as individual monotherapy have shown to reduce major cardiovascular events with statins alone reducing all cause mortality. However, it is uncertain whether the combination of statins with gemfibrozil is associated with further reduction in all cause mortality compared to mortality reduction by statins alone. We will examine the hypothesis that combination of gemfibrozil with statin is associated with greater reduction in all cause mortality compared to statin alone. Methods: We performed a retrospective cohort chart review of the VistA database between January 1, 2003 and January 1, 2013 at the Veterans Affairs Healthcare System in Fargo, North Dakota. All veterans greater than or equal to 18 years of age taking either the combination of statin and gemfibrozil or statin alone for a minimum of 12 months were included in the study. The subjects in either group were selected randomly from the pharmacy database, which divided the subjects into statin or combination group. The total sample size was 1800 with 900 subjects in each group. Our primary outcome variable was all cause mortality. The Kaplan Meier Survival curve was drawn for the combination group versus statin alone group. The adjustment for mortality covariates was by the Cox proportional hazard regression. Findings: Statin versus the combination group differed demographically by age (73 ± 11.5 vs 68 ± 11.8), BMI (29.9 ± 50 vs 31.7 ± 5.4), hypertension (72.1% vs 80.9%), diabetes mellitus (33.0% vs 47%), smoking (22% vs 28.2%) and stroke (8.3% vs 5.2%); all P<0.01. The two groups were similar for myocardial infarction, transient ischemic attack, peripheral vascular disease, coronary artery disease, and coronary artery bypass graft outcomes. The all cause mortality difference was 10.2% between statin and the combination group at 10 years (25% vs 14.8%, P<0.0001). The unadjusted Kaplan-Meier analysis over 10 years subsequent to lipid therapy initiation showed a highly significant group difference. Cox proportional hazard adjustment for age, BMI, hypertension, and diabetes revealed persistence of the group difference (P <0.0001). Conclusion: Combination of gemfibrozil with statin is associated with greater reduction in all cause mortality compared to statins alone. Keywords: gemfibrozil, mortality

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