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.

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.

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.

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.

Anaplastic hemangiopericytoma in the frontal horn of the lateral ventricle

2016 ◽  
Vol 26 ◽  
pp. 147-149 ◽  
Author(s):  
K.S. Avinash ◽  
Sumit Thakar ◽  
Nandita Ghosal ◽  
A.S. Hegde
Keyword(s):  
Lateral Ventricle ◽  
Frontal Horn

Orbital cortical approach to lesions around the frontal horn of the lateral ventricle: indication and surgical parameters

2014 ◽  
Vol 156 (4) ◽  
pp. 825-830 ◽  
Author(s):  
Atul Goel ◽  
Abhidha Shah ◽  
Raghvendra Ramdasi ◽  
Neeraj Patni
Keyword(s):  
Lateral Ventricle ◽  
Frontal Horn

Neuroendoscopic Navigated One-Step Removal of Crossed Ventricular Catheter Fragments: Technical Note

2021 ◽  
Author(s):  
Alessandro Calì ◽  
Gianluca Scalia ◽  
Salvatore Marrone ◽  
Carmelo Riolo ◽  
Giuseppe Vasta ◽  
...  
Keyword(s):  
Lateral Ventricle ◽  
Convective Flow ◽  
Congenital Hydrocephalus ◽  
Distal Catheter ◽  
Wide Range ◽  
Catheter Tip ◽  
History Of ◽  
One Step ◽  
The Right ◽  
Occipital Horn

Abstract Introduction Neuroendoscopy plays an important role in minimally invasive neurosurgery. The authors reported an interesting case of a pediatric patient with multiple ventriculoperitoneal shunt (VPS) revision surgeries, presenting with VPS infection and with two crossed intraventricular floating catheter fragments, successfully removed through a neuroendoscopic navigated one-step procedure. A literature review regarding this exceedingly rare condition has also been discussed. Case Description An 11-year-old female patient with a history of congenital hydrocephalus was admitted to the emergency department with symptoms of intracranial hypertension, psychomotor agitation, and tetraparesis. She had a history of previous multiple VPS revisions. She had an urgent brain computed tomography scan that documented hydrocephalus; the VPS's intraventricular catheter tip was sited at the level of the right frontal horn. Two small floating catheter fragments, not connected to the VPS, were identified: the first close to the right lateral ventricle at the level of the right occipital horn, the second one between the right occipital horn and the third ventricle. First, she underwent an exteriorization of the distal catheter for VPS. Cerebrospinal fluid examination documented hyperproteinorrachia and a positive culture for Staphylococcus aureus. Then a navigated right transfrontal endoscopic approach to the right lateral ventricle was performed extending to the previous burr hole and achieving a wide range of working angle with a rigid 0-degree lens endoscope. Intermittent irrigation generating convective flow was performed such as to mobilize the catheters tip gently upward, to remove them by grasping. Finally, a whole VPS replacement has been performed. Conclusion Persistence of intraventricular floating catheter fragments can lead to subacute or chronic infections. Neuroendoscopic retrieval represents a safe and effective alternative to a more extensive and invasive surgical approach. However, the exact catheter tip identification, grasping, and removal can be difficult to achieve, due to the technical instrumentation characteristics and altered intraventricular anatomy in chronic congenital hydrocephalus. In our experience, endoscopic convective flow induction through saline irrigation can determine floating intraventricular catheter fragments movement aiming to their identification and subsequent successful endoscopic retrieval.

Intraoperative Ventricular Puncture

Neurosurgery ◽  
1988 ◽  
Vol 22 (6P1-P2) ◽  
pp. 1107-1109 ◽  
Author(s):  
Jonathan T. Paine ◽  
H. Hunt Batjer ◽  
Duke Samson
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
Lateral Ventricle ◽  
Simple Technique ◽  
Acute Hydrocephalus ◽  
Frontal Horn ◽  
Brain Relaxation ◽  
Ventricular Puncture ◽  
Brain Retraction ◽  
Basal Cisterns

Abstract Modem neuroanesthetic techniques frequently provide the neurosurgeon with adequate brain relaxation for an atraumatic frontotemporal or transylvian dissection. Circumstances such as recent subarachnoid hemorrhage with brain edema and acute hydrocephalus can mandate significant frontal lobe retraction before access to cerebrospinal fluid (CSF) drainage from the basal cisterns is gained. A simple technique can give the “early” aneurysm surgeon reliable access to the frontal horn of the lateral ventricle for intraoperative drainage of CSF before brain retraction.

Aneurysm of the distal anterior cerebral artery radiologically mimicking a ventricular mass

2011 ◽  
Vol 114 (4) ◽  
pp. 1061-1064 ◽  
Author(s):  
A. Metin Şanlι ◽  
Saruhan Çekirge ◽  
Zeki Şekerci
Keyword(s):  
Cerebral Artery ◽  
Lateral Ventricle ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Ventricular Mass ◽  
Frontal Horn ◽  
Major Branch ◽  
The Right ◽  
Distal Anterior Cerebral Artery ◽  
Cerebral Artery Aneurysm

The ventricular system is a rare localization for intracranial aneurysms. Most ventricular aneurysms arise from a distal branch of the choroidal arteries and a major branch point of the circle of Willis. A 41-year-old-man suffering from dizziness of 2 weeks' duration was admitted to the clinic. On radiological examination, he had a well-circumscribed mass involving the frontal horn of the right lateral ventricle without radiological evidence of a prior or recent hemorrhage. Localization and radiological appearance were not typical of a ventricular mass and did not allow diagnosis. After cerebral angiography, an aneurysm arising from the distal anterior cerebral artery was incidentally found in an intraventricular location. This unruptured aneurysm was successfully treated via the endovascular route. The authors describe the unusual case of a distal anterior cerebral artery aneurysm with a dome extending into the right lateral ventricle, which appears to be the first such case in the literature. Angiography may be helpful to neurosurgeons in avoiding the disastrous complications of a biopsy procedure in such unusual cases.

MR Appearance of Central Neurocytoma

1993 ◽  
Vol 34 (5) ◽  
pp. 520-526 ◽  
Author(s):  
K. H. Chang ◽  
M. H. Han ◽  
D. G. Kim ◽  
J. G. Chi ◽  
D. C. Suh ◽  
...  
Keyword(s):  
Lateral Ventricle ◽  
Anterior Part ◽  
Pulse Sequences ◽  
Central Neurocytoma ◽  
Mr Images ◽  
3Rd Ventricle ◽  
Signal Void ◽  
Overall Evaluation ◽  
Immunohistochemical Studies ◽  
Tumor Extent

To provide a detailed description of the MR appearances of central neurocytoma, MR images of 13 patients with central neurocytoma were retrospectively reviewed and compared with CT examinations. The histology was confirmed by ultrastructural and immunohistochemical studies. In 12 patients the tumors were histologically benign and located in the anterior part of the lateral ventricle, 6 of which extended to the 3rd ventricle. There was one case of a histologically malignant variant involving the thalamus and lateral ventricle. The tumors were primarily solid, but contained cysts (85%, 11/13), calcifications (69%, 9/13), and signal void from tumor vessels (62%, 8/13), frequently producing heterogeneous signal intensity on both T1- and T2-weighted images. Most of the solid portion appeared isointense or slightly hyperintense relative to the cerebral cortex on all MR pulse sequences. Calcifications were iso- or hypointense on MR, making them difficult to characterize with MR alone. Intratumoral hemorrhage was seen in 2 patients on MR but not on CT. Contrast enhancement was variable in degree and pattern. Coronal and sagittal MR images were valuable in evaluating the tumor extent and origin site, and in planning the surgical approach. It is concluded that MR imaging appears to be more useful than CT in the overall evaluation of central neurocytoma, even though calcification is better characterized with CT.

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