EXTERNAL VENTRICULAR DRAIN INSERTION ACCURACY

Neurosurgery ◽  
2009 ◽  
Vol 65 (6) ◽  
pp. 1197-1201 ◽  
Author(s):  
Ahmed K. Toma ◽  
Sophie Camp ◽  
Laurence D. Watkins ◽  
Joan Grieve ◽  
Neil D. Kitchen
Keyword(s):  
Lateral Ventricle ◽  
External Ventricular Drain ◽  
Third Ventricle ◽  
Length Of Hospital Stay ◽  
Brain Parenchyma ◽  
The Body ◽  
Neurosurgical Procedure ◽  
Computed Tomographic ◽  
Frontal Horn ◽  
The Brain

Abstract OBJECTIVE Free-hand insertion of an external ventricular drain (EVD) is a common emergency neurosurgical procedure, mostly performed for critically ill patients. Although EVD complications have been studied thoroughly, the accuracy of EVD positioning has been audited only occasionally. METHODS Post-EVD insertion computed tomographic scans performed in our unit over a 2-year period were analyzed for EVD tip location and intracranial catheter length. RESULTS A total of 183 post-EVD insertion scans were reviewed. Of those, 73 EVD tips (39.9%) were in the ipsilateral frontal horn of the lateral ventricle (the desired target); of those, 18 (25%) required EVD revision/reinsertion. Of the others, 35 (19.1%) were in the third ventricle, 33 (18%) in the body of the lateral ventricle, 19 (10.4%) in the subarachnoid space, 5 (2.7%) in the contralateral frontal horn, and 18 (9.8%) within the brain parenchyma. When the EVD tip was outside the desired target, 44 of the patients (40%) required EVD revision/reinsertion procedure (P = 0.0383). CONCLUSION Free-hand insertion of an EVD is an inaccurate procedure, and further studies are required to assess the accuracy and feasibility of the routine use of neuronavigation, ultrasonography, or other guidance techniques and the possible implication of the decreasing revision rate, complications, and length of hospital stay.

Experimental Third Ventriculostomy Performed Using Endovascular Surgical Techniques and Their Adaptation to Percutaneous Intradural Neuronavigation: Proof of Concept Cadaver Study

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 387-392 ◽  
Author(s):  
Michael B. Horowitz ◽  
Kamal Ramzipoor ◽  
Ajit Nair ◽  
Susan Miller ◽  
George Rappard ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Surgical Techniques ◽  
Cadaver Study ◽  
Brain Parenchyma ◽  
Third Ventriculostomy ◽  
General Anesthetic ◽  
The Third ◽  
Noncommunicating Hydrocephalus ◽  
Pass Through ◽  
The Brain

Abstract OBJECTIVE Endoscopic third ventriculostomy has developed into a therapeutic alternative to shunting for the management of carefully selected patients with primarily noncommunicating hydrocephalus. This procedure, however, requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation near vital neural structures to access the floor of the third ventricle. Using two cadavers and off-the-shelf angiographic catheters, we sought to determine whether it was possible to navigate a catheter, angioplasty balloon, and stent percutaneously through the subarachnoid space from the thecal sac into the third ventricle so as to perform a third ventriculostomy from below. METHODS Using biplane angiography and off-the-shelf angiographic catheters along with angioplasty balloons and stents, we were able to pass a stent coaxially from the thecal sac to and across the floor of the third ventricle so as to achieve a third ventriculostomy from below. RESULTS Coaxial catheter techniques allowed for the percutaneous insertion of a stent across the floor of the third ventricle. Ventriculostomy was confirmed by injecting contrast medium into the lateral ventricle and seeing it pass through the stent and into the chiasmatic cistern. CONCLUSION We describe the performance of third ventriculostomies in two cadavers by use of the new concept of percutaneous intradural neuronavigation. This procedure may obviate the need for general anesthetic and minimize the potential for brain and vascular injury, especially if ultimately combined with magnetic resonance fluoroscopy.

scholarly journals Cilia-driven flows in the brain third ventricle

2019 ◽  
Vol 375 (1792) ◽  
pp. 20190154 ◽  
Author(s):  
Gregor Eichele ◽  
Eberhard Bodenschatz ◽  
Zuzana Ditte ◽  
Ann-Kathrin Günther ◽  
Shoba Kapoor ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Biochemical Properties ◽  
Brain Parenchyma ◽  
Ventricular Wall ◽  
Brain Ventricles ◽  
Cellular Targets ◽  
Signalling Molecules ◽  
The Third ◽  
Directional Transport ◽  
The Brain

The brain ventricles are interconnected, elaborate cavities that traverse the brain. They are filled with cerebrospinal fluid (CSF) that is, to a large part, produced by the choroid plexus, a secretory epithelium that reaches into the ventricles. CSF is rich in cytokines, growth factors and extracellular vesicles that glide along the walls of ventricles, powered by bundles of motile cilia that coat the ventricular wall. We review the cellular and biochemical properties of the ventral part of the third ventricle that is surrounded by the hypothalamus. In particular, we consider the recently discovered intricate network of cilia-driven flows that characterize this ventricle and discuss the potential physiological significance of this flow for the directional transport of CSF signals to cellular targets located either within the third ventricle or in the adjacent hypothalamic brain parenchyma. Cilia-driven streams of signalling molecules offer an exciting perspective on how fluid-borne signals are dynamically transmitted in the brain. This article is part of the Theo Murphy meeting issue ‘Unity and diversity of cilia in locomotion and transport’.

scholarly journals Immune cells and CNS physiology: Microglia and beyond

2018 ◽  
Vol 216 (1) ◽  
pp. 60-70 ◽  
Author(s):  
Geoffrey T. Norris ◽  
Jonathan Kipnis
Keyword(s):  
Central Nervous System ◽  
Immune Cells ◽  
Brain Function ◽  
Brain Parenchyma ◽  
The Body ◽  
Immune Repertoire ◽  
Perivascular Macrophages ◽  
The Central Nervous System ◽  
Cns Immunity ◽  
The Brain

Recent advances have directed our knowledge of the immune system from a narrative of “self” versus “nonself” to one in which immune function is critical for homeostasis of organs throughout the body. This is also the case with respect to the central nervous system (CNS). CNS immunity exists in a segregated state, with a marked partition occurring between the brain parenchyma and meningeal spaces. While the brain parenchyma is patrolled by perivascular macrophages and microglia, the meningeal spaces are supplied with a diverse immune repertoire. In this review, we posit that such partition allows for neuro–immune crosstalk to be properly tuned. Convention may imply that meningeal immunity is an ominous threat to brain function; however, recent studies have shown that its presence may instead be a steady hand directing the CNS to optimal performance.

Treatment Model of CNS Lymphoma Using Complement-Dependent Cytotoxicity Induced by Rituximab and Autoserum.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3739-3739
Author(s):  
Yasuyuki Miyake ◽  
Yasushi Okoshi ◽  
Takayuki Machino ◽  
Shigeru Chiba
Keyword(s):  
Lateral Ventricle ◽  
Raji Cell ◽  
Technical Problem ◽  
Brain Parenchyma ◽  
Autologous Serum ◽  
Ependymal Cells ◽  
Treatment Model ◽  
Complement Dependent Cytotoxicity ◽  
The Brain

Abstract Abstract 3739 Poster Board III-675 Background Primary central nervous system lymphoma (PCNSL) is almost exclusively CD20-positive non-Hodgkin lymphoma (NHL). Although rituximab (R) is widely used for CD20-positive NHL, it is not considered to reach brain lesions effectively beyond the blood brain barrier. Intraventricule administration (ivt) of R is reported to be effective in meningeal lymphoma but the effect on lesions in the brain parenchyma seems to be limited. Recently, a case of refractory PCNSL that was successfully treated with ivt of R with autologous serum was reported (Takami A, et al. Cancer Science, 2006). Because the cerebrospinal fluid does not contain complements which exists in the serum, induction of complement-dependent cytotoxicity by ivt of R plus autoserum was speculated. To investigate this effect, we developed an animal treatment model of CNSL. Materials and methods Raji, CD20-positive Burkitt lymphoma cell line, was inoculated into the deep frontal lobe of the brain of 8-week old F344 (nru-/nru-) nude rats, using brain stereotaxic apparatus. At the same time, a cannula was placed into the ipsilateral lateral ventricle. After several days, R or control immunoglobulin (cIg), plus human serum or saline, was administrated into the lateral ventricle. Results The brain was extracted 24 hours after the last administration and frozen section was made. Human CD20-positive Raji cell tumor was also positively stained with FITC-conjugated anti-human IgG antibody when R but not cIg was administrated. Consequently, R in the lateral ventricle was considered to penetrate ependymal cells and brain parenchyma, and bound to lymphoma cells. Next, these rats were treated with ivt of R plus serum (R + Serum), cIg plus serum (cIg + Serum), or R plus saline (R + saline). These were administrated once a day from day 5 to day 9 after inoculation of Raji, and then survival was monitored. When an obvious weakness, such as marked and consecutively loss of activity or weight, was observed, these rats were euthanized and this is defined as dead day. In each case, the brain was extirpated and examined whether lymphoma existed or not. Death without lymphoma or from technical problem was excluded from the analysis. Survival of each group was analyzed by Kaplan-Meier method and log-lank test. R + Serum group had longer survival than cIg + Serum (p = 0.049). Long-term survivors were only seen in R + Serum and this group seemed to be superior to R + saline but statistical difference was not detected (p = 0.083). There were no difference between cIg + Serum and R + saline (p =0.382) and neither group had long-term survivor. Conclusion The possibility of novel treatment of CNSL with ivt of R and autoserum was shown in the rat CNSL model. To confirm this approach, clinical trials are warranted. Disclosures: No relevant conflicts of interest to declare.

scholarly journals MORPHOMETRIC CHARACTERISTICS OF THE VENTRICULAR BRAIN SYSTEMS IN THE ELDERLY AGE

2020 ◽  
Vol 19 (4) ◽  
pp. 15-19
Author(s):  
O. Slobodian ◽  
V. Kryvetskyi ◽  
T. Khmara
Keyword(s):  
Magnetic Resonance ◽  
Human Brain ◽  
Lateral Ventricle ◽  
Hemispheric Asymmetry ◽  
Ventricular System ◽  
The Body ◽  
Elderly Persons ◽  
The Right ◽  
The Brain ◽  
Anterior Posterior

The introduction into medical practice of new methods of neuroimaging - computed and magnetic resonance imaging, has changed the principles of diagnosing morphological changes in the brain and opened up new horizons in the study of its structure. The literature sources provide conflicting and fragmentary data on the anatomical features and morphometric parameters of the parts of the brain, and especially its ventricular system, at different age periods of a person's life. The human brain is characterized by significant age-sex anatomical variability. It differs in men and women in different races, ethnic groups. Signs of difference persist from generation to generation and can be an important characteristic of the variability of the human brain as a species. However, the sex and age features of the structure of the cerebral ventricles, taking into account their individual anatomical variability, have not been sufficiently studied. During morphometric study of magnetic resonance tomograms a comprehensive in vivo characteristic of the cerebral ventricular system in elderly persons is presented. Gender peculiarities and inter-hemispheric asymmetry of relevant indicators are studied. The examinations were conducted in standard anatomical planes (sagittal, frontal and axial) in people with no visual signs of organic lesions of the brain and skull. 38 tomograms of elderly patients were analyzed 38 (14 men and 24 women). 13 indicators of the liquor system of the brain were studied and a significant increase of the following parameters were found in males: the length of the anterior horn of the right lateral ventricle, the length and width of the central part of the lateral ventricle both on the right and left, the length of the lower horn of the lateral ventricle on the left and right, and anterior-posterior size of the lateral ventricle on the right and left. Some of the parameters studied possessed reliable inter-hemispheric asymmetry, namely, in men on the left: the body width of the lateral ventricle, the length and width of the posterior horn of the lateral ventricle, anterior-posterior size of the lateral ventricle; in women – the length of the lower horn of the lateral ventricle on the right.

scholarly journals Cerebral equine hydatidosis in Southern Brazil

1997 ◽  
Vol 27 (2) ◽  
pp. 341-344 ◽  
Author(s):  
Jerônimo Lopes Ruas ◽  
Ana Lucia Schild ◽  
Cristina Gevehr Fernandes ◽  
João Luiz Montiel Ferreira ◽  
Gertrud Müller
Keyword(s):  
Lateral Ventricle ◽  
Third Ventricle ◽  
Brain Lesion ◽  
Clinical Signs ◽  
Occipital Lobe ◽  
Southern Brazil ◽  
The Third ◽  
Morphometric Features ◽  
The Brain ◽  
Gross Examination

Equine cerebral hydatid disease is described in a 7-year-old, crossbred, female horse. Clinical signs were characterized by circling gait, pressing of head against fences or objects and motor incoordination. On gross examination of the brain the hemispheres were swollen, mainly the left one. On transversal sections, a 5cm X 7cm fluid-filled cyst was observed within the lateral ventricle of the left hemisphere. The cyst extended from the parietal to the occipital lobe, and compressed the third ventricle. There was also marked mid line deviation. Histologically, the brain lesion adjacent to the cyst, was characterized by a piogranulomatous process and vacuolization of neuropil. A diagnosis of equine hydatidosis caused by Echinococcus granulosus was made on the basis of the morphometric features of protoscolices hooks.

scholarly journals Rare Case of Young Patient with Intraventricular Angiomatous Meningioma

2021 ◽  
pp. 19-25
Author(s):  
Gabriel Carvalho Heemann ◽  
Vinicius Rosa de Castro ◽  
Normando Guedes Pereira Neto ◽  
Camila Bocchi ◽  
Otavio Garcia Martins ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Lateral Ventricle ◽  
The Body ◽  
Neurological Sequela ◽  
Transcallosal Approach ◽  
Frontal Horn ◽  
Intraventricular Tumors ◽  
The Right ◽  
Clinical Stability

Pediatric meningiomas are rare and account for only 2.2% of CNS tumors. In this age group, they are more frequently located in atypical sites, such as, mainly, the ventricular system, with a frequency of 8.8 to 13.6%. Adding this to the fact that the angiomatous subtype constitutes only 2.1% of all meningiomas, the rarity of the case reported here i s corroborated. We report a 17-year-old female patient diagnosed with intraventricular angiomatous meningioma; she underwent surgical resection of the tumor in the body and frontal horn of the right lateral ventricle, and there was no neurological sequela. With a follow-up of 4 years, there was no recurrence and the patient had clinical stability. Intraventricular tumors usually have slow growth and reach considerable size until they cause symptoms and then are diagnosed. In addition, the tumor’s deep location and proximity to eloquent areas make such tumors an neurosurgical challenge. The angiomatous subtype, due to the presence of hypervascularization (consisting of more than 50% of vascular components), may, in some cases, hinder surgical resection as well as be erroneously diagnosed. However, surgical treatment aimed at total resection of the lesion remains the conduct of choice in the case reported here, especially in patients in the first two decades of life, in which the use of radiation is avoided. Specifically when it comes to the surgery, we chose a transcallosal approach that allows a good transoperative visualization of the lesion when located in the body and frontal horn of the lateral ventricle.

scholarly journals A simple and cost-effective model for ventricular catheter placement training: technical note

2020 ◽  
pp. 1-4
Author(s):  
Nathan Todnem ◽  
Khoi D. Nguyen ◽  
Vamsi Reddy ◽  
Dayton Grogan ◽  
Taylor Waitt ◽  
...  
Keyword(s):  
Medical Students ◽  
External Ventricular Drain ◽  
Test Group ◽  
Cost Effective ◽  
Ventricular System ◽  
Catheter Placement ◽  
Ventricular Catheter ◽  
Frontal Horn ◽  
Ventricular Catheters ◽  
The Brain

OBJECTIVEExternal ventricular drain (EVD) placement is one of first cranial procedures neurosurgery residents are expected to perform independently. While proper training improves patient outcomes, there are few options for practicing EVD placement prior to placing the EVD in patients in a clinical setting. Proposed solutions to this include using cadaveric models and virtual simulations, but barriers exist with these as well in regard to authenticity. EVD simulators using virtual reality technologies are a promising new technique for training, but the cost of these devices poses a barrier to general/widespread accessibility among smaller programs or underserved hospitals. The authors desribe a novel, yet simple, and cost-effective technique (less than $5 per mold) for developing a brain model constructed of homemade ballistics gelatin that can be used for teaching and practicing the placement of EVD.METHODSA brain model is made with ballistics gelatin using an anatomically correct skull model as a mold. A 3D-printed ventricular system model is used to create a mold of an anatomically correct ventricular system in the brain model. A group of medical students (n = 10) were given a basic presentation about EVD placement, including standard landmarks and placement techniques, and were also shown a demonstration of EVD placement on the brain model. They were then allowed to perform an EVD placement using the brain model. The students were surveyed on their experience with using the brain model, including usability and practicality of the model. Accuracy of EVD placement by each student was also assessed, with adequate position of catheter tip being in the ipsilateral frontal horn.RESULTSThe final product is fairly inexpensive and easy to make. It is soft enough to pass a catheter through, but it is also firm enough to maintain its shape, including a cavity representing the lateral ventricles. The dense gelatin holds the catheter in its final resting position, while the two halves are separated and inspected. All participants in the test group of medical students reported that the brain model was easy to use, helped them understand the steps and technique of EVD placement, and provided good feedback on the ideal position of ventricular catheters. All of the participants in the group had adequate positioning of their ventricular catheters after one attempt.CONCLUSIONSThe presented brain model is easy to replicate, inexpensive, anatomically accurate, and provides a medium for neurosurgeons to teach and practice ventricular catheter placement in a risk-free environment.

Quantitative anatomical comparison of the ipsilateral and contralateral interhemispheric transcallosal approaches to the lateral ventricle

2018 ◽  
Vol 128 (5) ◽  
pp. 1492-1502 ◽  
Author(s):  
Evgenii Belykh ◽  
Kaan Yağmurlu ◽  
Ting Lei ◽  
Sam Safavi-Abbasi ◽  
Mark E. Oppenlander ◽  
...  
Keyword(s):  
Navigation System ◽  
Lateral Ventricle ◽  
Third Ventricle ◽  
Lateral Wall ◽  
Head Region ◽  
Foramen Of Monro ◽  
Transcallosal Approach ◽  
Caudate Head ◽  
Contralateral Approach ◽  
Frontal Horn

OBJECTIVEThe best approach to deep-seated lateral and third ventricle lesions is a function of lesion characteristics, location, and relationship to the ventricles. The authors sought to examine and compare angles of attack and surgical freedom of anterior ipsilateral and contralateral interhemispheric transcallosal approaches to the frontal horn of the lateral ventricle using human cadaveric head dissections. Illustrative clinical experiences with a contralateral interhemispheric transcallosal approach and an anterior interhemispheric transcallosal transchoroidal approach are also related.METHODSFive formalin-fixed human cadaveric heads (10 sides) were examined microsurgically. CT and MRI scans obtained before dissection were uploaded and fused into the navigation system. The authors performed contralateral and ipsilateral transcallosal approaches to the lateral ventricle. Using the navigation system, they measured areas of exposure, surgical freedom, angles of attack, and angle of view to the surgical surface. Two clinical cases are described.RESULTSThe exposed areas of the ipsilateral (mean [± SD] 313.8 ± 85.0 mm2) and contralateral (344 ± 87.73 mm2) interhemispheric approaches were not significantly different (p = 0.12). Surgical freedom and vertical angles of attack were significantly larger for the contralateral approach to the most midsuperior reachable point (p = 0.02 and p = 0.01, respectively) and to the posterosuperior (p = 0.02 and p = 0.04) and central (p = 0.04 and p = 0.02) regions of the lateral wall of the lateral ventricle. Surgical freedom and vertical angles of attack to central and anterior points on the floor of the lateral ventricle did not differ significantly with approach. The angle to the surface of the caudate head region was less steep for the contralateral (135.6° ± 15.6°) than for the ipsilateral (152.0° ± 13.6°) approach (p = 0.02).CONCLUSIONSThe anterior contralateral interhemispheric transcallosal approach provided a more expansive exposure to the lower two-thirds of the lateral ventricle and striothalamocapsular region. In normal-sized ventricles, the foramen of Monro and the choroidal fissure were better visualized through the lateral ventricle ipsilateral to the craniotomy than through the contralateral approach.

Supratentorial Arachnoid Cyst Located in the Brain Parenchyma: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. E258-E262 ◽  
Author(s):  
Kyung-Jae. Park ◽  
Shin-Hyuk. Kang ◽  
Yang-Seok. Chae ◽  
Yong-Gu. Chung
Keyword(s):  
Frontal Lobe ◽  
Arachnoid Cyst ◽  
Clinical Presentation ◽  
Brain Parenchyma ◽  
Cystic Mass ◽  
Clear Fluid ◽  
Computed Tomographic ◽  
History Of ◽  
The Right ◽  
The Brain

abstract BACKGROUND AND IMPORTANCE: Arachnoid cysts have not been reported to be located within the brain parenchyma. We present a case of an arachnoid cyst that was contained entirely within the right frontal lobe devoid of communication with the subarachnoid space and ventricle. CLINICAL PRESENTATION: A 65-year-old woman presented with a 1-year history of progressive headache and nausea. Computed tomographic and magnetic resonance imagining scans showed a well-defined, nonenhancing mass measuring 5 × 5 × 3.5 cm in the right frontal lobe. The mass appeared to be contained entirely within the brain parenchyma. The patient underwent a right frontal craniotomy, at which time the cystic mass was identified in the brain parenchyma without any communication with the arachnoid space. The cyst contained a clear fluid, and its wall was excised. The fluid contents demonstrated a composition similar to that of normal cerebrospinal fluid. Histological and immunohistochemical examinations of the cyst wall were compatible with the diagnosis of an arachnoid cyst. Postoperatively, the symptoms of the patient resolved, and no recurrence was observed up to 6 months after removal. CONCLUSION: The present case showed an intraparenchymal arachnoid cyst arising in the frontal lobe. Although the etiology is not known, an arachnoid cyst should be included in the differential diagnosis of primary intracerebral cysts.

Sign in / Sign up

Export Citation Format

Share Document