A guide for ventricular catheter placement

1985 ◽  
Vol 63 (6) ◽  
pp. 985-986 ◽  
Author(s):  
Jamshid B. G. Ghajar
Keyword(s):  
Ventricular System ◽  
Catheter Placement ◽  
Ventricular Catheter ◽  
Content Type ◽  
Fine Print

✓ The author describes a device designed to guide a catheter into the anterior ventricular system.

Efficacy of the Ghajar Guide revisited: a prospective study

2000 ◽  
Vol 92 (5) ◽  
pp. 801-803 ◽  
Author(s):  
Shaun T. O'Leary ◽  
Max K. Kole ◽  
Devon A. Hoover ◽  
Steven E. Hysell ◽  
Ajith Thomas ◽  
...  
Keyword(s):  
Catheter Placement ◽  
Target Point ◽  
Ventricular Catheter ◽  
Foramen Of Monro ◽  
Content Type ◽  
Successful Cannulation ◽  
Tunnel Technique ◽  
Catheter Tip ◽  
A Prospective Study ◽  
Fine Print

Object. The goal of this study was to compare the freehand technique of catheter placement using external landmarks with the technique of using the Ghajar Guide for this procedure. The placement of a ventricular catheter can be a lifesaving procedure, and it is commonly performed by all neurosurgeons. Various methods have been described to cannulate the ventricular system, including the modified Friedman tunnel technique in which a soft polymeric tube is inserted through a burr hole. Paramore, et al., have noted that two thirds of noninfectious complications have been related to incorrect positioning of the catheter.Methods. Forty-nine consecutive patients were randomized between either freehand or Ghajar Guide—assisted catheter placement. The target was the foramen of Monro, and the course was through the anterior horn of the lateral ventricle approximately 10 cm above the nasion, 3 cm from the midline, to a depth of 5.5 cm from the inner table of the skull. In all cases, the number of passes was recorded for successful cannulation, and pre- and postplacement computerized tomography scans were obtained. Calculations were performed to determine the bicaudate index and the distance from the catheter tip to the target point.Conclusions. Successful cannulation was achieved using either technique; however, the catheters placed using the Ghajar Guide were closer to the target.

Accurate placement of coronal ventricular catheter using stereotactic coordinate-guided free-hand passage

1994 ◽  
Vol 80 (4) ◽  
pp. 750-755 ◽  
Author(s):  
Dachling Pang ◽  
Paul A. Grabb
Keyword(s):  
Choroid Plexus ◽  
Catheter Placement ◽  
Ventricular Catheter ◽  
Catheter Position ◽  
Foramen Of Monro ◽  
Shunt Insertion ◽  
Content Type ◽  
Surface Anatomy ◽  
Skull Radiographs ◽  
Fine Print

✓ Long-term patency of the ventricular catheter of a cerebrospinal fluid shunt depends on the positioning of the hole-bearing segment of the catheter. Placement of this segment near the choroid plexus or injured ependyma increases the probability of obstruction. Proper positioning for a coronal shunt in turn depends on the ventricular catheter length and target coordinates. The authors describe a method of calculating the catheter length based on bone landmarks on skull radiographs, and a technique for accurate ventricular catheter placement using free-hand passage guided by simple stereotactic coordinates based on visible and palpable surface anatomy. The insertion trajectory is aligned with the coronal obliquity of the lateral ventricle so that, even with slit ventricles, the entire hole-bearing segment of the catheter can be reliably situated within the anterior horn. The predetermined catheter length also fixes the tip at the foramen of Monro, away from the choroid plexus and injured ependyma. Of 160 children undergoing ventriculoperitoneal shunt insertion using this technique, only three required catheter revision during a mean follow-up period of 39 months. Radiographic grading of the ventricular catheter position in 112 children showed a satisfactory placement rate of 93.2%; all three children with occlusion showed poor catheter positioning. Thus, this method results in accurate ventricular catheter placement with a 1.9% obstruction rate, which compares favorably to the 16% to 18% incidence of proximal obstruction reported in the literature. This technique is applicable to patients of all ages but is particularly suitable for children because of the greater variability in head size.

A clinical comparison of subdural screw pressure measurements with ventricular pressure

1983 ◽  
Vol 58 (1) ◽  
pp. 45-50 ◽  
Author(s):  
A. David Mendelow ◽  
John O. Rowan ◽  
Lilian Murray ◽  
Audrey E. Kerr
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Severe Head Injury ◽  
Fluid Pressure ◽  
Ventricular Catheter ◽  
Pressure Measurements ◽  
Content Type ◽  
Single Lumen ◽  
Ventricular Fluid Pressure ◽  
Fine Print

✓ Simultaneous recordings of intracranial pressure (ICP) from a single-lumen subdural screw and a ventricular catheter were compared in 10 patients with severe head injury. Forty-one percent of the readings corresponded within the same 10 mm Hg ranges, while 13% of the screw pressure measurements were higher and 46% were lower than the associated ventricular catheter measurements. In 10 other patients, also with severe head injury, pressure measurements obtained with the Leeds-type screw were similarly compared with ventricular fluid pressure. Fifty-eight percent of the dual pressure readings corresponded, while 15% of the screw measurements were higher and 27% were lower than the ventricular fluid pressure, within 10-mm Hg ranges. It is concluded that subdural screws may give unreliable results, particularly by underestimating the occurrence of high ICP.

Contribution of CSF and vascular factors to elevation of ICP in severely head-injured patients

1987 ◽  
Vol 66 (6) ◽  
pp. 883-890 ◽  
Author(s):  
Anthony Marmarou ◽  
Angelo L. Maset ◽  
John D. Ward ◽  
Sung Choi ◽  
Danny Brooks ◽  
...  
Keyword(s):  
Severe Head Injury ◽  
Ventricular Catheter ◽  
Outflow Resistance ◽  
Content Type ◽  
Relative Contribution ◽  
Temporal Course ◽  
Head Injured ◽  
Predominant Factor ◽  
Injured Patients ◽  
Fine Print

✓ The authors studied the relative contribution of cerebrospinal fluid (CSF) and vascular parameters to the level of intracranial pressure (ICP) in 34 severely head-injured patients with a Glasgow Coma Scale score of less than 8. This was accomplished by first characterizing the temporal course of CSF formation and outflow resistance during the 5-day period postinjury. The CSF formation and outflow resistance were obtained from pressure responses to bolus addition and removal of fluid from an indwelling ventricular catheter. The vascular contribution to the level of ICP was assessed by withdrawing fluid at its rate of formation and observing the resultant change in equilibrium ICP level. It was found that, with the exception of patients with subarachnoid hemorrhage, CSF parameters accounted for approximately one-third of the ICP rise after severe head injury, and that a vascular mechanism may be the predominant factor in elevation of ICP.

Management of proximal shunt obstruction

1988 ◽  
Vol 68 (5) ◽  
pp. 817-819 ◽  
Author(s):  
Charles C. Duncan
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Intracranial Pressure ◽  
Signs And Symptoms ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Content Type ◽  
Cerebrospinal Fluid Flow ◽  
Shunt Obstruction ◽  
Fine Print

✓ Proximal shunt obstruction or obstruction of the ventricular catheter may present with signs and symptoms of shunt failure with either no cerebrospinal fluid flow or a falsely low intracranial pressure (ICP) upon shunt tap. The author reports a technique for lowering the ICP and for measuring the pressure in patients with such obstruction by cannulation of the reservoir and ventricular catheter to penetrate into the ventricle with a 3½-in. No. 22 spinal needle. The findings in 20 cases in which this approach was utilized are summarized.

Ventricular perfusion in cats with kaolin-induced hydrocephalus

1974 ◽  
Vol 41 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Howard M. Eisenberg ◽  
James E. McLennan ◽  
Keasley Welch
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Space ◽  
Central Canal ◽  
Ventricular System ◽  
Ventricular Pressure ◽  
Content Type ◽  
Lateral Ventricles ◽  
Spinal Subarachnoid Space ◽  
Wide Range ◽  
Fine Print

✓ Cats were made hydrocephalic by cisternal instillation of kaolin. Three to 8 weeks later it was found by perfusion between the ventricular system and the spinal subarachnoid space that communication had been reestablished through a demonstrably dilated central canal of the spinal cord. Absorption of fluid from the ventricular system, measured both by ventriculospinal perfusion and, after ligation of the spinal cord, by perfusion between the lateral ventricles, was found to be indistinguishable from zero over a wide range of ventricular pressure.

Electrophysiological topography of the human diencephalon

1973 ◽  
Vol 38 (2) ◽  
pp. 204-214 ◽  
Author(s):  
Francisco Velasco ◽  
Pedro Molina-Negro
Keyword(s):  
Electrical Activity ◽  
Movement Disorder ◽  
Internal Structure ◽  
Ventricular System ◽  
Intractable Pain ◽  
Content Type ◽  
Microelectrode Recordings ◽  
Electrical Activities ◽  
Fine Print ◽  
Made In

✓ Microelectrode recordings made in 64 human cases of movement disorder or intractable pain were used to study the relation of the site of electrical activity to the ventricular system. Standardizing the cases by dividing the AC-PC line in equal parts and using the same units to divide the areas above and below the intercommissural line and the distance of the electrodes to the midline revealed that the dispersion of the electrical activities in regard to AC-PC line was minimal and overlapping practically nonexistent. It is concluded that, at least for the areas explored, the size of each diencephalon nucleus is proportional to the size of other diencephalic nuclei, and its internal structure and relation to radiological landmarks are fairly constant.

Index for optimum ventricular catheter length

1991 ◽  
Vol 75 (1) ◽  
pp. 152-153
Author(s):  
Semih İ. Keskil ◽  
Necdet Çeviker ◽  
Kemali Baykaner ◽  
Hizir Alp
Keyword(s):  
Computerized Tomography ◽  
Head Circumference ◽  
Intraoperative Ultrasound ◽  
Ventricular Catheter ◽  
Considerable Time ◽  
Optimum Length ◽  
Content Type ◽  
The Individual ◽  
Tomography Scan ◽  
Fine Print

✓ The optimum length of a ventricular catheter to be placed in a particular patient may be difficult to determine when either intraoperative ultrasound is not available or considerable time has elapsed between the diagnostic computerized tomography scan and the operation. An index for estimating ventricular length based on the head circumference of the individual is described. This method was tested clinically and proved to be successful.

Favorable results with syringosubarachnoid shunts for treatment of syringomyelia

1982 ◽  
Vol 56 (4) ◽  
pp. 517-523 ◽  
Author(s):  
Charles H. Tator ◽  
Kotoo Meguro ◽  
David W. Rowed
Keyword(s):  
Neurological Deficit ◽  
Excellent Result ◽  
Therapeutic Modality ◽  
Ventricular Catheter ◽  
Favorable Result ◽  
Content Type ◽  
Spinal Arachnoiditis ◽  
History Of ◽  
Prognostic Feature ◽  
Fine Print

✓ From 1969 to 1979, 20 patients with syringomyelia were treated with a syringosubarachnoid shunt. The principal indications for this procedure were: significant progressive neurological deterioration and absent or minimal tonsillar ectopia. There were 15 patients with idiopathic syringomyelia, four with posttraumatic syringomyelia, and one with syringomyelia secondary to spinal arachnoiditis. The operations were performed with an operating microscope, and attention was directed to preserving the arachnoid membrane to ensure proper placement of the distal end of the shunt in an intact subarachnoid space. In all cases, a silicone rubber ventricular catheter was inserted into the syrinx through a posterior midline myelotomy. The average follow-up period was 5 years. A favorable result was obtained in 15 of the 20 patients (75%), including an excellent result with improvement of neurological deficit in 11 patients and a good result with cessation of progression in four patients. In the remaining five patients the result was poor with further progression of neurological deficit. A short duration of preoperative symptoms was usually a favorable prognostic feature. Four patients with a history of less than 6 months all had excellent results. Thirteen patients had a syringosubarachnoid shunt only, and all had good or excellent results. Seven patients had other surgical procedures, before, accompanying, or after shunt placement, and two had favorable results. Thus, the syringosubarachnoid shunt is an effective therapeutic modality for many patients with syringomyelia, particularly if there is little or no tonsillar herniation.

Cerebrospinal fluid edema: a rare complication of shunt operations for hydrocephalus

1982 ◽  
Vol 57 (5) ◽  
pp. 697-700 ◽  
Author(s):  
Yasuhiro Chiba ◽  
Hiroshi Takagi ◽  
Fumoto Nakajima ◽  
Satoshi Fujii ◽  
Takao Kitahara ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
White Matter ◽  
Rare Complication ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Operation ◽  
Low Density ◽  
Content Type ◽  
Low Density Area ◽  
Fine Print

✓ Three cases are presented in which a rare complication occurred after a shunt operation for hydrocephalus. On postoperative computerized tomography (CT) scans, extensive low-density areas appeared in the white matter along the ventricular catheter. After shunt revision, gradual resolution or disappearance of the low-density area was clearly demonstrated on CT. In one patient, a collection of cerebrospinal fluid (CSF) was confirmed at operation and appeared to lie in the extracellular spaces of the white matter. The phenomenon is considered to be localized CSF edema, different from porencephaly.

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