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 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.

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.

scholarly journals Shuntoscope-Guided Versus Free Hand Technique for Ventricular Catheter Placement: A Prospective Comparative Study of Intra-Ventricular Catheter Tip Position and Complication Rate

2021 ◽  
Author(s):  
Mohammed Issa ◽  
Mohammed Nofal ◽  
Nikolai Miotk ◽  
Angelika Seitz ◽  
Andreas W. Unterberg ◽  
...  
Keyword(s):  
Success Rate ◽  
Complication Rate ◽  
Catheter Placement ◽  
Optimal Placement ◽  
Proper Function ◽  
Ventricular Catheter ◽  
Cerebrospinal Fluid Diversion ◽  
Catheter Tip ◽  
Tip Position ◽  
A Prospective Study

Abstract Background: The position of the ventricular catheter (VC) is essential for a proper function of cerebrospinal fluid diversion system. A shuntoscope-guided (SG) method might be helpful in reducing complications. Objective: The purpose of this study is to compare the accuracy of catheter placement and the complication and revision rates between SG and free hand (FH) techniques. Methods: A prospective study of patients who underwent VC placement between September 2018 and March 2021. Accuracy of catheter placement was graded on postoperative imaging using three-point Hayhurst grading system. Complication and revision rates were documented and compared between both groups with an average follow up period of 19.56 months. Results: Fifty-five patients were included. SG technique was used in 29 patients (mean age was 6.3 years, 1.4 –27.7 years, 48.1% females), and FH technique was used in 26 patients (mean age was 28.6 years, 1.0 – 79.5 years, 73.1% female). The success rate for the optimal placement of the VC with a grade I on the Hayhurst scale was significantly higher in the SG group (93.1%) than in the FH group (67%), P = 0.031. The revision rate was higher in the FH group with 31.8% vs. 20.7% of in the SG group, P = 0.396. Conclusion: VC placement using the SG technique is a safe and effective procedure, which enabled a significantly higher success rate and lower revision and complication rate. Accordingly, we recommend using the SG technique specially in patients with morbid anatomy.

Thalamic lesions produced by gamma thalamotomy for movement disorders

2002 ◽  
Vol 97 ◽  
pp. 600-606 ◽  
Author(s):  
Chihiro Ohye ◽  
Tohru Shibazaki ◽  
Jie Zhang ◽  
Yoshitaka Andou
Keyword(s):  
Mr Imaging ◽  
Involuntary Movement ◽  
Gamma Knife Radiosurgery ◽  
Target Point ◽  
High Signal ◽  
Thalamic Lesion ◽  
Content Type ◽  
Stereotactic Thalamotomy ◽  
Thalamic Lesions ◽  
Fine Print

Object. The treatment of Parkinson disease and other kinds of involuntary movement by gamma knife radiosurgery (GKS) is presented. This is an extension of previous work. The clinical course and thalamic lesions were the main factors examined. Methods. Seventeen new cases were added to the previously reported 36 cases. The course and results for the whole series of 53 patients were examined. Treatment was undertaken using a single 4-mm collimator shot to deliver 130 Gy to the target. The target was determined in the previously treated patients by using classic methods involved in conventional stereotactic thalamotomy with microrecording. More recently, target localization has been performed by relating the target point to the total length of the thalamus. Points may then be defined as percentages of that length measured from the anterior pole. Targets can then be determined in relationship to the appropriate percentage. Thirty-five patients have been followed for more than 2 years and the longest follow up was 8 years. Two kinds of thalamic lesion were seen after GKS. Volumetric analysis on MR imaging revealed that the larger lesion was 400 to 500 mm3 at the beginning and gradually decreased in size. The smaller lesion occupied approximately 200 mm3 and also shrank over several months. Eighty percent of the treated cases showed good results and no significant complications, with the tremor subsiding at 1 year (Type 1). Several cases deviated from this standard course in four different ways (Types 2–5). If tremor persisted, conventional stereotactic thalamotomy with microrecording was performed. During such operations, normal neuronal activity was recorded from the region adjacent to the GKS thalamotomy target. This was the region showing a high signal on MR imaging. The activity patterns included the rhythmical grouped discharge of tremor rhythm. Conclusions. Gamma thalamotomy for functional disorders is still under development, but because the results with careful target planning are satisfactory, there are grounds for increasing optimism.

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.

Teratomas of the central nervous system: treatment considerations based on 34 cases

1998 ◽  
Vol 89 (5) ◽  
pp. 728-737 ◽  
Author(s):  
Yutaka Sawamura ◽  
Tsutomu Kato ◽  
Jun Ikeda ◽  
Jun-ichi Murata ◽  
Mitsuhiro Tada ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Adjuvant Therapy ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Treatment Considerations ◽  
Low Incidence ◽  
A Prospective Study ◽  
Fine Print

Object. The optimum clinical management of central nervous system (CNS) teratomas, particularly postsurgical adjuvant therapy, is still unclear, partly as a result of the tumors' low incidence. In this study the authors analyze 34 cases of CNS teratomas so that they may adequately indicate management of these lesions. Methods. The median age of the 34 patients was 13 years. Twenty-seven patients treated between 1970 and 1991 were retrospectively reviewed. Four of these 27 patients died as a result of radical surgery; each of them had a teratoma involving the hypothalamus. After initial treatment, which included radiation therapy, 20 patients (48%) had died. In all seven cases of mature teratomas there was no recurrence. In two cases of immature teratomas in which there was complete surgical resection there was recurrence; however, salvage therapies were effective. Seven of eight patients with highly malignant teratomas died; for these patients salvage therapies, including repeated radiation and chemotherapy, failed. Seven patients who presented with CNS teratomas between 1992 and 1996 received adjuvant chemotherapy and radiation therapy according to a prospective study protocol. All seven patients were free from recurrence with a 70 to 100% Karnofsky Performance Scale score at a median follow-up period of 41 months. Patients with CNS teratomas rarely responded completely to chemotherapy or radiation therapy; an effective adjuvant therapy produced a partial response at best. Conclusions. Because teratomas show various responses to adjuvant therapy, a misdiagnosis of their histological subtype will lead to inadequate therapy. A diverse therapeutic protocol based on histological diagnosis is necessary to plan appropriate management. Treatment recommendations are discussed in detail in the article.

Fetal nondopaminergic neural implants in parkinsonian primates

1991 ◽  
Vol 74 (1) ◽  
pp. 97-104 ◽  
Author(s):  
Krzysztof S. Bankiewicz ◽  
Robert J. Plunkett ◽  
David M. Jacobowitz ◽  
Irwin J. Kopin ◽  
Edward H. Oldfield
Keyword(s):  
Dopaminergic Neurons ◽  
Neural Implants ◽  
Behavioral Recovery ◽  
Foramen Of Monro ◽  
Caudate Nuclei ◽  
Content Type ◽  
Primate Brain ◽  
Brain Implants ◽  
Microsurgical Approach ◽  
Fine Print

✓ Implantation of fetal dopamine-containing tissue into preformed cavities in the caudate nucleus of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonian monkeys leads to behavioral recovery. Recovery may be related to two sources of dopamine: the grafted cells and/or the sprouted fibers from host dopaminergic neurons. The authors undertook this study to determine whether behavioral recovery requires release of dopamine by the implanted tissue, and to establish if nondopaminergic fetal central nervous system implants can induce sprouting of dopamine fibers in the primate brain and cause behavioral recovery. Rhesus monkeys with MPTP-induced hemiparkinsonism or full parkinsonism and a stable neurological deficit were used for this study. Cavities were created in the caudate nuclei anterior to the foramen of Monro via an open microsurgical approach. Fetal cerebellum or spinal cord was implanted into the preformed cavities of three monkeys. Control parkinsonian monkeys showed no recovery. However, implant-induced improvement was stable for up to 6 months after implantation. Sprouted dopaminergic fibers oriented from the ventral striatum and nucleus accumbens were found in the area of the tissue implant in the animals that received fetal grafts but were not present in the control monkeys. It is concluded that brain implants do not need to contain dopamine to induce functional recovery in MPTP-induced parkinsonian primates. Implant-induced and trophic factor-mediated dopaminergic sprouting by the host brain plays a role in the behavioral recovery and may well be responsible for the clinical improvement seen in parkinsonian patients after brain implants.

scholarly journals Intraoperative Fiber-Optic Endoscopy for Ventricular Catheter Insertion

2001 ◽  
Vol 28 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Philip V. Theodosopoulos ◽  
Aviva Abosch ◽  
Michael W. McDermott
Keyword(s):  
Fiber Optic ◽  
Catheter Placement ◽  
Ventricular Catheter ◽  
Neurosurgical Procedure ◽  
Significant Difference ◽  
Catheter Tip ◽  
Endoscopic Guidance ◽  
Ventricular Catheters ◽  
Tip Position ◽  
Optic Endoscopy

ABSTRACT:Objective:Ventricular catheter placement is a common neurosurgical procedure often resulting in inaccurate intraventricular positioning. We conducted a comparison of the accuracy of endoscopic and conventional ventricular catheter placement in adults.Methods:A retrospective analysis of data was performed on 37 consecutive patients undergoing ventriculo-peritoneal shunt (VPS) insertion with endoscopy and 40 randomly selected, unmatched patients undergoing VPS insertion without endoscopy, for the treatment of hydrocephalus of varied etiology. A grading system for catheter tip position was developed consisting of five intraventricular zones, V1-V5, and three intraparenchymal zones, A, B, C. Zones V1 for the frontal approaches and V1 or V2 for the occipital approaches were the optimal catheter tip locations. Postoperative scans of each patient were used to grade the accuracy of ventricular catheter placement.Results:Seventy-six percent of all endoscopic ventricular catheters were in zone V1 and 100% were within zones V1-V3. No endoscopically inserted catheters were observed in zones V4, V5 or intraparenchymally. Thirty-eight percent of the conventionally placed catheters were in zone V1, 53% in zones V1-3 and 15% intraparenchymally. There was a statistically significant difference in the percentage of catheters in optimal location versus in any other location, favoring endoscopic guidance (p<0.001).Conclusion:We conclude that endoscopic ventricular catheter placement provides improved positioning accuracy than conventional techniques.

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.

Sign in / Sign up

Export Citation Format

Share Document