Robotic catheter ventriculostomy: feasibility, efficacy, and implications

2008 ◽  
Vol 108 (2) ◽  
pp. 269-274 ◽  
Author(s):  
S. Scott Lollis ◽  
David W. Roberts
Keyword(s):  
Great Promise ◽  
Ventricular Catheter ◽  
Vp Shunt ◽  
Single Pass ◽  
Image Guided ◽  
Catheter Tip ◽  
Complications Of Surgery ◽  
Bridging Veins ◽  
The Mean ◽  
Ventricle Size

Object Robotic applications hold great promise for improving clinical outcomes and reducing complications of surgery. To date, however, there have been few widespread applications of robotic technology in neurosurgery. The authors hypothesized that image-guided robotic placement of a ventriculostomy catheter is safe, highly accurate, and highly reproducible. Methods Sixteen patients requiring catheter ventriculostomy for ventriculoperitoneal (VP) shunt or reservoir placement were included in this retrospective study. All patients underwent image-guided robotic placement of a ventricular catheter, using a preoperatively defined trajectory. Results All catheters were placed successfully in a single pass. There were no catheter-related hemorrhages and no injuries to adjacent neural structures. The mean distance of the catheter tip from the target was 1.5 mm. The mean operative times were 112 minutes for VP shunt placement and 42.3 minutes for reservoir placement. The mean operative times decreased over the course of the study by 49% for VP shunts and by 19% for reservoir placement. Conclusions The robotic placement of a ventriculostomy catheter using a preplanned trajectory is safe, highly accurate, and highly reliable. This makes single-pass ventriculostomy possible in all patients, even in those with very small ventricles, and may permit catheter-based therapies in patients who would otherwise be deemed poor surgical candidates because of ventricle size. Robotic placement also permits careful preoperative study and optimization of the catheter trajectory, which may help minimize the risks to bridging veins and sulcal vessels.

Using a burr hole valve prevents proximal shunt failure in infants and toddlers

2019 ◽  
Vol 24 (3) ◽  
pp. 315-322
Author(s):  
Chiu-Hao Hsu ◽  
Sheng-Che Chou ◽  
Shih-Hung Yang ◽  
Ming-Chieh Shih ◽  
Meng-Fai Kuo
Keyword(s):  
Protective Factor ◽  
Catheter Insertion ◽  
Burr Hole ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Catheter Migration ◽  
The Mean

OBJECTIVEProximal malfunction is the most common cause of ventriculoperitoneal (VP) shunt failure in young children. In this study, the authors sought to determine factors that affect the migration rate of ventricular catheters in hydrocephalic children who undergo shunt implantation in the first 3 years of life.METHODSThe authors reviewed the medical records and imaging studies of newly diagnosed and treated hydrocephalic children who were younger than 3 years. Patients who received VP shunt insertion through the parieto-occipital route were not included. In total, 78 patients were found who underwent VP shunt insertion between December 2006 and April 2017. Eighteen patients were excluded due to mortality, short follow-up period (< 1 year), and lack of imaging follow-up. The age, sex, etiology of hydrocephalus, initial length of ventricular catheter, valve type (burr hole vs non–burr hole), time to ventricular catheter migration, subsequent revision surgery, and follow-up period were analyzed. The diagnosis of a migrated ventricular catheter was made when serial imaging follow-up showed progressive withdrawal of the catheter tip from the ventricle, with the catheter shorter than 4 mm inside the ventricle, or progressive deviation of the ventricular catheter toward the midline or anterior ventricular wall.RESULTSSixty patients were enrolled. The mean age was 5.1 months (range 1–30 months). The mean follow-up period was 50.9 months (range 13–91 months). Eight patients had ventricular catheter migration, and in 7 of these 8 patients a non–burr hole valve was used. In the nonmigration group, a non–burr hole valve was used in only 6 of the 52 patients. Six of the 8 patients with catheter migration needed second surgeries, which included removal of the shunt due to disconnection in 1 patient. The remaining 2 patients with shunt migration were followed for 91 and 46 months, respectively, without clinical and imaging changes. The authors found that patient age at catheter insertion, ventricular catheter length, and the use of a burr hole valve were protective factors against migration. After ventricular catheter length and patient age at catheter insertion were treated as confounding variables and adjusted with multivariable Weibull proportional hazards regression, the use of a burr hole valve shunt remained a protective factor.CONCLUSIONSThe use of burr hole valves is a protective factor against ventricular catheter migration when the shunt is inserted via a frontal route. The authors suggest the use of a burr hole valve along with a frontal entry point in hydrocephalic children younger than 3 years to maintain long-term shunt function.

scholarly journals Accuracy of Ventricular Catheter Tip Placement Using Freehand Placement

2019 ◽  
Vol 5 (1) ◽  
pp. 59-63
Author(s):  
DM Arman ◽  
Sheikh Muhammad Ekramullah ◽  
Sudipta Kumer Mukherjee ◽  
Samantha Afreen ◽  
Md Anwarul Hoque Faraji ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Prospective Observational Study ◽  
Catheter Placement ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Single Institution ◽  
Vp Shunt ◽  
Shunt Procedure ◽  
Freehand Technique ◽  
Catheter Tip

Background: Inaccurate placement of VP shunt catheter is related to shunt failure. Objective: The objective of this study was to determine the accuracy of ventricular catheter placement during ventriculoperitoneal shunt operations using the freehand technique. Methodology: This prospective observational study included all patients from a single institution who underwent a ventriculoperitoneal shunt procedure in which a new ventricular catheter was placed between September 2013 and August 2016 for a period of three (03) years. Data abstracted for each patient included age, sex, diagnosis, site and side of ventricular catheter placement. Postoperative CT scan images were reviewed for accuracy of ventricular catheter placement. Results: There were 140 patients included in the study; accuracy ventricular catheter tip placement were 55 (39.28%) using freehand technique. Conclusion: Mechanical malfunction and infection are the most significant problems associated with shunts for the treatment of hydrocephalus. Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 59-63

Transventricular, transaqueductal scope-in-scope endoscopic excision of fourth ventricular neurocysticercosis: a series of 13 cases and a review

2008 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Ashish Suri ◽  
Rohit Kumar Goel ◽  
Faiz Uddin Ahmad ◽  
Ananth Kesav Vellimana ◽  
Bhawani Shankar Sharma ◽  
...  
Keyword(s):  
English Language ◽  
Third Ventriculostomy ◽  
Cyst Excision ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
The Central Nervous System ◽  
The Mean ◽  
Clinical Records ◽  
Ventricle Size

Object Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system worldwide. In patients presenting with acute hydrocephalus due to intraventricular NCC, surgery is the only option. Still, there is no consensus regarding the optimal surgical strategy, although neuroendoscopic excision is a promising method. However, the literature regarding the use of this modality in fourth ventricular NCC is scarce. The authors describe a series of patients with fourth ventricular NCC treated endoscopically. Methods The clinical records of 13 patients with fourth ventricular NCC who had presented with hydrocephalus were retrospectively analyzed. A fourth ventricular cyst was completely excised in all patients by using a transventricular, transaqueductal “scope-in-scope” endoscopic technique. Twelve endoscopic third ventriculostomies and 1 septostomy had been performed. Results Shunt placement was avoided in all patients. There were minimal peri- and postoperative complications. The mean duration of follow-up was 22.3 months (range 3–41 months). All patients had an improved clinical outcome. Follow-up neuroimaging revealed no residual lesion and a decreased ventricle size in all patients. Conclusions The present series of patients with fourth ventricular NCC is the largest in the existing English-language medical literature. Endoscopic fourth ventricular cysticercal cyst excision along with internal cerebrospinal fluid diversion via endoscopic third ventriculostomy is an effective alternative to open microneurosurgical procedures and avoids shunt placement and its related complications.

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.

Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience

2009 ◽  
Vol 3 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Brian Willis ◽  
Vijayakumar Javalkar ◽  
Prasad Vannemreddy ◽  
Gloria Caldito ◽  
Junko Matsuyama ◽  
...  
Keyword(s):  
Birth Weight ◽  
Surgical Treatment ◽  
Premature Infants ◽  
Preterm Neonates ◽  
Posthemorrhagic Hydrocephalus ◽  
Vp Shunt ◽  
Shunt Group ◽  
Institutional Experience ◽  
Csf Diversion ◽  
The Mean

Object The aim of the study was to analyze the outcome of surgical treatment for posthemorrhagic hydrocephalus in premature infants. Methods From 1990 to 2006, 32 premature infants underwent surgical treatment for posthemorrhagic hydrocephalus, and their charts were retrospectively reviewed to analyze the complications and outcome with respect to shunt revisions. Multivariate analysis and time series were used to identify factors that influence the outcome in terms of shunt revisions. Results The mean gestational age was 27 ± 3.3 weeks, and mean birth weight was 1192 ± 660 g. Temporary reservoir placement was performed in 15 patients, while 17 underwent permanent CSF diversion with a ventriculoperitoneal (VP) shunt. In 2 patients, reservoir tapping alone was sufficient to halt the progression of hydrocephalus; 29 patients received VP shunts. The mean follow-up period was 37.3 months. The neonates who received VP shunts first were significantly older (p = 0.02) and heavier (p = 0.04) than those who initially underwent reservoir placement. Shunts were revised in 14 patients; 42% of patients in the reservoir group had their shunts revised, while 53% of infants who had initially received a VP shunt required a revision. The revision rate per patient in the reservoir group was half that in the direct VP shunt group (p = 0.027). No patient in the reservoir group had > 2 revisions. Shunt infections developed in 3 patients (10.3%), and 2 patients in the reservoir group died of nonneurological issues related to prematurity. Conclusions Birth weight and age are useful parameters in decision making. Preterm neonates with low birth weights benefit from initial CSF drainage procedures followed by permanent CSF diversion with respect to the number of shunt revisions.

scholarly journals Improvised external ventricular drain in neurosurgery: A Nigerian tertiary hospital experience

2015 ◽  
Vol 6 (03) ◽  
pp. 304-308 ◽  
Author(s):  
O. A. Ojo ◽  
M. A. Asha ◽  
O. B. Bankole ◽  
O. O. Kanu
Keyword(s):  
External Ventricular Drain ◽  
Feeding Tube ◽  
Time Frame ◽  
Tertiary Hospital ◽  
Salvage Procedure ◽  
Vp Shunt ◽  
The Mean ◽  
A Prospective Study ◽  
Standard Sets ◽  
Eventual Outcome

Abstract Background: The most common type of hydrocephalus in developing countries is post infective hydrocephalus. Infected cerebrospinal fluid (CSF) however cannot be shunted for the reason that it will block the chamber of the ventriculo-peritoneal (VP) shunt due to its high protein content. In centers where standard external ventricular drain (EVD) sets are not available, improvised feeding tube can be used. Aim: The main focus of this study is to encourage the use of improvised feeding tube catheters for EVD when standard sets are not available to improve patients′ survival. Methodology: This was a prospective study. Consecutive patients with hydrocephalus that cannot be shunted immediately for high chances of shunt failure or signs of increasing intracranial pressure were recruited into the study. Other inclusion criteria were preoperative brain tumor with possibility of blocked CSF pathway and massive intraventricular hemorrhage necessitating ventricular drainage as a salvage procedure. Standard EVD set is not readily available and too expensive for most of the parents to afford. Improvised feeding tube is used to drain/divert CSF using the standard documented procedure for EVD insertion. Outcome is measured and recorded. Results: A total of 28 patients were recruited into the study over a time frame of 2 years. There were 19 (67.9%) male and 9 (32.1%) females with a ratio of about 2:1. Age ranges varied from as low as 7 days to 66 years. The median age of the study sample was 6.5 months while the mean was 173.8 months. Duration of EVD varied from 2 days to 11 days with a median of 7 while the average was 6 days. Eventual outcome following the procedure of EVD showed that 19 (67.9%) survived and were discharged either to go home or to have VP shunt afterwards while 8 (28.6%) of the patients died. Conclusions: External ventricular drain can and should be done when it is necessary. Potential mortalities could be reduced by the improvised drainage using a standard feeding tube as described.

scholarly journals Relationship of the Location of the Ventricular Catheter Tip and Function of the Ventriculoperitoneal Shunt

2019 ◽  
Vol 9 (1) ◽  
pp. 16-21
Author(s):  
DM Arman ◽  
Sheikh Muhammad Ekramullah ◽  
Sudipta Kumer Mukherjee ◽  
Joynul Islam ◽  
Mirza Hafizur Rashid ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Significant Proportion ◽  
Catheter Placement ◽  
Ventricular Catheter ◽  
Shunt Procedure ◽  
Freehand Technique ◽  
Catheter Tip ◽  
And Function ◽  
Relationship Of ◽  
The Relationship

Object: The objective of this study was to determine the relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt. Methods: This prospective observational study included 140 patients from a single institution who underwent a ventriculoperitoneal shunt procedure in which a new ventricular catheter was placed between September, 2013 and September 2016. Data abstracted for each patient included age, sex, diagnosis, site and side of ventricular catheter placement. Postoperative CT scan images were reviewed for accuracy of ventricular catheter placement. Patients were followed up over 2 ½ to 4 ½ years.63 patients were available for follow up. We lost communication with rest of the patients. The relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt was analyzed in 63 patients. Results: There were 140 patients included in the study; accuracy ventricular catheter tip placement were 55 (39.28%) using freehand technique. VP shunt functioned well in 43 (68.25%) of 63 patients. Among the 43 patients with well functioning shunt ,19 were in accurate group ,7 were in suboptimal group and 17 were in inaccurate group.26 patients (41.27%) had good outcome with normal development and normal IQ Conclusions: Mechanical malfunction and infection are the most significant problems associated with shunts for the treatment of hydrocephalus. Above all, a significant proportion of shunt failure was due to obstruction of the ventricular catheter, and accurate placement of the shunt catheter is highly important to reduce the incidence of shunt malfunction. Bang. J Neurosurgery 2019; 9(1): 16-21

scholarly journals Upconversion NIR-II fluorophores for mitochondria-targeted cancer imaging and photothermal therapy

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Hui Zhou ◽  
Xiaodong Zeng ◽  
Anguo Li ◽  
Wenyi Zhou ◽  
Lin Tang ◽  
...  
Keyword(s):  
Photothermal Therapy ◽  
Biomedical Applications ◽  
Cell Imaging ◽  
Upconversion Luminescence ◽  
Great Promise ◽  
Osteosarcoma Cells ◽  
Image Guided ◽  
Donor Acceptor ◽  
Subcellular Resolution

AbstractNIR-II fluorophores have shown great promise for biomedical applications with superior in vivo optical properties. To date, few small-molecule NIR-II fluorophores have been discovered with donor-acceptor-donor (D-A-D) or symmetrical structures, and upconversion-mitochondria-targeted NIR-II dyes have not been reported. Herein, we report development of D-A type thiopyrylium-based NIR-II fluorophores with frequency upconversion luminescence (FUCL) at ~580 nm upon excitation at ~850 nm. H4-PEG-PT can not only quickly and effectively image mitochondria in live or fixed osteosarcoma cells with subcellular resolution at 1 nM, but also efficiently convert optical energy into heat, achieving mitochondria-targeted photothermal cancer therapy without ROS effects. H4-PEG-PT has been further evaluated in vivo and exhibited strong tumor uptake, specific NIR-II signals with high spatial and temporal resolution, and remarkable NIR-II image-guided photothermal therapy. This report presents the first D-A type thiopyrylium NIR-II theranostics for synchronous upconversion-mitochondria-targeted cell imaging, in vivo NIR-II osteosarcoma imaging and excellent photothermal efficiency.

Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients

2020 ◽  
Vol 21 (5) ◽  
pp. 732-737
Author(s):  
Chunli Liu ◽  
Dingbiao Jiang ◽  
Tao Jin ◽  
Chuanyin Chen ◽  
Ruchun Shi ◽  
...  
Keyword(s):  
Upright Position ◽  
Body Posture ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Posture Change ◽  
Body Change ◽  
Catheter Tip ◽  
The Mean ◽  
Tip Position ◽  
Chinese Cancer Patients

Purpose: To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients. Methods: A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement. Results: A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was –15.83 ± 8.97 mm. The difference between the two positions was statistically significant ( p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index ( p = 0.009) and height ( p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change. Conclusion: The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

Computational and experimental study of proximal flow in ventricular catheters

2003 ◽  
Vol 99 (2) ◽  
pp. 426-431 ◽  
Author(s):  
Julian Lin ◽  
Martin Morris ◽  
William Olivero ◽  
Frederick Boop ◽  
Robert A. Sanford
Keyword(s):  
Water Table ◽  
Three Dimensional ◽  
Automated Testing ◽  
Ventricular Catheter ◽  
Shunt Insertion ◽  
Content Type ◽  
Testing Apparatus ◽  
Table Model ◽  
Catheter Tip ◽  
Ventricular Catheters

✓ The treatment of hydrocephalus with shunt insertion is fraught with high failure rates. Evidence indicates that the proximal holes in a catheter are the primary sites of blockage. The authors have studied ventricular catheter designs by using computational fluid dynamics (CFD), two-dimensional water table experiments, and a three-dimensional (3D) automated testing apparatus together with an actual catheter. With the CFD model, the authors calculated that 58% of the total fluid mass flows into the catheter's most proximal holes and that greater than 80% flows into the two most proximal sets of holes within an eight-hole catheter. In fact, most of the holes in the catheters were ineffective. These findings were experimentally verified using two completely different methodologies: a water table model of a shunt catheter and a 3D automated testing apparatus with an actual catheter to visualize flow patterns with the aid of ink. Because the majority of flow enters the catheter's most proximal holes, blockages typically occur at this position, and unlike blockages at distal holes, occlusion of proximal holes results in complete catheter failure. Given this finding, new designs that incorporated varying hole pattern distributions and size dimensions of the ventricular catheter were conceived and tested using two models. These changes in the geometrical features significantly changed the entering mass flow rate distribution. In conclusion, new designs in proximal ventricular catheters with variable hole diameters along the catheter tip allowed fluid to enter the catheter more uniformly along its length, thereby reducing the probability of its becoming occluded.

Sign in / Sign up

Export Citation Format

Share Document