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Intraoperative Fiber-Optic Endoscopy for Ventricular Catheter Insertion

Published online by Cambridge University Press:  02 March 2017

Philip V. Theodosopoulos ,
Aviva Abosch  and
Michael W. McDermott
Philip V. Theodosopoulos
Affiliation:
Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
Aviva Abosch
Affiliation:
Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
Michael W. McDermott*
Affiliation:
Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
*
Department of Neurological Surgery, Moffitt Hospital M787, 505 Parnassus Ave, Box 0112, San Francisco, CA 94143, USA
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Abstract:

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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.

Résumé:

RÉSUMÉ:Objectif:

La mise en place d'un cathéter ventriculaire est une procédure neurochirurgicale fréquente, souvent avec un positionnement intraventriculaire inexact. Nous avons comparé l'exactitude du positionnement ventriculaire de cathéters par endoscopie et par la méthode conventionnelle chez des adultes.

Méthodes:

Une analyse rétrospective des observations sur 37 patients consécutifs qui ont subi cette intervention par endoscopie et 40 patients sélectionnés au hasard, sans appariement, qui ont subi cette intervention sans endoscopie pour traiter une hydrocéphalie d'étiologie variée. Un système de classification de la position de la pointe du cathéter comprenant 5 zones intraventriculaires, V1-V5, et trois zones intraparenchymateuses A, B, C a été développé. Les zones V1 pour les approches frontales et V1 ou V2 pour les approches occipitales se sont avérées être les sites optimaux pour la pointe du cathéter. Les scans postopératoires de chaque patient ont été utilisés pour classifier l'exactitude du positionnement du cathéter.

Résultats:

Soixante-dix-sept pourcent de tous les cathéters placés sous endoscopie étaient dans la zone V1 et 100% étaient dans les zones V1-V3. Aucun des cathéters placés sous endoscopie n'était dans les zones V4, V5 ou dans le parenchyme. Trente-huit pourcent des cathéters mis en place par la méthode conventionnelle étaient dans la zone V1, 53% dans les zones V1-V3 et 15% dans le parenchyme. La différence entre le pourcentage des cathéters en position optimale et celui des cathéters en toute autre position était significative et en faveur du guidage endoscopique (p<0.001).

Conclusion:

Nous concluons que la mise en place de cathéters par endoscopie ventriculaire améliore la précision du positionnement par rapport aux techniques conventionnelles.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 1 , February 2001 , pp. 56 - 60
Copyright
Copyright © The Canadian Journal of Neurological 2001

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