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A new tool for frameless stereotactic placement of ventricular catheters
Lennart H Stieglitz1, Mario Giordano, Madjid Samii
1Department of Neurosurgery, International Neuroscience Institute Hannover, Hannover, Germany. Lennart.Stieglitz@insel.ch
Background:
The accurate position of the ventricular catheter inside the frontal horn of the lateral ventricle is essential to prevent proximal failure in shunt surgery. For optimal placement, endoscopic- and image-guided techniques are available.
Objective:
We introduce a newly constructed tool for quick and safe placement of ventricular catheters. It is mounted on a fixation device and therefore allows the surgeon's optimal concentration on the catheter insertion and feeling for the penetrated tissue. To check the feasibility of the new device, we performed a study with 4 patients.
Methods:
Two patients with communicative and 2 patients with noncommunicative hydrocephalus underwent ventricular catheter placement using the new shunt placement tool. Three patients had a complex anatomy of the ventricular system.
Results:
In all 4 procedures, correct placement of the ventricular catheters was achieved. The additional time needed for preparations did not exceed 15 minutes. The comparison of the postoperative computed tomography scans with the preoperative planning showed good accuracy of the instrument with a mean deviation of the catheter tips from the planned position of 1.5 mm (range 1.0-2.1 mm).
Conclusion:
The new tool allows safe and quick placement of ventricular catheters. The adjustment of the tool to the planned trajectory is performed before catheter insertion and allows optimal concentration on the insertion procedure and the fingertip feeling for the penetrated tissue.
