Ahmed AlAzri1,2, Kelvin Mok3, Jeffrey Chankowsky4,5, Mohammad Mullah6, Judith Marcoux7,8. 1. Department of Neurology and Neurosurgery, McGill University Montreal, Montreal, QC, Canada. 2. Department of Neurosurgery, McGill University Health Centre, 1650 Cedar Ave, Room L7-516, Montreal, QC, H3G 1A4, Canada. 3. Department of Biomedical Engineering, Montreal Neurological Institute McGill University, Montreal, QC, Canada. 4. Department of Diagnostic Radiology, McGill University, Montreal, QC, Canada. 5. Department of Radiology, McGill University Health Centre, Montreal, QC, Canada. 6. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. 7. Department of Neurology and Neurosurgery, McGill University Montreal, Montreal, QC, Canada. judith.marcoux@mcgill.ca. 8. Department of Neurosurgery, McGill University Health Centre, 1650 Cedar Ave, Room L7-516, Montreal, QC, H3G 1A4, Canada. judith.marcoux@mcgill.ca.
Abstract
BACKGROUND: External ventricular drain (EVD) placement is a frequently performed neurosurgical procedure. Inaccuracies in drain positioning and the need for multiple passes using the classic freehand insertion technique is well reported in the literature, especially in the traumatic brain injury (TBI) population. The purpose of this study was to evaluate if electromagnetic neuronavigation guidance for EVD insertion improves placement accuracy and minimizes the number of passes in severe TBI patients. METHODS: Navigation was applied prospectively for all new severe TBI patients who required ventricular catheter placement over a period of 1 year, and compared with a retrospective cohort of severe TBI patients who had EVD inserted freehand in the preceding year. The placement accuracy was evaluated using the Kakarla grading system; the number of passes was also compared. RESULTS: Fifty-four cases were recruited: 35 (64.8%) had their EVD placed using the freehand technique and 19 (35.2%) using navigation guidance. In the navigation group, the placement accuracy was: 94.7% (18/19) grade 1, 5.3% (1/19) grade 2, and none at grade 3. In comparison, freehand placement was associated with misplacement (grades 2 and 3) in 42.9% of the cases (p value = 0.009). The number of passes was significantly lower in the navigation group (mean of 1.16 ± 0.38), compared with the freehand group (mean of 1.63 ± 0.88) (p value = 0.018). CONCLUSIONS: Using the navigation to guide EVD placement was associated with a significantly better accuracy and a lower number of passes in severe TBI patients.
BACKGROUND: External ventricular drain (EVD) placement is a frequently performed neurosurgical procedure. Inaccuracies in drain positioning and the need for multiple passes using the classic freehand insertion technique is well reported in the literature, especially in the traumatic brain injury (TBI) population. The purpose of this study was to evaluate if electromagnetic neuronavigation guidance for EVD insertion improves placement accuracy and minimizes the number of passes in severe TBIpatients. METHODS: Navigation was applied prospectively for all new severe TBIpatients who required ventricular catheter placement over a period of 1 year, and compared with a retrospective cohort of severe TBIpatients who had EVD inserted freehand in the preceding year. The placement accuracy was evaluated using the Kakarla grading system; the number of passes was also compared. RESULTS: Fifty-four cases were recruited: 35 (64.8%) had their EVD placed using the freehand technique and 19 (35.2%) using navigation guidance. In the navigation group, the placement accuracy was: 94.7% (18/19) grade 1, 5.3% (1/19) grade 2, and none at grade 3. In comparison, freehand placement was associated with misplacement (grades 2 and 3) in 42.9% of the cases (p value = 0.009). The number of passes was significantly lower in the navigation group (mean of 1.16 ± 0.38), compared with the freehand group (mean of 1.63 ± 0.88) (p value = 0.018). CONCLUSIONS: Using the navigation to guide EVD placement was associated with a significantly better accuracy and a lower number of passes in severe TBIpatients.
Authors: Alejandro Enriquez-Marulanda; Luis C Ascanio; Mohamed M Salem; Georgios A Maragkos; Ray Jhun; Abdulrahman Y Alturki; Justin M Moore; Christopher S Ogilvy; Ajith J Thomas Journal: Neurocrit Care Date: 2018-12 Impact factor: 3.210
Authors: Charlene Y C Chau; Claudia L Craven; Andres M Rubiano; Hadie Adams; Selma Tülü; Marek Czosnyka; Franco Servadei; Ari Ercole; Peter J Hutchinson; Angelos G Kolias Journal: J Clin Med Date: 2019-09-10 Impact factor: 4.241
Authors: Keng Siang Lee; John Jiong Yang Zhang; Nagarjun Bolem; May Lian Leong; Chun Peng Goh; Rashidul Hassan; Al Amin Maa Salek; Asher Paul Tan Sein Lwin; Kejia Teo; Ning Chou; Vincent Nga; Tseng Tsai Yeo Journal: Asian J Neurosurg Date: 2020-02-25