Mohammad W Kassem1,2,3, Basem Ishak1, Karishma Mehta2, Joe Iwanaga1, Marios Loukas2, R Shane Tubbs4,5. 1. Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA. 2. Department of Anatomical Sciences, St. George's University, True Blue, Grenada. 3. Mercy Health Neuroscience Institute, Toledo, OH, USA. 4. Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA. shanet@seattlesciencefoundation.org. 5. Department of Anatomical Sciences, St. George's University, True Blue, Grenada. shanet@seattlesciencefoundation.org.
Abstract
PURPOSE: Intraosseous vascular access is often used when vascular access is difficult. However, the use of this space for a receptacle for cerebrospinal fluid (CSF) diversion has been scantly considered. MATERIALS AND METHODS: Six upper limbs of fresh frozen cadavers were used for this study. In the supine position, a small hole was drilled through the outer cortex of the proximal humerus and into the medullary cavity. A 16-gauge needle was placed into the hole in the humerus and 150 cc of saline infused. Next, the adjacent axillary vein and tributaries were dissected to observe dilation or the presence of the blue-colored saline. For part two of the study, shunt tubing was passed subcutaneously from a supraclavicular incision to the hole made in the humerus. Range of motion of the shoulder was then performed. RESULTS: On all sides, all 150 cc of fluid was easily infused into the humerus. No specimen was found to have leakage from the drill hole site or into the extravascular soft tissues. With dissection of the axillary vein and its tributaries, all sides were found to have engorgement of these vessels. No tension was placed on the distal shunt tubing with full range of motion of the shoulder. CONCLUSION: Based on our study, the humerus is another option available to the neurosurgeon for CSF diversion.
PURPOSE: Intraosseous vascular access is often used when vascular access is difficult. However, the use of this space for a receptacle for cerebrospinal fluid (CSF) diversion has been scantly considered. MATERIALS AND METHODS: Six upper limbs of fresh frozen cadavers were used for this study. In the supine position, a small hole was drilled through the outer cortex of the proximal humerus and into the medullary cavity. A 16-gauge needle was placed into the hole in the humerus and 150 cc of saline infused. Next, the adjacent axillary vein and tributaries were dissected to observe dilation or the presence of the blue-colored saline. For part two of the study, shunt tubing was passed subcutaneously from a supraclavicular incision to the hole made in the humerus. Range of motion of the shoulder was then performed. RESULTS: On all sides, all 150 cc of fluid was easily infused into the humerus. No specimen was found to have leakage from the drill hole site or into the extravascular soft tissues. With dissection of the axillary vein and its tributaries, all sides were found to have engorgement of these vessels. No tension was placed on the distal shunt tubing with full range of motion of the shoulder. CONCLUSION: Based on our study, the humerus is another option available to the neurosurgeon for CSF diversion.