Skip to main content
SpringerLink
Log in

Smartphone-assisted guide for the placement of ventricular catheters

  • Technical Note
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objective

Freehand placement of ventricular catheters (VC) is reported to be inaccurate in 10–40 %. Endoscopy, ultrasound, or neuronavigation are used in selected cases with significant technical and time-consuming efforts. We suggest a smartphone-assisted guiding tool for the placement of VC.

Methods

Measurements of relevant parameters in 3D-MRI datasets in a patient cohort with narrow ventricles for a frontal precoronal VC placement were performed. In this context, a guiding tool was developed to apply the respective measures for VC placement. The guiding tool was tested in a phantom followed by CT imaging to quantify placement precision. A smartphone application was designed to assist the relevant measurements. The guide was applied in 35 patients for VC placement.

Results

MRI measurements revealed the rectangular approach in the sagittal plane and the individual angle towards the tangent in the coronal section as relevant parameter for a frontal approach. The latter angle ranged from medial (91.96° ± 2.75°) to lateral margins (99.56° ± 4.14°) of the ventricle, which was similar in laterally shifted (±5 mm) entry points. The subsequently developed guiding tool revealed precision measurements in an agarose model with 1.1° ± 0.7° angle deviation. Using the smartphone-assisted guide in patients with narrow ventricles (frontal occipital horn ratio, 0.38 ± 0.05), a primary puncture of the ventricles was possible in all cases. No VC failure was observed during follow-up (9.1 ± 5.3 months).

Conclusions

VC placement in narrow ventricles requires accurate placement with simple means in an every-case routine. The suggested smartphone-assisted guide meets these criteria. Further data are planned to be collected in a prospective randomized study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Abdoh MG, Bekaert O, Hodel J, Diarra SM, Le Guerinel C, Nseir R, Bastuji-Garin S, Decq P (2012) Accuracy of external ventricular drainage catheter placement. Acta Neurochir (Wien) 154(1):153–159

    Article  Google Scholar 

  2. Abu-Serieh B, Ghassempour K, Duprez T, Raftopoulos C (2007) Stereotactic ventriculoperitoneal shunting for refractory idiopathic intracranial hypertension. Neurosurgery 60(6):1039–1043

    Article  PubMed  Google Scholar 

  3. Azeem SS, Origitano TC (2007) Ventricular catheter placement with a frameless neuronavigational system: a 1-year experience. Neurosurgery 60(4 Suppl 2):243–247

    PubMed  Google Scholar 

  4. Di Rocco C, Marchese E, Velardi F (1994) A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991–1992 Education Committee of the ISPN. Childs Nerv Syst 10(5):321–327

    Article  PubMed  Google Scholar 

  5. Ghajar JB (1985) A guide for ventricular catheter placement. Technical note. J Neurosurg 63(6):985–986

    Article  PubMed  CAS  Google Scholar 

  6. Giese H, Hoffmann KT, Winkelmann A, Stockhammer F, Jallo GI, Thomale UW (2010) Precision of navigated stereotactic probe implantation into the brainstem. J Neurosurg Pediatr 5(4):350–359

    Article  PubMed  Google Scholar 

  7. Harris CA, McAllister JP 2nd (2012) What we should know about the cellular and tissue response causing catheter obstruction in the treatment of hydrocephalus. Neurosurgery Jun 70(6):1589–1601

    Google Scholar 

  8. Hayhurst C, Beems T, Jenkinson MD, Byrne P, Clark S, Kandasamy J, Goodden J, Nandoe Tewarie RD, Mallucci CL (2010) Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study. J Neurosurg Dec 113(6):1273–1278

    Article  Google Scholar 

  9. Hermann EJ, Capelle HH, Tschan CA, Krauss JK (2012) Electromagnetic-guided neuronavigation for safe placement of intraventricular catheters in pediatric neurosurgery. J Neurosurg Pediatr. 10:327–333

    Article  PubMed  Google Scholar 

  10. Hsieh CT, Chen GJ, Ma HI, Chang CF, Cheng CM, Su YH, Ju DT, Hsia CC, Chen YH, Wu HY, Liu MY (2011) The misplacement of external ventricular drain by freehand method in emergent neurosurgery. Acta Neurol Belg 111(1):22–28

    PubMed  Google Scholar 

  11. Huyette DR, Turnbow BJ, Kaufman C, Vaslow DF, Whiting BB, Oh MY (2008) Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans. J Neurosurg 108(1):88–91

    Article  PubMed  Google Scholar 

  12. Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF (2008) Safety and accuracy of bedside external ventricular drain placement. Neurosurgery 63(1 Suppl 1):ONS162-6

    Google Scholar 

  13. Kandasamy J, Hayhurst C, Clark S, Jenkinson MD, Byrne P, Karabatsou K, Mallucci CL (2011) Electromagnetic stereotactic ventriculoperitoneal csf shunting for idiopathic intracranial hypertension: a successful step forward? World Neurosurg 75(1):155–160

    Article  PubMed  Google Scholar 

  14. Kestle JR, Drake JM, Cochrane DD, Milner R, Walker ML, Abbott R 3rd, Boop FA (2003) Endoscopic Shunt Insertion Trial participants. Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg 98(2):284–290

    Article  PubMed  Google Scholar 

  15. Knaus H, Abbushi A, Hoffmann KT, Schwarz K, Haberl H, Thomale UW (2009) Measurements of burr-hole localization for endoscopic procedures in the third ventricle in children. Childs Nerv Syst 25(3):293–299

    Article  PubMed  CAS  Google Scholar 

  16. Leonardo J, Hanel RA, Grand W (2009) Endoscopic tracking of a ventricular catheter for entry into the lateral ventricle: technical note. Minim Invasive Neurosurg. 52(5–6):287–289

    Article  PubMed  CAS  Google Scholar 

  17. Lind CR, Tsai AM, Lind CJ, Law AJ (2009) Ventricular catheter placement accuracy in non-stereotactic shunt surgery for hydrocephalus. J Clin Neurosci 16(7):918–920

    Article  PubMed  Google Scholar 

  18. Lind CR, Correia JA, Law AJ, Kejriwal R (2008) A survey of surgical techniques for catheterising the cerebral lateral ventricles. J Clin Neurosci 15(8):886–890

    Article  PubMed  Google Scholar 

  19. Lollis SS, Roberts DW (2008) Robotic catheter ventriculostomy: feasibility, efficacy, and implications. J Neurosurg 108(2):269–274

    Article  PubMed  Google Scholar 

  20. O'Neill BR, Velez DA, Braxton EE, Whiting D, Oh MY (2008) A survey of ventriculostomy and intracranial pressure monitor placement practices. Surg Neurol 70(3):268–273

    Article  PubMed  Google Scholar 

  21. Phillips SB, Gates M, Krishnamurthy S (2012) Strategic placement of bedside ventriculostomies using ultrasound image guidance: report of three cases. Neurocrit Care 17(2):255–259

    Article  PubMed  Google Scholar 

  22. Rehman T, Rehman AU, Rehman A, Bashir HH, Ali R, Bhimani SA, Khan S (2012) A US-based survey on ventriculostomy practices. Clin Neurol Neurosurg 114(6):651–654

    Article  PubMed  Google Scholar 

  23. Reig AS, Stevenson CB, Tulipan NB (2010) CT-based, fiducial-free frameless stereotaxy for difficult ventriculoperitoneal shunt insertion: experience in 26 consecutive patients. Stereotact Funct Neurosurg 88(2):75–80

    Article  PubMed  Google Scholar 

  24. Roth J, Constantini S (2012) Selective use of intra-catheter endoscopic-assisted ventricular catheter placement: indications and outcome. Childs Nerv Syst 28(8):1163–1169

    Article  PubMed  Google Scholar 

  25. Sainte-Rose C, Piatt JH, Renier D, Pierre-Kahn A, Hirsch JF, Hoffman HJ, Humphreys RP, Hendrick EB (1991) Mechanical complications in shunts. Pediatr Neurosurg 17(1):2–9

    Article  PubMed  Google Scholar 

  26. Saladino A, White JB, Wijdicks EF, Lanzino G (2009) Malplacement of ventricular catheters by neurosurgeons: a single institution experience. Neurocrit Care 10(2):248–252

    Article  PubMed  Google Scholar 

  27. Sampath R, Wadhwa R, Tawfik T, Nanda A, Guthikonda B (2012) Stereotactic placement of ventricular catheters: does it affect proximal malfunction rates? Stereotact Funct Neurosurg 90(2):97–103

    Article  PubMed  Google Scholar 

  28. Schulz M, Bohner G, Knaus H, Haberl H, Thomale UW (2010) Navigated endoscopic surgery for multiloculated hydrocephalus in children. J Neurosurg Pediatr 5(5):434–442

    Article  PubMed  Google Scholar 

  29. Sekula RF, Cohen DB, Patek PM, Jannetta PJ, Oh MY (2008) Epidemiology of ventriculostomy in the United States from 1997 to 2001. Br J Neurosurg 22(2):213–218

    Article  PubMed  CAS  Google Scholar 

  30. Stieglitz LH, Giordano M, Samii M, Luedemann WO (2010) A new tool for frameless stereotactic placement of ventricular catheters. Neurosurgery 67(3 Suppl Operative):ons131–ons135

    Article  PubMed  Google Scholar 

  31. Strowitzki M, Komenda Y, Eymann R, Steudel WI (2008) Accuracy of ultrasound-guided puncture of the ventricular system. Childs Nerv Syst 24(1):65–69

    Article  PubMed  CAS  Google Scholar 

  32. Thomale UW, Hosch H, Koch A, Schulz M, Stoltenburg G, Haberl EJ, Sprung C (2010) Perforation holes in ventricular catheters—is less more? Childs Nerv Syst 26(6):781–789

    Article  PubMed  Google Scholar 

  33. Thomale UW, Schlosser HG, Sprung C (2006) A simple solution for navigated placement of CSF catheters in slit-like or displaced ventricles. GMS CURAC 1:Doc 5, http://www.egms.de/de/journals/curac/2006-1/curac000005.shtml

  34. Toma AK, Camp S, Watkins LD, Grieve J, Kitchen ND (2009) External ventricular drain insertion accuracy: is there a need for change in practice? Neurosurgery 65(6):1197–1200

    Article  PubMed  Google Scholar 

  35. Wan KR, Toy JA, Wolfe R, Danks A (2011) Factors affecting the accuracy of ventricular catheter placement. J Clin Neurosci 18(4):485–488

    Article  PubMed  Google Scholar 

  36. Whitehead WE, Jea A, Vachhrajani S, Kulkarni AV, Drake JM (2007) Accurate placement of cerebrospinal fluid shunt ventricular catheters with real-time ultrasound guidance in older children without patent fontanelles. J Neurosurg 107(5 Suppl):406–410

    PubMed  Google Scholar 

  37. Villavicencio AT, Leveque JC, McGirt MJ, Hopkins JS, Fuchs HE, George TM (2003) Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters. Surg Neurol 59(5):375–379

    Article  PubMed  Google Scholar 

  38. Vinchon M, Rekate HL, Kulkarni AV (2012) Pediatric hydrocephalus outcomes: a review. Fluids Barriers CNS 9(1):18

    Article  PubMed  Google Scholar 

  39. Yamada SM, Yamada S, Goto Y, Nakaguchi H, Murakami M, Hoya K, Matsuno A (2012) A simple and consistent technique for ventricular catheter insertion using a tripod. Clin Neurol Neurosurg 114(6):622–626

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    U. W. Thomale, A. Schaumann, S. A. Ahmadi & M. Schulz

  2. Christoph Miethke GmbH, Potsdam, Germany

    T. Knitter & C. Miethke

  3. Reflare UG, Berlin, Germany

    P. Ziegler

  4. Department of Neurosurgery, Heinrich Heine Universität, Düsseldorf, Germany

    S. A. Ahmadi

Authors
  1. U. W. Thomale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Knitter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Schaumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. A. Ahmadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Ziegler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Schulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Miethke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. W. Thomale.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomale, U.W., Knitter, T., Schaumann, A. et al. Smartphone-assisted guide for the placement of ventricular catheters. Childs Nerv Syst 29, 131–139 (2013). https://doi.org/10.1007/s00381-012-1943-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-012-1943-1

Keywords

Search

Navigation