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CT fluoroscopy: novel application for the treatment of ventricular pathologies

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

Recent advances in multidetector CT imaging (MDCT) provide real-time “fluoroscopic-like” capabilities with excellent spatial resolution. MDCT fluoroscopy expands our ability to perform image-guided interventions in anatomically complex locations. Although MDCT fluoroscopy is currently used at our institution for a variety of procedures ranging from spinal nerve blocks to RFA ablation, we believe these same techniques can be used to navigate within the ventricles of the central nervous system to treat conditions requiring placement of intraventricular catheters, depth electrodes, or potentially stents for the relief of CSF outlet obstruction.

Methods

Using three fresh, unfrozen human cadavers, we studied the feasibility of using MDCT fluoroscopy for intraventricular catheter placement and to stent the aqueduct of Sylvius.

Results

The ventricles were entered via a single needle pass and catheters were placed over the wire. Contrast agent was then injected to visualize the distribution. To stent the aqueduct of Sylvius, a wire was passed into the 4th ventricle and a coronary stent was then inserted over the wire and deployed.

Conclusion

Based on our success with these procedures, we believe this technique can be used to limit complications and improve efficacy of a number of neurosurgical procedures.

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References

  1. Katada K, Anno H, Koga S et al (1994) Initial trial with CT fluoroscopy (abstract). Radiology 190(P):662

    Google Scholar 

  2. Katada K, Anno H, Ogura Y et al (1994) Early clinical experience with real-time CT fluoroscopy (abstract). Radiology 193(P):339

    Google Scholar 

  3. Katada K, Anno H, Takeshita G et al (1994) Development of real-time CT fluoroscopy. Nippon Igaku Hoshasen Gakkai Zasshi 54:1172–1174

    PubMed  CAS  Google Scholar 

  4. Katada K, Anno H, Ogura Y et al (1995) Development and early trials of real-time CT fluoroscopy. Neuroradiology [Suppl] 37:587–588

    Google Scholar 

  5. Katada K, Anno H, Ogura Y, Koga S, Nonomura K, Kanno T (1995) Puncture and drainage of intracranial lesions with CT: fluoroscopic guidance (abstract). Radiology 197(P):494

    Google Scholar 

  6. Kato R, Katada K, Anno H, Ida Y, Suetsugu S, Koga S (1995) Transthoracic needle biopsy with real-time CT fluoroscopy (abstract). Radiology 197(P):529

    Google Scholar 

  7. Linn FH, Rinkel GJ, Algra A, Van Gijn J (1996) Incidence of subarachnoid haemorrhage. Role of region year and rate of CT scanning: a meta-analysis. Stroke 27:625–629

    PubMed  CAS  Google Scholar 

  8. Naff NJ, Carhuapoma JR, Williams MA et al (2000) Treatment of intraventricular hemorrhage with urokinase: effects on 30-day survival. Stroke 31:841–847

    PubMed  CAS  Google Scholar 

  9. Naff NJ, Hanley DF, Keyl PM et al (2004) Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind, controlled trial. Neurosurgery 54:577–584

    Article  PubMed  Google Scholar 

  10. Ajshekhar V (2001) Current status of stereotactic biopsy. Stereotact Funct Neurosurg 76:137–139

    Article  Google Scholar 

  11. Boviatsis EJ, Kouyialis AT, Stranjalis G, Korfias S, Sakas DE (2003) CT-guided stereotactic biopsies of brain stem lesions: personal experience and literature review. Neurol Sci 24:97–102

    Article  PubMed  CAS  Google Scholar 

  12. Carlson SK, Bender CE, Oberg AL et al (2001) Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology 219:5515–5520

    Google Scholar 

  13. Kato R, Katada K, Anno H (1996) Radiation dosimetry at CT fluoroscopy: physician’s hand dose and development of needle holders. Radiology 201:576–578

    PubMed  CAS  Google Scholar 

  14. Nickoloff EL, Alderson PO (2001) Radiation exposures to patients from CT. AJR Am J of Roentgenol 177:285–287

    PubMed  CAS  Google Scholar 

  15. Seliem RM, Assaad MW, Gorombey SJ, Moral LA, Kirkwood JR, Otis CN (2003) Fine-needle aspiration biopsy of the central nervous system performed freehand under computed tomography guidance without stereotactic instrumentation. Cancer 99:277–284

    Article  PubMed  Google Scholar 

  16. Gianfelice D, Lepanto L, Perreault P, Chartrand-Lefebvre C, Milette P (2000) Effect of the learning process on procedure times and radiation exposure for CT fluoroscopy-guided percutaneous biopsy procedures. J Vasc Interv Radiol 11:1217–1221

    PubMed  CAS  Google Scholar 

  17. Nawfel RD, Judy PF, Silverman SG, Hooten S, Tuncali K, Adams DF (2000) Patient and personnel exposure during CT fluoroscopy-guided interventional procedures. Radiology 216:180–184

    PubMed  CAS  Google Scholar 

  18. Meleka S, Ajanta P, Minkoff E, Murphy K (2004) Value of computed tomographic fluoroscopy for cervical and lumbar facet blocks. Neurosurg Q 15:14–16

    Article  Google Scholar 

  19. Venbrux AC, Montague BJ, Murphy KP, Bobonis LA, Washington SB, Soltes AP, Frassica FJ (2003) Image-guided percutaneous radiofrequency ablation for osteoid osteomas. J Vasc Interv Radiol 14:375–380

    PubMed  Google Scholar 

  20. Katada K, Kato R, Anno H et al (1996) Guidance with real-time CT fluoroscopy: early clinical experience. Radiology 200:851–856

    PubMed  CAS  Google Scholar 

  21. Daly B, Templeton PA (1999) Real-time CT Fluoroscopy: evolution of an interventional tool. Radiology 211:309–315

    PubMed  CAS  Google Scholar 

  22. Weiss N, Naff N, Hanley D (2003) Prospective study of intraventricular catheter insertions: accuracy of placement and risk of hemorrhage (abstract, April). Article 17694. American Association of Neurological Surgeons. http://www.aans.org/Library/Article.aspx?ArticleId=17694

  23. Tominaga J, Shimoda M, Oda S, Kumasaka A, Yamazaki K, Tsugane R (2001) MR imaging findings after ventricular puncture in patients with SAH. Acta Neurochir (Wien) 143:1133–1140

    Article  CAS  Google Scholar 

  24. Nakajima S, Sampei T, Mizuno M, Suzuki A, Yasui N (1992) Ventricular puncture; is it a safe procedure? No Shinkei Geka 20:349–356

    PubMed  CAS  Google Scholar 

  25. Longatti PL, Martinuzzi A, Fiorindi A, Maistrello L, Carteri A (2004) Neuroendoscopic management of intraventricular hemorrhage. Stroke 35:e35–38

    Article  PubMed  CAS  Google Scholar 

  26. Krotz M, Linsenmaier U, Kanz KG, Pfeifer KJ, Mutschler W, Reiser M (2004) Evaluation of minimally invasive percutaneous CT-controlled ventriculostomy in patients with severe head trauma. Eur Radiol 14:227–233

    Article  PubMed  CAS  Google Scholar 

  27. Sgaramella E, Sotgiu S, Crotti FM (2003) Neuroendoscopy: one year of experience – personal results, observations and limits. Minim Invasive Neurosurg 46:215–219

    Article  PubMed  CAS  Google Scholar 

  28. Smyth MD, Tubbs RS, Wellons JC 3rd, Oakes WJ, Blount JP, Grabb PA (2003) Endoscopic third ventriculostomy for hydrocephalus secondary to central nervous system infection or intraventricular hemorrhage in children. Pediatr Neurosurg 39:258–263

    Article  PubMed  Google Scholar 

  29. Mohanty A (2003) Endoscopic third ventriculostomy with cystoventricular stent placement in the management of Dandy-Walker malformation: technical case report of three patients. Neurosurgery 53:1223–1228; discussion 1228–1229

    Article  PubMed  Google Scholar 

  30. Sgaramella E, Castelli G, Sotgiu S (2004) Chronic subdural collection after endoscopic third ventriculostomy. Acta Neurochir (Wien) 146:529–530

    Article  CAS  Google Scholar 

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Conflict of interest statement

Kieran Murphy receives research funding from Toshiba, the manufacturer of the CT scanner used for this study.

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Authors and Affiliations

  1. Interventional Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA

    Kieran Murphy & Philippe Gailloud

  2. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    David A. Nussbaum

Authors
  1. Kieran Murphy
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  2. David A. Nussbaum
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  3. Philippe Gailloud
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Corresponding author

Correspondence to Kieran Murphy.

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Murphy, K., Nussbaum, D.A. & Gailloud, P. CT fluoroscopy: novel application for the treatment of ventricular pathologies. Neuroradiology 49, 373–378 (2007). https://doi.org/10.1007/s00234-007-0208-2

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  • DOI: https://doi.org/10.1007/s00234-007-0208-2

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