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首页> 外文期刊>British journal of neurosurgery >Trajectories for frontal external ventricular drain placement: Virtual cannulation of adults with acute hydrocephalus
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Trajectories for frontal external ventricular drain placement: Virtual cannulation of adults with acute hydrocephalus

机译：额叶外脑室引流的轨迹：成人急性脑积水的虚拟插管

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Objectives. External ventricular drains (EVDs) are commonly placed freehand using targeting landmarks unchanged since the pre-CT era; it is known to be an inaccurate procedure. To our knowledge, this is the first study to assess the geometric reliability of specific trajectories in a three-dimensional model. Design. Three-dimensional volume reconstruction of EVD trajectories in a Stealth Station S7. Subjects. Adults with a primary EVD sited for acute hydrocephalus secondary to spontaneous subarachnoid haemorrhage with CT angiography less than 24 hours previously. Methods. CT angiograms from 10 consecutive patients meeting the inclusion criteria were reconstructed. The surgical planning tool was used to construct three trajectories from Kocher's point: i) perpendicular to the skull (PTS) ii) towards the ipsilateral medial canthus coronally and the external auditory meatus sagitally (IMC) iii) towards the contralateral medial canthus coronally and the external auditory meatus sagitally (CMC). Their engagement with the frontal horn of the ipsilateral lateral ventricle (FILV) and distance from the ventricular wall and foramen of Monro were measured. Results. Mean supratentorial ventricular volume was 55.8 cc (range 35.283.4 cc). The IMC met the FILV in only one patient, on average missing the ventricular wall by 5.5±2.3 degrees (95% confidence interval). CMC and PTS met the FILV in 9 and 10 cases, respectively. Mean engagement was 16.3±5.1 mm (95% confidence interval) for PTS and 20.0±7.1 mm (95% confidence interval) for CMC. CMC and PTS gave significantly better engagement and aiming error margins than the IMC trajectory. Conclusions. Despite its widespread use, the IMC trajectory performed poorly; PTS and CMC trajectories are more reliable ways of targeting the FILV when placing an EVD.
机译：目标。自CT时代以来，通常使用目标地标徒手放置外部心室引流（EVD）;已知这是不准确的过程。据我们所知，这是第一个评估三维模型中特定轨迹的几何可靠性的研究。设计。隐身站S7中EVD轨迹的三维体积重建。主题。原发性EVD的成年人发生于自发蛛网膜下腔出血继发的急性脑积水，CT血管造影术少于24小时。方法。重建了符合纳入标准的10例连续患者的CT血管造影照片。手术计划工具用于从Kocher角度构造三个轨迹：i）垂直于颅骨（PTS）ii）朝向同侧内侧角膜冠状和外耳道矢状向（IMC）iii）朝向对侧内侧角膜冠状和矢状外耳道（CMC）。测量它们与同侧侧脑室（FILV）的前角的接合以及与室壁和门罗孔的距离。结果。室上平均心室容积为55.8 cc（范围35.283.4 cc）。 IMC仅在一名患者中符合FILV，平均缺失室壁5.5±2.3度（95％置信区间）。 CMC和PTS分别在9例和10例中符合FILV。 PTS的平均参与度为16.3±5.1毫米（95％置信区间），CMC的平均参与度为20.0±7.1毫米（95％置信区间）。与IMC轨迹相比，CMC和PTS提供了更好的接合和瞄准误差。结论尽管已被广泛使用，但IMC的轨迹仍然表现不佳。 PTS和CMC轨迹是放置EVD时瞄准FILV的更可靠方法。

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