Ultrasound-Guided Insertion of the Ventricular Catheter in Ventriculoperitoneal Shunt Surgery: Evaluation of Accuracy and Feasibility in a Prospective Cohort

2020 ◽  
Vol 82 (01) ◽  
pp. 009-017
Author(s):  
Severina Leu ◽  
Maria Kamenova ◽  
Luigi Mariani ◽  
Jehuda Soleman
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Perioperative Complications ◽  
Univariate Analysis ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
Anatomical Landmarks ◽  
Ultrasound Guided ◽  
The Us ◽  
Evans Index ◽  
Shunt Survival

Abstract Objective Ventriculoperitoneal shunt (VPS) placement is one of the most frequent neurosurgical procedures. The position of the proximal catheter is important for shunt survival. Shunt placement is done either without image guidance (“freehand”) according to anatomical landmarks or by use of various image-guided techniques. Studies evaluating ultrasound-guided (US-G) VPS placement are sparse. We evaluate the accuracy and feasibility of US-G VPS placement, and compare it to freehand VPS placement. Methods We prospectively collected data of consecutive patients undergoing US-G VPS placement. Thereafter, the US cohort was compared with a cohort of patients in whom VPS was inserted using the freehand technique (freehand cohort). Primary outcome was accuracy of catheter positioning, and secondary outcomes were postoperative improvement in Evans' index (EI), rates of shunt dysfunction and revision surgery, perioperative complications, as well as operation, and anesthesia times. Results We included 15 patients undergoing US-G VPS insertion. Rates of optimally placed shunts were higher in the US cohort (67 vs. 49%, p = 0.28), whereas there were no malpositioned VPS (0%) in the US cohort, compared with 10 (5.8%) in the freehand cohort (p = 0.422). None of the factors in the univariate analysis showed significant association with nonoptimal (NOC) VPS placement in the US cohort. The mean EI improvement was significantly better in the US cohort than in the freehand cohort (0.043 vs. 0.014, p = 0.035). Conclusion Based on our preliminary results, US-G VPS placement seems to be feasible, safe, and increases the rate of optimally placed catheters.

No significant improvement in the rate of accurate ventricular catheter location using ultrasound-guided CSF shunt insertion: a prospective, controlled study by the Hydrocephalus Clinical Research Network

2013 ◽  
Vol 12 (6) ◽  
pp. 565-574 ◽  
Author(s):  
William E. Whitehead ◽  
Jay Riva-Cambrin ◽  
John C. Wellons ◽  
Abhaya V. Kulkarni ◽  
Richard Holubkov ◽  
...  
Keyword(s):  
Ultrasound Image ◽  
Intraoperative Ultrasound ◽  
Research Network ◽  
Ventricular Catheter ◽  
Ultrasound Guided ◽  
Shunt Insertion ◽  
Frontal Horn ◽  
Catheter Tip ◽  
Shunt Survival ◽  
Catheter Location

Object Cerebrospinal fluid shunt ventricular catheters inserted into the frontal horn or trigone are associated with prolonged shunt survival. Developing surgical techniques for accurate catheter insertion could, therefore, be beneficial to patients. This study was conducted to determine if the rate of accurate catheter location with intraoperative ultrasound guidance could exceed 80%. Methods The authors conducted a prospective, multicenter study of children (< 18 years) requiring first-time treatment for hydrocephalus with a ventriculoperitoneal shunt. Using intraoperative ultrasound, surgeons were required to target the frontal horn or trigone for catheter tip placement. An intraoperative ultrasound image was obtained at the time of catheter insertion. Ventricular catheter location, the primary outcome measure, was determined from the first postoperative image. A control group of patients treated by nonultrasound surgeons (conventional surgeons) were enrolled using the same study criteria. Conventional shunt surgeons also agreed to target the frontal horn or trigone for all catheter insertions. Patients were triaged to participating surgeons based on call schedules at each center. A pediatric neuroradiologist blinded to method of insertion, center, and surgeon determined ventricular catheter tip location. Results Eleven surgeons enrolled as ultrasound surgeons and 6 as conventional surgeons. Between February 2009 and February 2010, 121 patients were enrolled at 4 Hydrocephalus Clinical Research Network centers. Experienced ultrasound surgeons (> 15 cases prior to study) operated on 67 patients; conventional surgeons operated on 52 patients. Experienced ultrasound surgeons achieved accurate catheter location in 39 (59%) of 66 patients, 95% CI (46%–71%). Intraoperative ultrasound images were compared with postoperative scans. In 32.7% of cases, the catheter tip moved from an accurate location on the intraoperative ultrasound image to an inaccurate location on the postoperative study. This was the most significant factor affecting accuracy. In comparison, conventional surgeons achieved accurate location in 24 (49.0%) of 49 cases (95% CI [34%–64%]). The shunt survival rate at 1 year was 70.8% in the experienced ultrasound group and 66.9% in the conventional group (p = 0.66). Ultrasound surgeons had more catheters surrounded by CSF (30.8% vs 6.1%, p = 0.0012) and away from the choroid plexus (72.3% vs 58.3%, p = 0.12), and fewer catheters in the brain (3% vs 22.4%, p = 0.0011) and crossing the midline (4.5% vs 34.7%, p < 0.001), but they had a higher proportion of postoperative pseudomeningocele (10.1% vs 3.8%, p = 0.30), wound dehiscence (5.8% vs 0%, p = 0.13), CSF leak (10.1% vs 1.9%, p = 0.14), and shunt infection (11.6% vs 5.8%, p = 0.35). Conclusions Ultrasound-guided shunt insertion as performed in this study was unable to consistently place catheters into the frontal horn or trigone. The technique is safe and achieves outcomes similar to other conventional shunt insertion techniques. Further efforts to improve accurate catheter location should focus on prevention of catheter migration that occurs between intraoperative placement and postoperative imaging. Clinical trial registration no.: NCT01007786 (ClinicalTrials.gov).

scholarly journals Intraoperative Ultrasound Guided compared to Stereotactic Navigated Ventriculoperitoneal Shunt Placement: Study Protocol for a Randomized Controlled Study

2021 ◽  
Author(s):  
Severina Leu ◽  
Florian Halbeisen ◽  
Luigi Mariani ◽  
Jehuda Soleman
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Intraoperative Ultrasound ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
Shunt Placement ◽  
Randomized Controlled ◽  
Prospective Comparison ◽  
Development Data

Abstract Background Ventriculoperitoneal shunt (VPS) placement is one of the most frequent neurosurgical procedures. The position of the proximal ventricular catheter is important since it influences shunt functioning and survival. With freehand placement rates of malpositioned VPS are still high. Several navigation techniques for improvement of shunt placement have been development. Data comparing these techniques is sparse. The aim of this study is to prospectively compare ultrasound (US) guided to stereotactic navigated shunt placement with the focus on safety and feasibility. Methods In this prospective randomized, single-centre study we include all patients undergoing VPS placement in our clinic. The patients are randomized into two groups, one group undergoing US guided and the other group stereotactic navigated VPS placement. The study primarily seeks to compare the surgical intervention time between the two methods. Secondary objectives are different aspects of feasibility and safety of both methods. Discussion To date, there is no data available about the prospective comparison of these navigation techniques regarding feasibility and safety. A randomized controlled study is urgently needed in order to provide class I evidence for the best possible treatment of this large group of patients.

Image Guidance in Ventricular Cerebrospinal Fluid Shunt Catheter Placement

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. 321-331 ◽  
Author(s):  
Cody L. Nesvick ◽  
Nickalus R. Khan ◽  
Gautam U. Mehta ◽  
Paul Klimo
Keyword(s):  
Image Guidance ◽  
Meta Analysis ◽  
Catheter Placement ◽  
Frameless Stereotaxy ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
Shunt Failure ◽  
Premature Failure ◽  
Shunt Catheter ◽  
Shunt Survival

Abstract BACKGROUND: Ventricular shunt placement for treating hydrocephalus is one of the most common neurosurgical procedures. The rate of shunt failure, however, has not appreciably changed with time. OBJECTIVE: To investigate whether intraoperative image guidance using ultrasound or stereotaxy contributes to accurate shunt catheter placement and survival. METHODS: We performed a systematic literature review using PubMed and MEDLINE databases for studies that use ultrasound and frameless stereotaxy for ventricular catheter placement for hydrocephalus. All articles assessed the accuracy of catheter tip placement and/or overall shunt survival, and the rate of accurate shunt catheter placement, the overall failure rate, and the average time to shunt failure were extracted for analysis. RESULTS: Although each modality (ultrasound/stereotaxy) did not increase catheter placement accuracy, a combined random-effects meta-analysis of 738 catheters (136 guided by ultrasound, 168 guided by frameless stereotaxy, and 434 freehand) demonstrated a weak benefit of image guidance (risk ratio: 1.19, 95% confidence interval: 1.02-1.39, P = .02), but this result was limited by considerable heterogeneity among studies (I2 = 86%, P &lt; .001 by Cochrane's Q test). A meta-analysis could not be performed for shunt survival due to heterogeneity in data reporting. CONCLUSION: Although image guidance offers a promising solution to lower the risk of inaccurate catheter placement, which could lead to lower premature failure of ventricular shunts, our review demonstrated that there is not yet a clear benefit of these technologies. Current literature is limited to case series and cohort studies, and significant between-study heterogeneity in methodology and reporting currently limits a higher order analysis.

scholarly journals Ultrasound-guided implantation of radioactive 125I seed in radioiodine refractory differentiated thyroid carcinoma

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Chen ◽  
Yu kun Luo ◽  
Ying Zhang ◽  
Qing Song ◽  
Jie Tang
Keyword(s):  
Thyroid Carcinoma ◽  
Reduction Rate ◽  
Differentiated Thyroid Carcinoma ◽  
Comprehensive Treatment ◽  
Efficacy And Safety ◽  
Ultrasound Guided ◽  
Contrast Enhanced ◽  
The Us ◽  
Median Volume

Abstract Background Treatment for radioiodine refractory differentiated thyroid carcinoma (RR-DTC) is challenging. The purpose of this study was to assess the efficacy and safety of ultrasound-guided implantation of radioactive 125I-seed in radioiodine refractory differentiated thyroid carcinoma. Methods Thirty-six cervical metastatic lymph nodes (CMLNs) diagnosed with RR-DTC from 18 patients were enrolled in this retrospective study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before implantation. Follow-up comprised US, CEUS, thyroglobulin (Tg) level and routine hematology at 1–3, 6, 9 and 12 months and every 6 months thereafter. The volumes of the nodules were compared before implantation and at each follow-up point. The volume reduction rate (VRR) of nodules was also recorded. Results The median volume of the nodules was 523 mm3 (148, 2010mm3) initially, which decreased significantly to 53mm3 (0, 286mm3) (P < 0.01) at the follow-up point of 24 months with a median VRR as 95% (86,100%). During the follow-up period (the range was 24–50 months), 25 (69%) nodules had VRR greater than 90%, of which 12 (33%) nodules had VVR ≈ 100% with unclear structures and only 125I seed images were visible in the US. At the last follow-up visit, the serum Tg level decreased from 57.0 (8.6, 114.8) ng/ml to 4.9 (0.7, 50.3) ng/ml, (P < 0.01). Conclusion US-guided 125I seed implantation is safety and efficacy in treating RR- DTC. It could be an effective supplement for the comprehensive treatment of thyroid cancer.

scholarly journals Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program–Pediatrics

2017 ◽  
Vol 19 (3) ◽  
pp. 361-371 ◽  
Author(s):  
Benjamin J. Kuo ◽  
Joao Ricardo N. Vissoci ◽  
Joseph R. Egger ◽  
Emily R. Smith ◽  
Gerald A. Grant ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Univariate Analysis ◽  
Patient Characteristics ◽  
Quality Improvement Program ◽  
Neurosurgical Procedures ◽  
Continuous Variables ◽  
Improvement Program ◽  
Surgical Quality ◽  
Defect Repair

OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program–Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012–2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas admission from outside hospital transfer was a significant predictor of any AE for all procedure groups except craniotomy/craniectomy. CONCLUSIONS This analysis of NSQIP-Peds, a large risk-adjusted national data set, confirms low perioperative mortality but high morbidity for pediatric neurosurgical procedures. These data provide a baseline understanding of current expected clinical outcomes for pediatric neurosurgical procedures, identify the need for collecting neurosurgery-specific risk factors and complications, and should support targeted QI programs and clinical management interventions to improve care of children.

Effect of Intraoperative Computed Tomography on Ventriculoperitoneal Shunt Survival

2021 ◽  
Author(s):  
Pulat Akin Sabanci ◽  
Tugrul Cem Unal ◽  
Onur Ozturk ◽  
Duygu Dolen ◽  
Ilyas Dolas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ventriculoperitoneal Shunt ◽  
Intraoperative Computed Tomography ◽  
Shunt Survival

Diagnostic block and radiofrequency ablation of the acromial branches of the lateral pectoral and suprascapular nerves for shoulder pain: a 3D cadaveric study

2021 ◽  
Vol 46 (4) ◽  
pp. 305-312
Author(s):  
John Tran ◽  
Philip Peng ◽  
Anne Agur ◽  
Nimish Mittal
Keyword(s):  
Radiofrequency Ablation ◽  
Shoulder Pain ◽  
Coracoid Process ◽  
Electrode Position ◽  
Anatomical Landmarks ◽  
Ultrasound Guided ◽  
Pectoral Nerve ◽  
Diagnostic Block ◽  
Superior Surface ◽  
Capture Rates

Background and objectivesAcromial branches of the lateral pectoral and suprascapular nerves have been proposed as targets for diagnostic block and radiofrequency ablation to treat superior shoulder pain; however, the nerve capture rates of these procedures have not been investigated. The objectives of this study were to use dissection and 3D modeling technology to determine the course of these acromial branches, relative to anatomical landmarks, and to evaluate nerve capture rates using ultrasound-guided dye injection and lesion simulation.MethodsUltrasound-guided dye injections, targeting the superior surface of coracoid process and floor of supraspinous fossa, were performed (n=5). Furthermore, needles targeting the superior and posterior surfaces of the coracoid process were placed under ultrasound guidance to simulate needle electrode position (n=5). Specimens were dissected, digitized, and modeled to determine capture rates of acromial branches of lateral pectoral and suprascapular nerves.ResultsThe course of acromial branches of lateral pectoral and suprascapular nerves were documented. Dye spread capture rates: acromial branches of lateral pectoral and suprascapular nerves were captured in all specimens. Lesion simulation capture rates: (1) when targeting superior surface of coracoid process, the entire acromial branch of lateral pectoral nerve was captured in all specimens and (2) when targeting posterior surface of coracoid process, the acromioclavicular and bursal branches of acromial branch of suprascapular nerve were captured in all specimens; coracoclavicular branch was captured in 3/5 specimens.ConclusionsThis study supports the anatomical feasibility of ultrasound-guided targeting of the acromial branches of lateral pectoral and suprascapular nerves. Further clinical investigation is required.

scholarly journals Paediatric bacterial meningitis in the USA: outcomes and healthcare resource utilization of nosocomial versus community-acquired infection

2020 ◽  
Author(s):  
Syed M. Adil ◽  
Sarah E. Hodges ◽  
Lefko T. Charalambous ◽  
Musa Kiyani ◽  
Beiyu Liu ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Hospital Mortality ◽  
Resource Utilization ◽  
Cerebral Oedema ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
The Usa ◽  
Multivariable Regression

Introduction. Paediatric bacterial meningitis remains a costly disease, both financially and clinically. Hypothesis/Gap Statement. Previous epidemiological and cost studies of bacterial meningitis (BM) have largely focused on adult populations or single pathogens. There have been few recent, large-scale studies of pediatric BM in the USA. Aim. We examined healthcare resource utilization (HCRU) and associated morbidity and mortality of community-acquired versus nosocomial bacterial infections in children across the USA. Methodology. The IBM MarketScan Research databases were used to identify patients <18 years old admitted to USA hospitals from 2008 to 2015 with a primary diagnosis of BM. Cases were categorized as either community-acquired or nosocomial. HCRU, post-diagnosis neurosurgical procedures, 30-day in-hospital mortality, and complications were compared between groups. Multivariable regression adjusted for sex, age and Gram staining was used to compare costs of nosocomial versus community-acquired infections over time. Results. We identified 1928 cases of paediatric BM without prior head trauma or neurological/systemic complications. Of these, 15.4 % were nosocomial and 84.6 % were community-acquired infections. After diagnostic lumbar puncture (37.1 %), the most common neurosurgical procedure was placement of ventricular catheter (12.6 %). The 30-day complication rates for nosocomial and community-acquired infections were 40.5 and 45.9 %, respectively. The most common complications were hydrocephalus (20.8 %), intracranial abscess (8.8 %) and cerebral oedema (8.1 %). The 30-day in-hospital mortality rates for nosocomial and community-acquired infections were 2.7 and 2.8 %, respectively. Median length of admission was 14.0 days (Q1: 7 days, Q3: 26 days). Median 90-day cost was $40 861 (Q1: $11 988, Q3: $114,499) for the nosocomial group and $56 569 (Q1: $26 127, Q3: $142 780) for the community-acquired group. In multivariable regression, the 90-day post-diagnosis total costs were comparable between groups (cost ratio: 0.89; 95 % CI: 0.70 to 1.13), but at 2 years post-diagnosis, the nosocomial group was associated with 137 % higher costs (CR: 2.37, 95 % CI: 1.51 to 3.70). Conclusion. In multivariable analysis, nosocomial infections were associated with significantly higher long-term costs up to 2 years post-infection. Hydrocephalus, intracranial epidural abscess and cerebral oedema were the most common complications, and lumbar punctures and ventricular catheter placement were the most common neurosurgical procedures. This study represents the first nation-wide, longitudinal comparison of the outcomes and considerable HCRU of nosocomial versus community-acquired paediatric BM, including characterization of complications and procedures contributing to the high costs of these infections.

scholarly journals Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jingyang Sun ◽  
Bohan Zhang ◽  
Lei Geng ◽  
Qingyuan Zheng ◽  
Juncheng Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Influencing Factors ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Femoral Stem ◽  
Femoral Anteversion ◽  
Total Hip

Abstract Background Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. Methods We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10–30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. Results After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, −9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. Conclusions This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

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