Dataset Information

Integrated flat detector CT and live fluoroscopic-guided external ventricular drain placement within the neuroangiography suite.

ABSTRACT:

Purpose

To demonstrate the feasibility of the application of integrated flat detector (FD) CT and fluoroscopic guidance (iGuide) for the placement of external ventricular drains (EVD) within the neuroangiography suite.

Methods

A retrospective review of a prospectively maintained endovascular database identified six patients who underwent EVD placement using iGuide. Patient characteristics, operator, number of passes, accuracy of placement, immediate and delayed periprocedural complications and radiation exposure were assessed.

Results

Five patients with subarachnoid hemorrhage and one patient with a large cerebellar infarct (average age 45.5 years (range 39-53), four women) underwent EVD placement within the angiography suite using iGuide. Four procedures were performed by a neuroradiologist and two by a neurosurgeon. All catheters were placed with a single pass and all terminated within the frontal horn of the ipsilateral lateral ventricle. No parenchymal or intraventricular hemorrhages were encountered after catheter placement. No patients experienced any immediate or delayed periprocedural complications. Radiation exposure related to the FD CTs required for placement was 593.7?mGy (range 539-673).

Conclusions

EVD placement under combined CT and fluoroscopic control within the neuroangiography suite is feasible. The technique predictably allows optimized EVD catheter placement with a single pass. We propose that this technique could improve the accuracy, and potentially reduce the complications, of EVD insertion in cerebrovascular patients.

SUBMITTER: Fiorella D

PROVIDER: S-EPMC4112487 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Publications

Integrated flat detector CT and live fluoroscopic-guided external ventricular drain placement within the neuroangiography suite.

Fiorella David D Peeling Lissa L Denice Christine M CM Sarmiento Marily M Woo Henry H HH

Journal of neurointerventional surgery 20130726 6

<h4>Purpose</h4>To demonstrate the feasibility of the application of integrated flat detector (FD) CT and fluoroscopic guidance (iGuide) for the placement of external ventricular drains (EVD) within the neuroangiography suite.<h4>Methods</h4>A retrospective review of a prospectively maintained endovascular database identified six patients who underwent EVD placement using iGuide. Patient characteristics, operator, number of passes, accuracy of placement, immediate and delayed periprocedural comp ...[more]

PMID: 23892444

Similar Datasets

Project description:BackgroundSurvivors of aneurysmal subarachnoid hemorrhage (SAH) face a protracted intensive care unit (ICU) course and are at risk for developing refractory hydrocephalus with the need for a permanent ventriculoperitoneal shunt (VPS). Management of the external ventricular drain (EVD) used to provide temporary cerebrospinal fluid diversion may influence the need for a VPS, ICU length of stay (LOS), and drain complications, but the optimal EVD management approach is unknown. Therefore, we sought to determine the effect of EVD discontinuation strategy on VPS rate.MethodsThis was a prospective multicenter observational study at six neurocritical care units in the United States. The target population included adults with suspected aneurysmal SAH who required an EVD. Patients were preassigned to rapid or gradual EVD weans based on their treating center. The primary outcome was the rate of VPS placement. Secondary outcomes were EVD duration, ICU LOS, hospital LOS, and drain complications.ResultsA rapid EVD wean protocol was associated with a lower rate of VPS placement, including a delayed posthospitalization shunt, in an adjusted Cox proportional analysis (hazard ratio 0.52 [p = 0.041]) and adjusted logistic regression model (odds ratio 0.43 [95% confidence interval 0.18-1.03], p = 0.057). A rapid wean was also associated with 2.1 fewer EVD days (p = 0.007) and saved an estimated 2.5 ICU days (p = 0.049), as compared with a gradual wean protocol. There were fewer nonfunctioning EVDs in the rapid group (odds ratio 0.32 [95% confidence interval 0.11-0.92]). Furthermore, we found that the time to first wean and the number of weaning attempts were important independent covariates that affected the likelihood of receiving a VPS and the duration of ICU admission.ConclusionsA rapid EVD wean was associated with decreased rates of VPS placement, decreased ICU LOS, and decreased drain complications in survivors of aneurysmal SAH. These findings suggest that a randomized multicentered controlled study comparing rapid vs. gradual EVD weaning protocols is justified.

Dataset Information

Integrated flat detector CT and live fluoroscopic-guided external ventricular drain placement within the neuroangiography suite.

Purpose

Methods

Results

Conclusions

Publications

Integrated flat detector CT and live fluoroscopic-guided external ventricular drain placement within the neuroangiography suite.

Similar Datasets

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