title: Efficacy of the Ghajar Guide revisited: a prospective study.
abstract: OBJECTIVE
  The goal of this study was to compare the freehand technique of catheter placement using external landmarks with the technique of using the Ghajar Guide for this procedure. The placement of a ventricular catheter can be a lifesaving procedure, and it is commonly performed by all neurosurgeons. Various methods have been described to cannulate the ventricular system, including the modified Friedman tunnel technique in which a soft polymeric tube is inserted through a burr hole. Paramore, et al., have noted that two thirds of noninfectious complications have been related to incorrect positioning of the catheter.
  
  
  METHODS
  Forty-nine consecutive patients were randomized between either freehand or Ghajar Guide-assisted catheter placement. The target was the foramen of Monro, and the course was through the anterior horn of the lateral ventricle approximately 10 cm above the nasion, 3 cm from the midline, to a depth of 5.5 cm from the inner table of the skull. In all cases, the number of passes was recorded for successful cannulation, and pre- and postplacement computerized tomography scans were obtained. Calculations were performed to determine the bicaudate index and the distance from the catheter tip to the target point.
  
  
  CONCLUSIONS
  Successful cannulation was achieved using either technique; however, the catheters placed using the Ghajar Guide were closer to the target.
authors.affiliation: Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. nssho@neuro.hfh.edu
authors.forename: S T
authors.initials: ST
authors.lastname: O'Leary
authors.forename: M K
authors.initials: MK
authors.lastname: Kole
authors.forename: D A
authors.initials: DA
authors.lastname: Hoover
authors.forename: S E
authors.initials: SE
authors.lastname: Hysell
authors.forename: A
authors.initials: A
authors.lastname: Thomas
authors.forename: C I
authors.initials: CI
authors.lastname: Shaffrey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002552:Cerebral Ventricles / Q000473:pathology; D004867:Equipment Design; D005260:Female; D006801:Humans; D020547:Lateral Ventricles / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019291:Skull Base / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014696:Ventriculostomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods