title: Ultrasound-guided neuronavigation improves safety of ventricular catheter insertion in preterm infants.
abstract: BACKGROUND
  Intra-ventricular hemorrhage (IVH) is a frequent cause of shunt-dependent hydrocephalus. The management of IVH in preterm babies remains a challenge both for neonatologists and pediatric neurosurgeons, compounded by the lack of low-risk, validated therapy techniques.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the feasibility and safety of a novel technique involving the ultrasound-guided placement of a central catheter connected with a Rickham-Capsule in a cohort of preterm, low-birth-weight babies with post-hemorrhagic hydrocephalus (PHH).
  
  
  METHODS
  Eight preterm infants with PHH in which a Rickham-Capsule was placed from 2008-2012 were included. Conventional surgical techniques were used in four preterm infants; whereas in the other four preterm babies ultrasound guided catheter placement was performed with an 8 MegaHertz (MHz) micro convex transducer from LOGIQ 9, GE Healthcare; whereby the anterior fontanel was used as an acoustic window.
  
  
  RESULTS
  Overall gestational age was 24-31 weeks, mean age at operation was 20.1 (7-36) days, mean birth weight 972.5±370 g, mean weight at first surgical intervention 1023.75±400.4 g. Six patients had bilateral IVH II-III°, two patients had parenchymal involvement. Using the conventional approach, incorrect catheter placement occurred in one of four patients below 1000 g, whereas none of the ultrasound guided cases needed correction.
  
  
  CONCLUSIONS
  Ultrasound-guided neuronavigation represents a relevant tool in the treatment of hydrocephalus in preterm infants through increased accuracy in placement of a central catheter connected to a Rickham-Capsule. The benefit of utilizing this form of neuronavigation needs to be assessed through corresponding standardized studies.
authors.affiliation: Department of Pediatrics, University of Erlangen-Nuremberg, Germany. Electronic address: Nicole.heussinger@uk-erlangen.de.
authors.forename: Nicole
authors.initials: N
authors.lastname: Heussinger
authors.forename: Ilker Y
authors.initials: IY
authors.lastname: Eyüpoglu
authors.forename: Oliver
authors.initials: O
authors.lastname: Ganslandt
authors.forename: Stephanie
authors.initials: S
authors.lastname: Finzel
authors.forename: Regina
authors.initials: R
authors.lastname: Trollmann
authors.forename: Jörg
authors.initials: J
authors.lastname: Jüngert
mesh_terms: D002404:Catheterization / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000150:complications; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D038361:Neuronavigation / Q000379:methods*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*; D017287:Ventriculoperitoneal Shunt