title: Image-guided implantation of pre-calibrated catheters in the ICU: a feasibility study.
abstract: BACKGROUND
  Image-guided implantation of intracranial catheters is a routine procedure. Although time for surgery is short, transport from the intensive care unit (ICU) to the operation room (OR) is time-consuming and endangers patients in vulnerable intracranial pressure phases. Unfortunately, technical aspects of image guidance have so far required surgery to be performed in the operation room. In this observational study we investigated the feasibility of image-guided catheter placement in the ICU using a pre-calibrated stylet for implantation of intracranial catheters for a variety of indications and compare the results of procedures performed in the OR.
  
  
  METHODS
  Twenty-three patients received implantation of 31 image-guided intracranial catheters or external ventricular drains using a pre-calibrated stylet in the ICU or in the OR. The times required for navigation planning, transport and surgery were assessed. Pre-operative trajectory planning, intra-operative screenshots of the navigation system and postoperative computed tomography (CT) scans were compared.
  
  
  RESULTS
  Eleven external ventricular drains and nine intracranial catheters for fibrinolytic therapy of intracerebral haemorrhage were implanted in the OR, whereas ten external ventricular drains and one catheter for fibrinolytic therapy were implanted in the ICU. All catheters implanted on the ICU, 81.8 % of external ventricular drains and 88.8 % of lysis catheters placed in the OR had an optimal position to function.
  
  
  CONCLUSIONS
  A pre-calibrated stylet in combination with the flexible headband equipped with reference arrays allows the application of image guidance in the ICU. It reduced time expended for patients and employees, and avoided the risks of ICU transport to the OR.
authors.affiliation: Department of Neurosurgery, Johannes-Gutenberg-University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. naureen.keric@unimedizin-mainz.de
authors.forename: Naureen
authors.initials: N
authors.lastname: Keric
authors.forename: Axel
authors.initials: A
authors.lastname: Neulen
authors.forename: Sven Rainer
authors.initials: SR
authors.lastname: Kantelhardt
authors.forename: Alf
authors.initials: A
authors.lastname: Giese
mesh_terms: D057785:Catheters; D004322:Drainage / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D038361:Neuronavigation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome