title: Integrated flat detector CT and live fluoroscopic-guided external ventricular drain placement within the neuroangiography suite.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurological Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Fiorella
authors.affiliation: Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Lissa
authors.initials: L
authors.lastname: Peeling
authors.affiliation: Department of Neurological Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Denice
authors.affiliation: Seimens Medical Imaging, Erlangen, Germany.
authors.forename: Marily
authors.initials: M
authors.lastname: Sarmiento
authors.affiliation: Department of Neurological Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
authors.forename: Henry H
authors.initials: HH
authors.lastname: Woo
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000601:surgery; D002404:Catheterization; D002526:Cerebellar Diseases / Q000601:surgery; D002552:Cerebral Ventricles / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods*
keywords: Intracranial Pressure; Navigation; Subarachnoid; Technology
references.citation: Br J Neurosurg. 2010 Dec;24(6):625-32
references.pmid: 20854058
references.citation: Neurocrit Care. 2009;10(2):241-7
references.pmid: 18449808
references.citation: J Neurosurg. 2008 Jan;108(1):88-91
references.pmid: 18173315
references.citation: J Neurosurg. 2010 Oct;113(4):901-7
references.pmid: 20225920
references.citation: Neurosurgery. 2012 May;70(5):1258-63; discussion 1263-4
references.pmid: 22067423
references.citation: Neurosurgery. 2009 Dec;65(6):1197-200; discussion 1200-1
references.pmid: 19934980
references.citation: Neurosurgery. 2005 Nov;57(5):845-9; discussion 845-9
references.pmid: 16284554
references.citation: Acta Neurochir (Wien). 2012 Jan;154(1):153-9
references.pmid: 21892637
references.citation: Acta Neurol Belg. 2011 Mar;111(1):22-8
references.pmid: 21510229
references.citation: Surg Neurol. 2008 Sep;70(3):268-73; discussion 273
references.pmid: 18207539
references.citation: Eur Radiol. 2009 Mar;19(3):619-25
references.pmid: 18813932
references.citation: Clin Neurol Neurosurg. 2012 Jul;114(6):651-4
references.pmid: 22257519
references.citation: Neurosurgery. 2006 Oct;59(4 Suppl 2):ONS419-24; discussion ONS424-5
references.pmid: 17041512
references.citation: Neurosurgery. 2013 Jun;72(2 Suppl Operative):ons208-13; discussion ons213
references.pmid: 23149976
references.citation: Neurosurgery. 2008 Jul;63(1 Suppl 1):ONS162-6; discussion ONS166-7
references.pmid: 18728595
references.citation: J Neurosurg. 2009 May;110(5):1021-5
references.pmid: 19199471
references.citation: Curr Neurol Neurosci Rep. 2012 Feb;12(1):24-33
references.pmid: 22002766