Intraoperative ultrasound-guided ventricular cannulation in patients with normal-sized ventricles

Unal T. C., Dolas İ., Sahin D., Gulsever C. İ., Dolen D., Aras Y., ...Daha Fazla

NEUROCHIRURGIE, cilt.69, sa.5, 2023 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 69 Sayı: 5
  • Basım Tarihi: 2023
  • Doi Numarası: 10.1016/j.neuchi.2023.101463
  • Dergi Adı: NEUROCHIRURGIE
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, PASCAL
  • Anahtar Kelimeler: Idiopathic intracranial hypertension, Intraoperative ultrasound, Leptomeningeal metastases, Neuronavigation, Ommaya reservoir, Slit ventricles, Ventriculoperitoneal shunt
  • İstanbul Üniversitesi Adresli: Evet

Özet

Introduction. - Many pathologies require normal-sized ventricle cannulation, which may be technically challenging even with neuronavigation guidance. This study presents a series of ventricular cannulation of normal-sized ventricles using intraoperative ultrasound (iUS) guidance and the outcomes of patients treated by this technique, for the first time. Methods. - The study included patients who underwent ultrasound-guided ventricular cannulation of normal-sized ventricles (either ventriculoperitoneal (VP) shunting or Ommaya reservoir) between January 2020 and June 2022. All patients underwent iUS-guided ventricular cannulation from the right Kocher's point. The inclusion criteria for normal-sized ventricles were as follows: (1) Evans index < 30%, and (2) widest third ventricle diameter < 6 mm. Medical records and pre-, intra- and post-operative imaging were retrospectively analyzed. Results. - Nine of the 18 included patients underwent VP shunt placement; 6 had idiopathic intracranial hypertension (IIH), 2 had resistant cerebrospinal fluid fistula following posterior fossa surgery, and 1 had iatrogenic intracranial pressure elevation following foramen magnum decompression. Nine patients underwent Ommaya reservoir implantation, 6 of whom had breast carcinoma and leptomeningeal metastases and 3 hematologic disease and leptomeningeal infiltration. All catheter tip positions were achieved in a single attempt, and none were placed suboptimally. Mean follow-up was 10 months. One IIH patient (5.5%) had early shunt infection which necessitated shunt removal. Conclusion. - iUS is a simple and safe method for accurate cannulation of normal-sized ventricles. It provides an effective real-time guidance option for challenging punctures. & COPY; 2023 Elsevier Masson SAS. All rights reserved.