徒手脑室插管精确性分析

Accuracy of barehanded ventricular catheter ization

目的分析徒手经额脑室插管(ventricular catheter,VC)的精确性。方法回顾性分析自2002-05至2010-11空军总医院神经外科130例患者146侧徒手VC术后CT影像9,8例为脑室腹腔或心房分流术3,2例为脑室外引流置管。为了评估插管尖位置,笔者使用改良的Kakarla分级方法:1级,位于Monro孔前侧脑室额角内;2级,位于除同侧额角外的侧脑室或三脑室内,具有引流功能;3级,位于脑实质内或非靶点脑脊液间隙内,有或无引流功能。结果理想放置1级45个(30.8%);2级85个(58.2%);3级16个(11.0%)。结论徒手VC放置是一个不精确的操作,还有很大的改进空间。发明一个易用、方便的影像引导系统可能会保证VC的精确放置。

Objective To study the accuracy of the barehanded technique for frontal ventricular catheter ization.Methods Retrospective evaluation was performed on the head computed tomography(CT) scans of 130 patients who underwent 146 barehanded ventricular catheterizations in this hospital.Among all the patients,ventriculoperitoneal/ventriculoatrial shunts were performed in 98 patients and eatra ventricular drain ages(EVD) in 32 patients.To evaluate catheter tip position,we used a modified Kakarla grading system: grade 1,optimal placement in the ipsilateral frontal angle,just in front of the foramen of Monro;grade 2,functional placement in the lateral ventricle except ipsilateral frontal angle,or third ventricle;and grade 3,suboptimal placement in the cerebral parenchyma or nontarget cerebrospinal fluid space,with or without functional drainage.Results The mean age of the patients was(44.91±20.5) years(age range,2.5-78 years).There were 45(30.8%) grade 1,85(58.2%)grade 2,and 16(11.0%)grade 3 catheterizations.Conclusions The results of this study have shown that only 30.8% catheter tips were in ideal target position,and 11.0% of these catheter tips were placed in nonventricular spaces.We consider that barehanded ventricular catheterization may be an inaccurate procedure,and there is certainly much room for improvement.The development of an easy to use,portable,image-guided system may guarantee accuracy of ventricular catheterizations.