Journal of Korean Neurosurgical Society

  • 제60권5호
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  • Pages.604-609
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  • 2017
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Adjustable Ghajar Guide Technique for Accurate Placement of Ventricular Catheters : A Pilot Study

  • Yoon, Sang-Youl (Department of Neurosurgery and Research Center for Neurosurgical Robotic Systems, Kyungpook National University School of Medicine) ;
  • Kwak, Youngseok (Department of Neurosurgery and Research Center for Neurosurgical Robotic Systems, Kyungpook National University School of Medicine) ;
  • Park, Jaechan (Department of Neurosurgery and Research Center for Neurosurgical Robotic Systems, Kyungpook National University School of Medicine)
  • 투고 : 2016.11.17
  • 심사 : 2017.06.13
  • 발행 : 2017.09.01
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초록

Objective : An adjustable Ghajar guide is presented to improve the accuracy of the original Ghajar guide technique. The accuracy of the adjustable Ghajar guide technique is also investigated. Methods : The coronal adjustment angle from the orthogonal catheter trajectory at Kocher's point is determined based on coronal head images using an electronic picture archiving and communication system. For the adjustable Ghajar guide, a protractor is mounted on a C-shaped basal plate that is placed in contact with the margin of a burrhole, keeping the central $0^{\circ}$ line of the protractor orthogonal to the calvarial surface. A catheter guide, which is moved along the protractor and fixed at the pre-determined adjustment angle, is then used to guide the ventricular catheter into the frontal horn adjacent to the foramen of Monro. The adjustable Ghajar guide technique was applied to 20 patients, while a freehand technique based on the surface anatomy of the head was applied to another 47 patients. The accuracy of the ventricular catheter placement was then evaluated using postoperative computed tomography scans. Results : For the adjustable Ghajar guide technique (AGT) patients, the bicaudate index ranged from 0.23 to 0.33 ($mean{\pm}standard$ deviation [SD] : $0.27{\pm}0.03$) and the adjustment angle ranged from $0^{\circ}$ to $10^{\circ}$ ($mean{\pm}SD:5.2^{\circ}{\pm}3.2^{\circ}$). All the AGT patients experienced successful cerebrospinal fluid diversion with only one pass of the catheter. Optimal placement of the ventricular catheter in the ipsilateral frontal horn approximating the foramen of Monro (grade 1) was achieved in 19 patients (95.0%), while a suboptimal trajectory into a lateral corner of the frontal horn passing along a lateral wall of the frontal horn (grade 3) occurred in 1 patient (5.0%). Thus, the AGT patients experienced a significantly higher incidence of optimal catheter placement than the freehand catheterized patients (95.0% vs. 68.3%, p=0.024). Moreover, none of the AGT patients experienced any tract hemorrhages along the catheter or procedure-related complications. Conclusion : The proposed adjustable Ghajar guide technique, using angular adjustment in the coronal plane from the orthogonal trajectory at Kocher's point, facilitates accurate freehand placement of a ventricular catheter for hydrocephalic patients.

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참고문헌

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피인용 문헌

  1. Freehand Insertion of External Ventricular Drainage Catheter: Evaluation of Accuracy in a Single Center vol.15, pp.1, 2017, https://doi.org/10.4103/ajns.ajns_292_19
  2. Compared with conventional procedures, an intraoperative navigation system for ventriculoperitoneal shunting via the occipital horn improves outcomes in patients with hydrocephalus vol.35, pp.3, 2017, https://doi.org/10.1080/02688697.2020.1789555
  3. Systematic review and meta-analysis of external ventricular drain placement accuracy and narrative review of guidance devices vol.94, pp.None, 2021, https://doi.org/10.1016/j.jocn.2021.10.014