| BackgroundWith the developing of the methods of examination and treatment,now we have had advanced imaging means(such as CT,MRI etc.),microsurgical techniques,but compared with the past,the accuracy of ventricular catheterization was not improved much and complication rate is still high,barehanded ventricular catheterization mainly depends on the feeling of spatial localization and experience of Neurosurgery,lacking of scientific judgment.At present,neurosurgery is developing into to the neurosurgery period.of minimally invasive reducing the error of subjective judgment and improving the accuracy of operation has always been the goal of medical workers.For senior neurosurgeons,they can make a judgment on direction and depth of ventricular catheterization depending on their experience and the position of the lateral ventricle,and have the ability to to improve the quality of surgery.For the young doctors lacking of experience,with the help of advanced equipment,they can also reduce the uncertainty of clinical practice,and also accumulated valuable clinical experience.Years of research,with the help of neuronavigation,and other auxiliary equipment can improve the accuracy of ventricular catheterization,reduce the blockage,brain bleeding and other complications.With the rapid development of science and technology,medical equipment has been significantly updated,thus neuronavigation has gradually applied in neurosurgery.Due to more focus on the accuracy of operation,the neuronavigation system has been rapid developed in the field of neurosurgery.In 90 s of last century,with the rapid development of computer technology and technology of location tracking,the navigation system has become a bridge connecting the modern imaging technology with microneurosurgery.With the Department of neurosurgery operation navigation system,gradually improve the popularity,but also promote the development of Department of neurosurgery operation concept,change the concept of operation of the Department of Neurosurgery,the Department of Neurosurgery surgery entered the era of minimally invasive surgery.With the help of neuronavigation,people can position accurately and implement real-time navigation during the surgery by 3D imaging,With the help of neuronavigation,people can make traditional surgical site,which can not look by the naked eye,more visible,and make operation more accurately and reduce accidental trauma.Its advantage is got worldwide recognition from neurosurgeons,and is widely used in biopsy,tumor resection,and other vascular malformation in Neurosurgery.ObjectiveRetrospective evaluation was performed on the head computerized tomography(CT)scans of patients who underwent ventriculoperitoneal shunt;lateral external ventricular drain,puncture drainage tube length,tube tip position,and discusse the factors influence the accuracy of ventricular catheter,find the effective measures which could improve the accuracy of ventricular catheter.MethodsWe analyzed retrospectively,between June 2014 and June 2016,70 patients who underwent ventriculoperitoneal shunt and lateral external ventricular drain treated by the Department of Neurosurgery of our hospital,according to different operative method,patients were divided into A,B two groups,there were 54 patients who underwent barehanded ventricular catheterization,they were selected as group A.there were 16 patients who underwent ventricular catheterization aided by neuronavigation,they were selected as B group,the postoperative CT were retrospectively analyzed to determine the drainage tube tip was located on the forehead,the ipsilateral lateral ventricle of third ventricle,the contralateral frontal horn of lateral ventricle,lateral ventricle,corpus cal osum,interhemispheric,thalamus basal ganglia.Through looking surgical records,we can determine the distance between the tipof drainage tube and surface brain.ResultsIn group A,there were 39 grade ?,13 grade?,2grade? catheterizations;In group B,there were 16 grade?catheterizations.72% catheter tip the ideal class were in ideal target in group.A.100% catheter tip the ideal class were in ideal target in group.B.(p<0.05).group B was better than group A.In group A,the distance between the tip of drainage tube and surface brain: minimum 5.5cm,maximum 8cm,the average 6.54cm;in group B,the distance between the tip of drainage tube and surface brain: minimum 5.5cm,maximum 7cm,the average 6.36 cm There was no significant difference between the two groups(P > 0.05).There were 60 patients who underwent ventriculoperitoneal shunt,2 cases(3.3%)definite infections were identified.of which one case pulled out the tube,one case was improved after drug treatment.1 cases(1.6%)suspected infections was identified,2 cases(3.3%)were with ventricular tube blocked 1 cases(1.6%)was with abdominal obstruction,1 case(1.6%)was with postoperative patency decreased.3 cases(5%)were with subdural effusion after operation.Including 2 cases got better after adjusting pressure,1 case got better after receiving subdural effusion drilling drainage,1 case was with parenchymal hemorrhage and got better after reciving symptomatic treatment.There were 10 patients who underwent lateral external ventricular drain ventricular,1 case was with parenchymal hemorrhage and got better after reciving symptomatic treatment.comparing postoperative complications,there was no significant difference between the two groups(P > 0.05).Conclusion1.Compared with barehanded ventricular catheterization,using neuronavigation can improve the accuracy of the ventricular catheter.2.There was no significant difference between Postoperative complications of the two groups,but its long efficacy needs more cases,more evaluation index and longer time follow-up to prove. |
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