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sEVD—smartphone-navigated placement of external ventricular drains


Baumann, Michelle. sEVD—smartphone-navigated placement of external ventricular drains. 2020, University of Zurich, Faculty of Medicine.

Abstract

Background Currently, the trajectory for insertion of an external ventricular drain (EVD) is mainly determined using anatomical landmarks. However, non-assisted implantations frequently require multiple attempts and are associated with EVD malpositioning and complications. The authors evaluated the feasibility and accuracy of a novel smartphone-guided, angleadjusted technique for assisted implantations of an EVD (sEVD) in both a human artificial head model and a cadaveric head. Methods After computed tomography (CT), optimal insertion angles and lengths of intracranial trajectories of the EVDs were determined. A smartphone was calibrated to the mid-cranial sagittal line. Twenty EVDs were placed using both the premeasured data and smartphone-adjusted insertion angles, targeting the center of the ipsilateral ventricular frontal horn. The EVD positions were verified with post-interventional CT. Results All 20 sEVDs (head model, 8/20; cadaveric head, 12/20) showed accurate placement in the ipsilateral ventricle. The sEVD tip locations showed a mean target deviation of 1.73° corresponding to 12 mm in the plastic head model, and 3.45° corresponding to 33mm in the cadaveric head. Themean duration of preoperativemeasurements on CT data was 3 min, whereas sterile packing, smartphone calibration, drilling, and implantation required 9 min on average. Conclusions By implementation of an innovative navigation technique, a conventional smartphone was used as a protractor for the insertion of EVDs. Our ex vivo data suggest that smartphone-guided EVD placement offers a precise, rapidly applicable, and patient-individualized freehand technique based on a standard procedure with a simple, cheap, and widely available multifunctional device.

Abstract

Background Currently, the trajectory for insertion of an external ventricular drain (EVD) is mainly determined using anatomical landmarks. However, non-assisted implantations frequently require multiple attempts and are associated with EVD malpositioning and complications. The authors evaluated the feasibility and accuracy of a novel smartphone-guided, angleadjusted technique for assisted implantations of an EVD (sEVD) in both a human artificial head model and a cadaveric head. Methods After computed tomography (CT), optimal insertion angles and lengths of intracranial trajectories of the EVDs were determined. A smartphone was calibrated to the mid-cranial sagittal line. Twenty EVDs were placed using both the premeasured data and smartphone-adjusted insertion angles, targeting the center of the ipsilateral ventricular frontal horn. The EVD positions were verified with post-interventional CT. Results All 20 sEVDs (head model, 8/20; cadaveric head, 12/20) showed accurate placement in the ipsilateral ventricle. The sEVD tip locations showed a mean target deviation of 1.73° corresponding to 12 mm in the plastic head model, and 3.45° corresponding to 33mm in the cadaveric head. Themean duration of preoperativemeasurements on CT data was 3 min, whereas sterile packing, smartphone calibration, drilling, and implantation required 9 min on average. Conclusions By implementation of an innovative navigation technique, a conventional smartphone was used as a protractor for the insertion of EVDs. Our ex vivo data suggest that smartphone-guided EVD placement offers a precise, rapidly applicable, and patient-individualized freehand technique based on a standard procedure with a simple, cheap, and widely available multifunctional device.

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Additional indexing

Item Type:Dissertation (monographical)
Referees:Eisenring Christian V, Burn Felice, Stieglitz Lennart, Kockro R A, Beck Jürgen, Raabe Andreas, Oertel Markus F
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
UZH Dissertations
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 December 2020
Deposited On:15 Feb 2021 11:38
Last Modified:16 Feb 2021 04:41
Number of Pages:9
OA Status:Closed

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