Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy
| Autor: | Naosuke Nonoguchi, Naokado Ikeda, Tomohisa Ohmura, Toshihiko Kuroiwa, Yoshinaga Kajimoto, Adam Tucker, Shinji Kawabata, Motomasa Furuse |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Lumboperitoneal shunt Neurosurgical Procedures Catheterization 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Lumbar Hematoma Cerebrospinal fluid Idiopathic normal pressure hydrocephalus Humans Image-guided surgery Medicine Fluoroscopy Lumbar spondylosis CSF shunting Aged Retrospective Studies Aged 80 and over Lumbar Vertebrae Catheter insertion medicine.diagnostic_test business.industry Reproducibility of Results medicine.disease Cerebrospinal Fluid Shunts Hydrocephalus Normal Pressure Surgery Shunting Catheter Spinal catheter Female Technique Assessment Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Operative Neurosurgery |
| ISSN: | 2332-4260 2332-4252 |
| Popis: | BACKGROUND Spinal catheter insertion in lumboperitoneal (LP) shunt surgery for idiopathic normal pressure hydrocephalus (iNPH) is frequently associated with technical difficulties especially in patients with obesity and elderly patients with vertebral deformities. OBJECTIVE To elucidate the accuracy and safety of image-guided spinal catheter placement using a paramedian approach (PMA). METHODS We retrospectively analyzed 39 consecutive iNPH patients treated by LP shunting with spinal catheter insertion via the PMA. The success rate of catheter placement and the number of changes in puncture location were evaluated. Accuracy of catheter insertion was assessed by measuring both vertical and horizontal deviations in the point of catheter dural penetration from the center of the interlaminar space. RESULTS The success rate of catheter placement was 100% (39/39). The difficulty rate for catheter insertion, measured by the number of changes in puncture location, was 2.6% (1/39). No bloody punctures or surgical infections were observed. Accuracy of catheter insertion, measured as the degree of deviation, was 0.5 ± 1.9 mm horizontally and 0.0 ± 2.4 mm vertically. The rates of minor complications, including caudal catheter insertion, transient low-pressure headache, and root pain, were 5.1% (2/39), 10.4% (4/39), and 0% (0/43), respectively. Subdural hematoma requiring surgical intervention occurred in 1 case (2.6%). During the mean follow-up period of 36 mo, spinal catheter rupture at the level of the spinous processes was not observed. CONCLUSION Fluoroscopic-guided spinal catheter placement via the PMA was safe, accurate, and reliable, even for use in geriatric and obese patients. |
| Databáze: | OpenAIRE |
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