Cargando…
Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy
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 accura...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417911/ https://www.ncbi.nlm.nih.gov/pubmed/30011016 http://dx.doi.org/10.1093/ons/opy176 |
_version_ | 1783403635098517504 |
---|---|
author | Tucker, Adam Kajimoto, Yoshinaga Ohmura, Tomohisa Ikeda, Naokado Furuse, Motomasa Nonoguchi, Naosuke Kawabata, Shinji Kuroiwa, Toshihiko |
author_facet | Tucker, Adam Kajimoto, Yoshinaga Ohmura, Tomohisa Ikeda, Naokado Furuse, Motomasa Nonoguchi, Naosuke Kawabata, Shinji Kuroiwa, Toshihiko |
author_sort | Tucker, Adam |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6417911 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-64179112019-03-20 Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy Tucker, Adam Kajimoto, Yoshinaga Ohmura, Tomohisa Ikeda, Naokado Furuse, Motomasa Nonoguchi, Naosuke Kawabata, Shinji Kuroiwa, Toshihiko Oper Neurosurg (Hagerstown) Technique Assessment 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. Oxford University Press 2019-04 2018-07-13 /pmc/articles/PMC6417911/ /pubmed/30011016 http://dx.doi.org/10.1093/ons/opy176 Text en © Congress of Neurological Surgeons 2017. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Technique Assessment Tucker, Adam Kajimoto, Yoshinaga Ohmura, Tomohisa Ikeda, Naokado Furuse, Motomasa Nonoguchi, Naosuke Kawabata, Shinji Kuroiwa, Toshihiko Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy |
title | Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy |
title_full | Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy |
title_fullStr | Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy |
title_full_unstemmed | Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy |
title_short | Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy |
title_sort | fluoroscopic-guided paramedian approach for lumbar catheter placement in cerebrospinal fluid shunting: assessment of safety and accuracy |
topic | Technique Assessment |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417911/ https://www.ncbi.nlm.nih.gov/pubmed/30011016 http://dx.doi.org/10.1093/ons/opy176 |
work_keys_str_mv | AT tuckeradam fluoroscopicguidedparamedianapproachforlumbarcatheterplacementincerebrospinalfluidshuntingassessmentofsafetyandaccuracy AT kajimotoyoshinaga fluoroscopicguidedparamedianapproachforlumbarcatheterplacementincerebrospinalfluidshuntingassessmentofsafetyandaccuracy AT ohmuratomohisa fluoroscopicguidedparamedianapproachforlumbarcatheterplacementincerebrospinalfluidshuntingassessmentofsafetyandaccuracy AT ikedanaokado fluoroscopicguidedparamedianapproachforlumbarcatheterplacementincerebrospinalfluidshuntingassessmentofsafetyandaccuracy AT furusemotomasa fluoroscopicguidedparamedianapproachforlumbarcatheterplacementincerebrospinalfluidshuntingassessmentofsafetyandaccuracy AT nonoguchinaosuke fluoroscopicguidedparamedianapproachforlumbarcatheterplacementincerebrospinalfluidshuntingassessmentofsafetyandaccuracy AT kawabatashinji fluoroscopicguidedparamedianapproachforlumbarcatheterplacementincerebrospinalfluidshuntingassessmentofsafetyandaccuracy AT kuroiwatoshihiko fluoroscopicguidedparamedianapproachforlumbarcatheterplacementincerebrospinalfluidshuntingassessmentofsafetyandaccuracy |