Beck, Jürgen

Eisenring, Christian

Oertel, Markus Florian

Raabe, Andreas

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	   	  128	  S	  	  P63	  Smartphone	  navigated	  insertion	  of	  external	  ventricular	  drainages	  	  CV	  Eisenring	  [1],	  J	  Beck	  [1],	  M	  Oertel	  [1]	  	  [1]	  Inselspital	  Bern,	  Bern,	  Switzerland	  	  Objective	  Anatomical	   landmarks	   determine	  primarily	   the	   trajectory	   for	   placements	   of	   external	   ventricular	   drainages	  (EVDs).	   Nevertheless,	   non-­‐assisted	   implantations	   are	   frequently	   complicated	   by	   multiple	   attempts	   and	  suboptimal	  EVDs	  locations	  especially	  if	  anatomical	  variants	  and	  narrowing	  of	  the	  ventricles	  exist.	  Therefore,	  the	  authors	  evaluated	  the	  feasibility	  and	  accuracy	  of	  smartphone-­‐guided	  angle-­‐adjusted	  EVDs	  implantations	  in	  both	  a	  human	  artificial	  and	  cadaveric	  model.	  	  Methods	  A	   total	   of	   20	   EVDs	   (skull	   phantom	   8/20,	   cadaver	   head	   12/20)	   were	   implanted.	   After	  multi-­‐planar	   CT	   3D	  reformation	  a	  trajectory	  was	  set	  from	  Kocher’s	  point	  to	  the	  centre	  of	  the	  ipsilateral	  ventricular	  frontal	  horn	  according	  to	  the	  horizontal	  and	  vertical	  diameter.	  Intended	  insertion	  angles	  and	  distances	  to	  the	  catheter	  tip	  were	   measured.	   The	   smartphone	   was	   calibrated	   to	   the	   mid-­‐cranial	   sagittal	   line	   with	   the	   skull	   in	   neutral	  supine	   position.	   EVDs	   were	   placed	   using	   both	   the	   measured	   catheter	   lengths	   and	   smartphone-­‐adjusted	  insertion	   angles.	   Insertion	   angles	   and	   intracranial	   distance	   to	   the	   catheter	   tip	   were	   measured	   on	  postinterventional	  CT.	  	  Results	  All	  EVDs	  were	  placed	  in	  the	  frontal	  horn	  of	  the	  ipsilateral	  ventricle	  as	  intended.	  EVDs	  tip	  locations	  showed	  a	  mean	  deviation	  of	  2.76°	  from	  the	  planned	  trajectory	  with	  a	  1.93°	  standard	  deviation	  (SD).	  The	  mean	  distance	  of	   the	  EVDs	  tips	  to	  the	   intended	  targets	  was	  0.4	  cm	  (SD	  ±	  0.26	  cm).	  The	  mean	  duration	  of	  measurement	  of	  implantation	   angles	   and	   intraventricular	   lengths	  was	   3	  min,	   and	   of	   sterile	   packing	  with	   calibration	   of	   the	  smartphone,	  drilling	  and	  angle-­‐adjusted	  EVDs	  implantation	  9	  min,	  respectively.	  	  	  	  Conclusions	  For	   the	   first	   time,	  a	  smartphone	  was	  used	  as	  a	   tool	   for	  placement	  of	  EVDs.	  Our	  ex	  vivo	  study	  suggests	   that	  smartphone-­‐guided	  EVDs	  placement	  represents	  a	  precise	  and	  fast	  assisted	  free-­‐hand	  technique	  with	  a	  simple	  and	  broadly	  available	  device.	  	  	   	  

Smartphone navigated insertion of external ventricular drainages

https://boris.unibe.ch/92290/1/Smartphone%20navigated.pdf

Smartphone navigated insertion of external ventricular drainages

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