Neuronavigation as a diagnostic tool: An innovative application

A virtual reality-based data analysis for optimizing freehand external ventricular drain insertion

PURPOSE

This work exploits virtual reality technique to analyse and optimize the preoperative planning of freehand external ventricular drain (EVD) insertion. Based on the three-dimensional (3D) virtual brain models, neurosurgeons can directly observe the anatomical landmarks and complete the simulated EVD insertion. Simulation data is used to optimize preoperative planning parameters to ensure the surgical performance.

METHODS

We used the computed tomography (CT) scans to construct the 3D virtual brain models. A group of EVD insertions were simulated by inserting virtual catheters at different entry points. The key parameters including the location of entry point, the catheter orientation, the catheter tip position on lateral ventricles, and the insertion depth were recorded. A data analysis method was then applied to optimize these parameters, resulting in the optimal parameters for the EVD insertion.

RESULTS

When the lateral distance of entry point ranged from 2.5 to 3 cm, the success rate of 204 cases was 97.79%, which was higher than that of the classic method (59.52%). The optimal insertion angle towards the sagittal plane ranged from 10.46° to 12.73°. To prevent penetrating the lateral ventricles, the insertion depth was optimized to be 3.28 to 4.58 cm.

CONCLUSIONS

The proposed data analysis method is helpful to optimize the key parameters of the preoperative planning, and provides useful references for neurosurgeons to perform the freehand EVD insertion. The EVD insertion experiments on 3D printing model had a success rate of 93.75%, which verified the effectiveness of the data analysis.

Preliminary study on Sina (Sina Intraoperative Neurosurgical Assist) APP assisted localization of supratentorial lesions by smart phone

This article is aimed at investigating the use of smart phone software Sina in the localization of supratentorial lesions, finding the error between Sina method and neuronavigation, and identifying the reliability of the new method. Neuronavigation and Sina measurement were used to locate the lesion in the patients whose lesion lengths are between 2 cm and 6 cm. The reference point was the center of the lesion. We found the error of Sina method is 13.6 ± 0.55 mm comparing with neuronavigation, so the Sina method still cannot replace the localization method of the neuronavigation system. However, in practical clinical work, with the help of the new method, the lesion can be located more precisely and easily.

Reduced Radiation in Children Presenting to the ED With Suspected Ventricular Shunt Complication

BACKGROUND

Ventricular shunt complications in children can be severe and life-threatening if not identified and treated in a timely manner. Evaluation for shunt obstruction is not without risk, including lifetime cumulative radiation as patients routinely receive computed tomography (CT) scans of the brain and shunt series (multiple radiographs of the skull, neck, chest, and abdomen).

METHODS

A multidisciplinary team collaborated to develop a clinical pathway with the goal of standardizing the evaluation and management of patients with suspected shunt complication. The team implemented a low-dose CT scan, specifically tailored for the detection of hydrocephalus and discouraged routine use of shunt series with single-view radiographs used only when specifically indicated.

RESULTS

There was a reduction in the average CT effective dose (millisievert) per emergency department (ED) encounter of 50.6% (confidence interval, 46.0-54.9; P ≤ .001) during the intervention period. There was a significant reduction in the number of shunt surveys obtained per ED encounter, from 62.4% to 5.32% (P < .01). There was no significant change in the 72-hour ED revisit rate or CT scan utilization rate after hospital admission. There were no reports of inadequate patient evaluations or serious medical events.

CONCLUSIONS

A new clinical pathway has rapidly reduced radiation exposure, both by reducing the radiation dose of CT scans and eliminating or reducing the number of radiographs obtained in the evaluation of patients with ventricular shunts without compromising clinical care.