A novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement: an experimental animal study
Abstract Background External ventricular drain (EVD) insertion is one of the most commonly performed neurosurgical procedures. Herein, we introduce a new concept of a cranial fixation device for insertion of EVDs, that reduces reliance on freehand placement and drilling techniques and provides a sim...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-12-01
|
| Series: | Patient Safety in Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13037-024-00420-0 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832585497513295872 |
|---|---|
| author | Atai Daniel Matan Coronel Segev Peer Ben Grinshpan Soner Duru Jose L. Peiro James L. Leach Elena Abellán Carolyn M. Doerning David Zarrouk Francesco T. Mangano |
| author_facet | Atai Daniel Matan Coronel Segev Peer Ben Grinshpan Soner Duru Jose L. Peiro James L. Leach Elena Abellán Carolyn M. Doerning David Zarrouk Francesco T. Mangano |
| author_sort | Atai Daniel |
| collection | DOAJ |
| description | Abstract Background External ventricular drain (EVD) insertion is one of the most commonly performed neurosurgical procedures. Herein, we introduce a new concept of a cranial fixation device for insertion of EVDs, that reduces reliance on freehand placement and drilling techniques and provides a simple, minimally invasive approach that provides strong fixation to minimal thickness skulls. Methods An experimental device for catheter insertion and fixation was designed and tested in both ex-vivo and in-vivo conditions to assess accurate cannulation of the ventricle and to test the strength of fixation to the skull. The ex-vivo experiments were conducted at Ben-Gurion University of the Negev (BGU) in Be’er Sheva, Israel. These experiments included functionality bench testing and pullout force measurements for the ball mechanism and catheter fixation. For the in-vivo experiments the fixation device was initially tested at the Cincinnati Children’s Hospital Medical Center (CCHMC) in Cincinnati, Ohio on one day of life 1 (DOL 1) male control lamb. Additional experiments were conducted on 3 hydrocephalic DOL 0 lambs (1 male 2 female) at the Jesús Usón Minimally Invasive Surgery Centre (JUMISC) in Caceres, Spain. The hydrocephalic animal model used for this study was created with in utero intracisternal injection of BioGlue in fetal lambs. The catheter insertion trajectory was determined using MR imaging to assess the device’s impact on the placement accuracy. The fixation device was evaluated on reaching the ventricle and enabling extraction of CSF for all 7 fixations placed. For 5 of the fixation devices, post-mortem pullout force was measured. The general functionality of the device was also evaluated. Results In the experiments, 7/7 (100%) catheter trajectories successfully reached the ventricle without any apparent complications related to the device or the procedure. The cranial fixation device base demonstrated significant strength in withstanding an average pull-out force of 4.18kgf (STD $$\:\pm\:$$ 0.72, N = 5) without detachment from the subject’s skull for all 5 devices included in this test. Additionally, the EVD catheter pull test was conducted with the addition of a safety loop which did not allow movement of the EVD to a force of 3.6kgf. At this force the catheter tore but did not release from its fixation point. Conclusion The newly designed experimental device demonstrates initial proof of concept from ex vivo and in vivo testing. It appears suitable for accurate ventricular catheter placement and cranial fixation. |
| format | Article |
| id | doaj-art-683d905014ff44129a920bb9ba756433 |
| institution | Kabale University |
| issn | 1754-9493 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Patient Safety in Surgery |
| spelling | doaj-art-683d905014ff44129a920bb9ba7564332025-01-26T12:47:48ZengBMCPatient Safety in Surgery1754-94932024-12-0118111010.1186/s13037-024-00420-0A novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement: an experimental animal studyAtai Daniel0Matan Coronel1Segev Peer2Ben Grinshpan3Soner Duru4Jose L. Peiro5James L. Leach6Elena Abellán7Carolyn M. Doerning8David Zarrouk9Francesco T. Mangano10Department of Mechanical Engineering, Ben-Gurion University of the NegevDepartment of Mechanical Engineering, Ben-Gurion University of the NegevDepartment of Mechanical Engineering, Ben-Gurion University of the NegevDepartment of Mechanical Engineering, Ben-Gurion University of the NegevDivision of Neurosurgery, Cincinnati Children’s Hospital Medical CenterThe Center for Fetal and Placental Research, Fetal Care Center, Division of General and Thoracic Surgery, Cincinnati Children’s Hospital Medical CenterDepartment of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical CenterMicrosurgery Department, Jesús Usón Minimally Invasive Surgery CentreDivision of Veterinary Services, Cincinnati Children’s Hospital Medical CenterDepartment of Mechanical Engineering, Ben-Gurion University of the NegevDivision of Neurosurgery, Cincinnati Children’s Hospital Medical CenterAbstract Background External ventricular drain (EVD) insertion is one of the most commonly performed neurosurgical procedures. Herein, we introduce a new concept of a cranial fixation device for insertion of EVDs, that reduces reliance on freehand placement and drilling techniques and provides a simple, minimally invasive approach that provides strong fixation to minimal thickness skulls. Methods An experimental device for catheter insertion and fixation was designed and tested in both ex-vivo and in-vivo conditions to assess accurate cannulation of the ventricle and to test the strength of fixation to the skull. The ex-vivo experiments were conducted at Ben-Gurion University of the Negev (BGU) in Be’er Sheva, Israel. These experiments included functionality bench testing and pullout force measurements for the ball mechanism and catheter fixation. For the in-vivo experiments the fixation device was initially tested at the Cincinnati Children’s Hospital Medical Center (CCHMC) in Cincinnati, Ohio on one day of life 1 (DOL 1) male control lamb. Additional experiments were conducted on 3 hydrocephalic DOL 0 lambs (1 male 2 female) at the Jesús Usón Minimally Invasive Surgery Centre (JUMISC) in Caceres, Spain. The hydrocephalic animal model used for this study was created with in utero intracisternal injection of BioGlue in fetal lambs. The catheter insertion trajectory was determined using MR imaging to assess the device’s impact on the placement accuracy. The fixation device was evaluated on reaching the ventricle and enabling extraction of CSF for all 7 fixations placed. For 5 of the fixation devices, post-mortem pullout force was measured. The general functionality of the device was also evaluated. Results In the experiments, 7/7 (100%) catheter trajectories successfully reached the ventricle without any apparent complications related to the device or the procedure. The cranial fixation device base demonstrated significant strength in withstanding an average pull-out force of 4.18kgf (STD $$\:\pm\:$$ 0.72, N = 5) without detachment from the subject’s skull for all 5 devices included in this test. Additionally, the EVD catheter pull test was conducted with the addition of a safety loop which did not allow movement of the EVD to a force of 3.6kgf. At this force the catheter tore but did not release from its fixation point. Conclusion The newly designed experimental device demonstrates initial proof of concept from ex vivo and in vivo testing. It appears suitable for accurate ventricular catheter placement and cranial fixation.https://doi.org/10.1186/s13037-024-00420-0Catheter insertionCatheter placementCranial fixationExternal ventricular drainPediatric hydrocephalusVentricular catheter |
| spellingShingle | Atai Daniel Matan Coronel Segev Peer Ben Grinshpan Soner Duru Jose L. Peiro James L. Leach Elena Abellán Carolyn M. Doerning David Zarrouk Francesco T. Mangano A novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement: an experimental animal study Patient Safety in Surgery Catheter insertion Catheter placement Cranial fixation External ventricular drain Pediatric hydrocephalus Ventricular catheter |
| title | A novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement: an experimental animal study |
| title_full | A novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement: an experimental animal study |
| title_fullStr | A novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement: an experimental animal study |
| title_full_unstemmed | A novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement: an experimental animal study |
| title_short | A novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement: an experimental animal study |
| title_sort | novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement an experimental animal study |
| topic | Catheter insertion Catheter placement Cranial fixation External ventricular drain Pediatric hydrocephalus Ventricular catheter |
| url | https://doi.org/10.1186/s13037-024-00420-0 |
| work_keys_str_mv | AT ataidaniel anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT matancoronel anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT segevpeer anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT bengrinshpan anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT sonerduru anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT joselpeiro anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT jameslleach anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT elenaabellan anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT carolynmdoerning anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT davidzarrouk anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT francescotmangano anovelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT ataidaniel novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT matancoronel novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT segevpeer novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT bengrinshpan novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT sonerduru novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT joselpeiro novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT jameslleach novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT elenaabellan novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT carolynmdoerning novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT davidzarrouk novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy AT francescotmangano novelminimallyinvasiveneurosurgicalcranialfixationdeviceforimprovedaccuracyofintraventricularcatheterplacementanexperimentalanimalstudy |