SURGICAL VIDEO App-Assisted External Ventricular Catheter Insertion With Display Casting ∗ ∗ Kristy Scandrett, MBBS , Craig Vonhoff, MBBS , Ashraf Dower, MD, ∗ ∗ ‡ BMed Sci(Hon) , Behzad Eftekhar, MD, MPH, FRACS Department of Neurosurgery, Nepean Hospital, The University of Sydney, Sydney, Australia; Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia This video demonstrates insertion of external ventricular drain Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/ (EVD) assisted by an Android smartphone app (Sina Neurosur- opx167 gical Assist, Behzad Eftekhar, Sydney, Australia) with the option of display casting. The smartphone app superimposes a patient’s technique or technology, there are questions that only time can answer coronal brain CT images onto the live feed from the device camera as to whether that which is new will actually “stick”. In this case, there in order to guide the trajectory of the catheter. The option of seem to be some opportunities for error that may put off some providers. display casting removes the need for the surgeon to rely upon an Specifically, making sure the correct coronal point is chosen on the assistant’s guidance who may not necessarily share the respon- patient’s scalp and being certain that the phone and patient’s head are sibility of the care. What follows illustrates the technique of oriented in the same rotational plane. That being said, there is a case to assisted EVD insertion and the addition of casting the smart- be made that this would be an excellent training tool for EVD placement phone screen on an external monitor, so that the surgeon can view without the radiation exposure of being in a CT scanner. I also think this the overlapping of the images. Using monopod holster/selfie stick type of approach may encourage others to employ novel thinking which, to remove the need for assistant as a potential future alternative has over time, may make the fusion of cell phone, CT and a simple app even better. also been trialed. However, using available monopod holsters, the intraoperative readjustment of the smartphones has been difficult. Alan M. Scarrow At this stage, the design of monopod holsters needs to improve in Springfield, Missouri order to be used routinely for this purpose. Written informed consent has been obtained from the patient his technology makes explicit the “mental image” of the MRI scan for the publication of the operating video. T an experienced surgeon holds in his or her head when passing a ventricular catheter. Like this mental image, the app-assisted ventricular Disclosure catheter technique depends vitally on proper alignment between the The authors have no personal, financial, or institutional interest in any of the navigation device, patient’s head, and surgeon. Unlike established drugs, materials, or devices described in this article. frameless navigation, however, there is no mechanism available to reliably fixate these spatial relationships. Of note, the device has received no explicit regulatory testing or approval in any venue. Thus, its use should REFERENCE currently be limited to educational or preparatory purposes, such as 1. Eftehkar B. App-assisted external ventricular drain insertion. JNeurosurg. training residents using model or cadaver-based simulation, or for patient 2016;125(3):754-758. specific pre-procedure rehearsal prior to performing an actual ventricular drain insertion. Acknowledgment In future, after appropriate validation and approval, this device may be of benefit in patients with small ventricles when there is not enough The authors would like to thank the Nepean Hospital members of staff time to use dedicated neuro-navigation (such as the case of emergency including Dr Christopher Davidoff for their assistance in preparation of the video. ventricular drain placement for spontaneous subarachnoid hemorrhage that is simulated in this video). Ultimately, one hopes that using this device will aid young surgeons in developing their own 3-dimensional COMMENTS ‘mental models’ that allow them to practice safely and independently in his is a very innovative approach to a fairly old problem - how to emergency situations in which navigation aids are completely lacking. increase the accuracy and decrease the morbidity of EVD placement. This technique uses common electronics like a cell phone and a monitor Nathan R. Selden to make EVD placement safer and more accurate. As with any new Portland, Oregon OPERATIVE NEUROSURGERY VOLUME 14 | NUMBER 4 | APRIL 2018 | 461 Downloaded from https://academic.oup.com/ons/article-abstract/14/4/461/4057689 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Operative Neurosurgery – Oxford University Press
Published: Apr 1, 2018
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