Use of navigation technologies in the installation of external ventricular drainage in patients with severe combined traumatic brain injury

Abstract

The study investigated the possibilities and effectiveness of surgical navigation in the installation of external ventricular drainage in patients with severe combined traumatic brain injury. In total, 41 patients were examined, and in those with urgent indications during the first period of traumatic illness, external ventricular drainage was installed (up to 2 days). All patients were divided into the main group (n = 14) and control group (n = 27). In the main group, external ventricular drainage was installed using surgical navigation. The control group underwent surgery without surgical navigation. According to the treatment results of the main group, the use of surgical navigation during the introduction of ventricular drainage significantly increased the accuracy of its installation and reduced the number of complications and rechecks. The accuracy of ventricular drainage installation was improved by 35%. Thus, out of 13 drainage installations, 12 (92.3%) had an optimal position, and 1 had a satisfactory position because its tip had a deviation of 2 mm; however, this drainage did not require re-examination, performing its function. Moreover, in the control group using the classical “free hand” technique, out of 21 cases with drainage installed, only 12 (57.1%) had an optimal position, 9 (42.9%) drains were rechecked because of deviation from the specified trajectory over 3 mm, and 4 (19%) required repeated rechecking (p = 0.039). The main causes of errors and complications of the surgical treatment of patients with craniocerebral injuries are related to the difficulties in installing ventricular drainage, namely, inaccurate positioning of the drainage tip, placement of the drainage in the brain substance at a distance from the planned point (28.6%), the drainage is going beyond the ventricular system of the brain (14.3%), re-drainage during the operation (44.4%), which often (42.9%) leads to incorrect introduction of the drainage into the ventricular system of the brain. Thus, the application of the navigation technology technique when installing drains into the ventricular system of the brain is very effective in the treatment of patients with severe combined traumatic brain injury. This innovative technique for ventricular drainage in severe combined traumatic brain injury will reduce the frequency of errors and complications associated with repeated drains, which is fundamentally important in unstable patients with multiple traumas. The navigation system allows for accurate installation of the drainage to the planned location from the first attempt.

Keywords

ventricular drainage / intracranial pressure / ventricle of the brain / severe combined trauma / surgical navigation / traumatic brain injury / free hand technique / polytrauma / traumatic illness

References

[1] Bel’skikh AN, Samokhvalov IM, editors. Ukazaniya po voenno-polevoi khirurgii. Moscow, 2013. 474 p. (In Russ.).

[2] Указания по военно-полевой хирургии / под ред. А.Н. Бельских, И.М. Самохвалова. Москва, 2013. 474 c.

[3] Vishnevskii AG, Andreev EM. Naselenie Rossii v pervoi polovine novogo veka. Voprosy Ekonomiki. 2001;(1):27–44. (In Russ.).

[4] Вишневский А.Г., Андреев Е.М. Население России в первой половине нового века // Вопросы экономики. 2001. № 1. С. 27–44.

[5] Badalov VI, Korostelev KE, Sen’ko IV. Sovremennyi podkhod v lechenii sochetannykh travm pozvonochnika. Proceedings of the IV Congress of neurosurgeons of Russia. Moscow, 2006. P. 6–7. (In Russ.).

[6] Бадалов В.И., Коростелев К.Е., Сенько И.В. Современный подход в лечении сочетанных травм позвоночника // Материалы IV съезда нейрохирургов России. Москва, 2006. С. 6–7.

[7] Agadzhanyan VV, Kravtsov SA. Polytrauma, the ways of development. Polytrauma. 2015;(2):6–12. (In Russ.).

[8] Агаджанян В.В., Кравцов С.А. Политравма, пути развития (терминология) // Политравма. 2015. № 2. С. 6–12.

[9] Ovsyannikov DM, Chekhonatsky AA, Kolesov VN, Bubashvili AI. Social and epidemiological aspects of craniocerebral trauma (review). Saratov Journal of Medical Scientific Research. 2012;8(3): 777–785. (In Russ.).

[10] Овсянников Д.М., Чехонацкий А.А., Колесов В.Н., Бубашвили А.И. Социальные и эпидемиологические аспекты черепно-мозговой травмы // Саратовский научно-медицинский журнал. 2012. Т. 8, № 3. С. 777–785.

[11] Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic brain injury: An overview of epidemiology, pathophysiology, and medical management. Med Clin North Am. 2020;104(2):213–238. DOI: 10.1016/j.mcna.2019.11.001

[12] Capizzi A., Woo J., Verduzco-Gutierrez M. Traumatic brain injury: An overview of epidemiology, pathophysiology, and medical management // Med Clin North Am. 2020. Vol. 104, No. 2. P. 213–238. DOI: 10.1016/j.mcna.2019.11.001

[13] Konovalov AN, Potapov AA, Likhterman LB. Patogenez, diagnostika i lechenie cherepno-mozgovoi travmy i ee posledstvii. Voprosy neirokhirurgii. 2004;(4):18–25. (In Russ.).

[14] Коновалов А.Н., Потапов А.А., Лихтерман Л.Б. Патогенез, диагностика и лечение черепно-мозговой травмы и ее последствий // Вопросы нейрохирургии. 2004. № 4. С. 18–25.

[15] Grin’ AA. Khirurgicheskoe lechenie bol’nykh s povrezhdeniem pozvonochnika i spinnogo mozga pri sochetannoi travme [dissertation]. Moscow, 2008. 320 p. (In Russ.).

[16] Гринь А.А. Хирургическое лечение больных с повреждением позвоночника и спинного мозга при сочетанной травме: дис. … д-ра мед. наук. Москва, 2008. 320 c.

[17] Krylov VV. Cherepno-mozgovaya travma (printsipy diagnostiki i lecheniya). Intensivnaya terapiya tyazheloi cherepno-mozgovoi travmy. Moscow, 2004. P. 3–14. (In Russ.).

[18] Крылов В.В. Черепно-мозговая травма (принципы диагностики и лечения) // Интенсивная терапия тяжелой черепно-мозговой травмы. Москва, 2004. С. 3–14.

[19] Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3):16–24. DOI: 10.1227/01.NEU.0000210364.29290.C9

[20] Bullock M.R., Chesnut R., Ghajar J., et al. Surgical management of acute subdural hematomas // Neurosurgery. 2006. Vol. 58, No. 3, P. 16–24. DOI: 10.1227/01.NEU.0000210364.29290.C9

[21] Werner C, Engelhard K. Pathophysiology of traumatic brain injury. Br J Anaesth. 2007;99(1):4–9. DOI: 10.1093/bja/aem131

[22] Werner C., Engelhard K. Pathophysiology of traumatic brain injury // Br J Anaesth. 2007. Vol. 99, Nо. 1. P. 4–9. DOI: 10.1093/bja/aem131

[23] Badalov VI, Spitsyn MI, Korostelev KE, et al. Navigational technologies in injury surgery. Russian military medical journal. 2021;342(9):30–40. (In Russ.). DOI: 10.52424/00269050_2021_342_9_30

[24] Бадалов В.И., Спицын М.И., Коростелев К.Е., и др. Навигационные технологии в хирургии повреждений // Военно-медицинский журнал. 2021. Т. 342, № 9. С. 30–40. DOI: 10.52424/00269050_2021_342_9_30

[25] Shaklunov AN. Bezramnaya neironavigatsiya v neotlozhnoi neirokhirurgii vnutrimozgovykh krovoizliyanii [dissertation]. Moscow; 2013. 134 p. (In Russ.).

[26] Шаклунов А.Н. Безрамная нейронавигация в неотложной нейрохирургии внутримозговых кровоизлияний: дис. … канд. мед. наук. Москва, 2013. 134 с.

[27] Kakarla UK, Chang SWM, Theodore N, et al. Safety and accuracy of bedside external ventricular drain placement. Neurosurgery. 2008;63(1):ONS162-166. DOI: 10.1227/01.neu.0000335031.23521.d0

[28] Kakarla U.K., Chang S.W.M., Theodore N., et al. Safety and accuracy of bedside external ventricular drain placement // Neurosurgery. 2008. Vol. 63, Nо. 1. ID ONS162-166. DOI: 10.1227/01.neu.0000335031.23521.d0

RIGHTS & PERMISSIONS

Eco-Vector