Method of needle immobilization for ventriculography Technical note
CHARLES M. STROTHER, M.D., AND THOMAS H. NEWTON, M.D.
Neuroradiology Section, Department of Radiology, University of California, San Francisco, California ~" The authors describe a method of needle immobilization for ventriculography, which minimizes cerebral trauma incident to ventriculograms. KEvWoRns
9 ventriculography
HE increasing availability and improved accuracy of angiography as well as the recent development of computerized tomographic scanning have greatly reduced the indications for ventriculography. However, in the evaluation of an infant with rapidly increasing head size, ventriculography often remains the diagnostic procedure of choice. A well-known complication of ventriculography is the persistence of "needle tracts" with the subsequent development of communicating porencephalic cysts. 1'~ In an effort to minimize the cerebral trauma caused by ventriculography, we have developed an alternative method of needle immobilization. We believe this method represents an improvement over existing techniques.
T
262
9 needle immobilization
9 technique
Technique After the scalp has been shaved and prepped, a needle puncture is made through the skin at the point where the ventricular needle is to be introduced. A hole closely matching the needle size is made through the bottom of a sterile transparent cup. The skin puncture site and the hole in the bottom of the cup are aligned and the device is taped in place (Fig. 1 upper). The ventricular needle can then be introduced in the usual manner until cerebrospinal fluid (CSF) is obtained (Fig. 1 lower). The cup serves to immobilize the distal end of the needle and prevents lateral movements as air is introduced. An additional advantage of this method is that it
J. Neurosurg. / Volume 44 / February, 1976
Needle immobilization for ventrieulography allows the use of a long connecting tube so that air may be injected under fluoroscopic control. We believe that the use of this method significantly reduces trauma to the brain at the time of ventriculography. References
1. Bergeron RT, Rumbaugh CL: Problems incident to pneumographic and other nonangiographic radiologic contrast studies of the brain. Bull Los Angeles Neurol Soc 36:1-10, 1971 2. Lorber J, Grainger RG: Cerebral cavities following ventricular punctures in infants. Clin Radiol 14:98-109, 1963
Fro. 1. Upper." A sterile plastic cup has been taped to the infant's head after alignment of the hole in the bottom of the cup with the skin puncture site. Lower." The needle has been advanced into the ventricle. Movement of the needle is prevented by fixation at the skin and the cup (arrows).
J. Neurosurg. / Volume 44 / February, 1976
Dr. Strother is an Academic Trainee in Diagnostic Neuroradiology, supported by Grant GM 1701 from the National Institutes of Health, United States Public Health Service, Bethesda, Maryland. Address reprint requests to." Thomas H. Newton, M.D., Department of Radiology, University of California, San Francisco, California 94143.
263
CHARLES M. STROTHER, M.D., AND THOMAS H. NEWTON, M.D.
Neuroradiology Section, Department of Radiology, University of California, San Francisco, California ~" The authors describe a method of needle immobilization for ventriculography, which minimizes cerebral trauma incident to ventriculograms. KEvWoRns
9 ventriculography
HE increasing availability and improved accuracy of angiography as well as the recent development of computerized tomographic scanning have greatly reduced the indications for ventriculography. However, in the evaluation of an infant with rapidly increasing head size, ventriculography often remains the diagnostic procedure of choice. A well-known complication of ventriculography is the persistence of "needle tracts" with the subsequent development of communicating porencephalic cysts. 1'~ In an effort to minimize the cerebral trauma caused by ventriculography, we have developed an alternative method of needle immobilization. We believe this method represents an improvement over existing techniques.
T
262
9 needle immobilization
9 technique
Technique After the scalp has been shaved and prepped, a needle puncture is made through the skin at the point where the ventricular needle is to be introduced. A hole closely matching the needle size is made through the bottom of a sterile transparent cup. The skin puncture site and the hole in the bottom of the cup are aligned and the device is taped in place (Fig. 1 upper). The ventricular needle can then be introduced in the usual manner until cerebrospinal fluid (CSF) is obtained (Fig. 1 lower). The cup serves to immobilize the distal end of the needle and prevents lateral movements as air is introduced. An additional advantage of this method is that it
J. Neurosurg. / Volume 44 / February, 1976
Needle immobilization for ventrieulography allows the use of a long connecting tube so that air may be injected under fluoroscopic control. We believe that the use of this method significantly reduces trauma to the brain at the time of ventriculography. References
1. Bergeron RT, Rumbaugh CL: Problems incident to pneumographic and other nonangiographic radiologic contrast studies of the brain. Bull Los Angeles Neurol Soc 36:1-10, 1971 2. Lorber J, Grainger RG: Cerebral cavities following ventricular punctures in infants. Clin Radiol 14:98-109, 1963
Fro. 1. Upper." A sterile plastic cup has been taped to the infant's head after alignment of the hole in the bottom of the cup with the skin puncture site. Lower." The needle has been advanced into the ventricle. Movement of the needle is prevented by fixation at the skin and the cup (arrows).
J. Neurosurg. / Volume 44 / February, 1976
Dr. Strother is an Academic Trainee in Diagnostic Neuroradiology, supported by Grant GM 1701 from the National Institutes of Health, United States Public Health Service, Bethesda, Maryland. Address reprint requests to." Thomas H. Newton, M.D., Department of Radiology, University of California, San Francisco, California 94143.
263
