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  • Integrated live biplane fluoroscopic and cone-beam CT-guided external ventricular drain placement in the neurointerventional suite

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Letter to the editor
Integrated live biplane fluoroscopic and cone-beam CT-guided external ventricular drain placement in the neurointerventional suite
  1. Albert H Y Chiu1,2,3,
  2. Thomas R Marotta2,4,
  3. Julian Spears3
  1. 1St Michael's Neurovascular Program, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
  3. 3Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Albert H Y Chiu, St Michael's Neurovascular Program, Departments of Radiology and Neurosurgery, St Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada M5B 1W8; albert.h.chiu{at}gmail.com

https://doi.org/10.1136/neurintsurg-2016-012560

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    We read with interest the article by Fiorella et al,1 which presents their experience in the iGuide guidance system (Siemens, Erlangen, Germany) for on-table external ventricular drain placement. The article describes catheter placement under a trajectory that is planned on cone-beam CT (CBCT).

    We have in our practice identified modifications which we feel increase accuracy:

    1. After antiseptic preparation a 23G needle is placed at Kocher's point. CBCT is then performed, allowing delineation of the expected point-of-entry, and adjustment if necessary.

    2. After CBCT, both the A- and B-planes are moved …

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    Footnotes

    • Contributors AHYC conceived the article and drafted the manuscript. All authors reviewed and approved submission of the final manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.