Trigone point as an alternative location for ventricular shunt insertion

Yuriz Bakhtiar; Dewi Sartika; Zainal Muttaqin; Muhammad Thohar Arifin; Sukma Imawati; Farah Hendara Ningrum

doi:10.15562/bmj.v12i2.4309

Trigone point as an alternative location for ventricular shunt insertion

Yuriz Bakhtiar ,

Dewi Sartika ,

Zainal Muttaqin ,

Muhammad Thohar Arifin ,

Sukma Imawati ,

Farah Hendara Ningrum ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i2.4309 |
Published: 2023-07-04

Abstract

Link of Video Abstract: https://youtu.be/BtHvICeUONY

Background: Hydrocephalus is a condition in which cerebrospinal fluid (CSS) buildup in the ventricles is caused by excessive CSS production or disturbance of CSS circulation or absorption. Insertion of a shunt catheter into the lateral ventricle can be performed at the Kocher, Keen, Dandy, Frazier, Kaufmann, or Tubbs points. This study aims to evaluate the trigone point as an alternative location for ventricular shunt insertion

Methods: This is a retrospective study. We performed a three-dimensional head CT scan reconstruction of hydrocephalus patients; then, we calculated the vertical and horizontal distances perpendicular to each other from the upper edge of the auricle that intersects the trigone point on the right and left sides of the patient. Data were analyzed using SPSS version 26.0 for Windows.

Results: A total of 30 hydrocephalus patients at Kariadi Hospital Semarang from 2021 – 2022 were enrolled in this study. We got the averages of the vertical line is 25.05 mm and the horizontal is 33.00 mm for the right trigone point. In addition, the average vertical line is 25.78 mm and the horizontal line is 34.72 mm for the left trigone point. There was no significant difference between the vertical distance of the right and left trigone points (p=0.578) and the horizontal distance of the right and left trigone points (p=0.185). We found no significant difference between the location of the right and left trigone points.

Conclusion: Trigone point can be an alternative location for ventricular shunt installation.

References

Kahle KT, Kulkarni AV, Limbrick DD Jr, Warf BC. Hydrocephalus in children. Lancet. 2016;387(10020):788-799.
Karimy JK, Reeves BC, Damisah E, Duy PQ, Antwi P, David W, et al. Inflammation in acquired hydrocephalus: pathogenic mechanisms and therapeutic targets. Nat Rev Neurol. 2020;16(5):285-296.
Wilson TJ, Stetler WR Jr, Al-Holou WN, Sullivan SE. Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation. J Neurosurg. 2013;119(1):66-70.
Crowley RW, Dumont AS, Asthagiri AR, Torner JC, Medel R, Jane JA Jr, et al. Intraoperative ultrasound guidance for the placement of permanent ventricular cerebrospinal fluid shunt catheters: a single-center historical cohort study. World Neurosurg. 2014;81(2):397-403.
Yamada S, Ishikawa M, Nakajima M, Nozaki K. Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures. Front Neurol. 2022;12:798488.
Bergsneider M, Miller C, Vespa PM, Hu X. Surgical management of adult hydrocephalus. Neurosurgery. 2008;62 Suppl 2:643-660.
Konar S, Shukla D. Bilateral Lambdoid and Sagittal Craniosynostosis with Hydrocephalus: ETV, Bifrontal Craniotomy, Anterior Cranial Vault Remodeling, and Posterior Cranial Vault Expansion. Neurol India. 2021;69(3):592-594.
Mortazavi MM, Adeeb N, Griessenauer CJ, Sheikh H, Shahidi S, Tubbs RI, et al. The ventricular system of the brain: a comprehensive review of its history, anatomy, histology, embryology, and surgical considerations. Childs Nerv Syst. 2014;30(1):19-35.
Roka YB. A review of trajectories for external cranial ventricular access. Nepal Journal of Neuroscience. 2021;18(2):2-8.
Arifin MT, Purnomo F, Muttaqin Z, Bakhtiar Y, Andar E, Priambada D, et al. Cerebrospinal fluid contents and risk of shunt exposure in hydrocephalus. Bali Medical Journal. 2019;8(3):661-663.
Ruspanah I, Hermanto Y, Taihuttu YMJ, Ruspanah A, Adam A, Imron A. Implications of VP-Shunt, Sodium Level, Glucose Level Ratio and Neurologic Deficit as Clinical Outcome Prognostic Factor in Adult Meningitis Tuberculosis with Acute Hydrocephalus in Dr. Hasan Sadikin General Hospital. Bali Medical Journal. 2022;11(2):715-721.
Wardhana DPW, Maliawan S. Operative nuances of endoscopic third ventriculostomy for pediatric obstructive hydrocephalus. Bali Medical Journal. 2018;7(2):351-355.

[1] Kahle KT, Kulkarni AV, Limbrick DD Jr, Warf BC. Hydrocephalus in children. Lancet. 2016;387(10020):788-799.

[2] Karimy JK, Reeves BC, Damisah E, Duy PQ, Antwi P, David W, et al. Inflammation in acquired hydrocephalus: pathogenic mechanisms and therapeutic targets. Nat Rev Neurol. 2020;16(5):285-296.

[3] Wilson TJ, Stetler WR Jr, Al-Holou WN, Sullivan SE. Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation. J Neurosurg. 2013;119(1):66-70.

[4] Crowley RW, Dumont AS, Asthagiri AR, Torner JC, Medel R, Jane JA Jr, et al. Intraoperative ultrasound guidance for the placement of permanent ventricular cerebrospinal fluid shunt catheters: a single-center historical cohort study. World Neurosurg. 2014;81(2):397-403.

[5] Yamada S, Ishikawa M, Nakajima M, Nozaki K. Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures. Front Neurol. 2022;12:798488.

[6] Bergsneider M, Miller C, Vespa PM, Hu X. Surgical management of adult hydrocephalus. Neurosurgery. 2008;62 Suppl 2:643-660.

[7] Konar S, Shukla D. Bilateral Lambdoid and Sagittal Craniosynostosis with Hydrocephalus: ETV, Bifrontal Craniotomy, Anterior Cranial Vault Remodeling, and Posterior Cranial Vault Expansion. Neurol India. 2021;69(3):592-594.

[8] Mortazavi MM, Adeeb N, Griessenauer CJ, Sheikh H, Shahidi S, Tubbs RI, et al. The ventricular system of the brain: a comprehensive review of its history, anatomy, histology, embryology, and surgical considerations. Childs Nerv Syst. 2014;30(1):19-35.

[9] Roka YB. A review of trajectories for external cranial ventricular access. Nepal Journal of Neuroscience. 2021;18(2):2-8.

[10] Arifin MT, Purnomo F, Muttaqin Z, Bakhtiar Y, Andar E, Priambada D, et al. Cerebrospinal fluid contents and risk of shunt exposure in hydrocephalus. Bali Medical Journal. 2019;8(3):661-663.

[11] Ruspanah I, Hermanto Y, Taihuttu YMJ, Ruspanah A, Adam A, Imron A. Implications of VP-Shunt, Sodium Level, Glucose Level Ratio and Neurologic Deficit as Clinical Outcome Prognostic Factor in Adult Meningitis Tuberculosis with Acute Hydrocephalus in Dr. Hasan Sadikin General Hospital. Bali Medical Journal. 2022;11(2):715-721.

[12] Wardhana DPW, Maliawan S. Operative nuances of endoscopic third ventriculostomy for pediatric obstructive hydrocephalus. Bali Medical Journal. 2018;7(2):351-355.

Trigone point as an alternative location for ventricular shunt insertion

Abstract

References

How to Cite

Search Panel