Journal article
The Wishbone: A Cranial Midline Localizing Device
World neurosurgery, Vol.128, pp.600-605.e1
08/2019
DOI: 10.1016/j.wneu.2019.05.046
PMID: 31100521
Abstract
The Wishbone device is designed to enable surgeons to quickly and accurately localize the cranial midline. It is intended to be of particular use when localizing the burr hole site during posterior ventriculoperitoneal shunt (VPS) surgery.
The Wishbone is a simple mechanical device with 2 adjustable caliper arms that reversibly attach to a patient's left and right external auditory canals. The Wishbone's laser localizer illuminates the midline scalp. The Wishbone was used to localize the posterior midline in a pilot series of patients undergoing VPS surgery. Midline localization and ventricular catheter placement accuracy were determined using findings from postoperative computed tomography scans.
The Wishbone is a mechanically robust device and proved easy for surgeons to use. Forty patients underwent VPS surgery using the Wishbone to localize the posterior midline. The localization procedure took less than 3 minutes. The average distance separating the Wishbone-localized midline scalp location and the computed tomography−defined anatomical midline was 2.9 mm (95% confidence interval 1.6–4.1 mm). In all cases, the ventricular catheter entered the ipsilateral lateral ventricle. The catheter tips were placed in the ipsilateral (n = 34) or contralateral (n = 5) frontal horn in all but 1 patient. In 1 patient, the catheter tip entered the parenchyma due to a burr hole localization error in the rostrocaudal dimension, unrelated to the Wishbone.
We describe a simple, efficient, and cost-effective system for accurately localizing the posterior cranial midline. A larger patient series is required to definitively compare its clinical utility relative to frameless stereotaxis-based midline localization methods.
Details
- Title: Subtitle
- The Wishbone: A Cranial Midline Localizing Device
- Creators
- Mario Zanaty - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAMatei Banu - Department of Neurosurgery, Columbia University, New York, New York, USAOliver Flouty - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USASean Grady - Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USAMarshall T Holland - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAAlbert Isaacs - Department of Neurosurgery, Washington University, Saint Louis, Missouri, USADavid Kung - Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USADavid D Limbrick - Department of Neurosurgery, Washington University, Saint Louis, Missouri, USAGuy McKhann - Department of Neurosurgery, Columbia University, New York, New York, USAYasunori Nagahama - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAGregory J Zipfel - Department of Neurosurgery, Washington University, Saint Louis, Missouri, USAMatthew A Howard - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.128, pp.600-605.e1
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.wneu.2019.05.046
- PMID
- 31100521
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Language
- English
- Date published
- 08/2019
- Academic Unit
- Neurology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984013999102771
Metrics
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