2016 Winter Project Week/Projects/EVD
Key Investigators
- Kirby Vosburgh (BWH)
- P. Jason White (BWH)
Project Description
Measuring Anatomic Factors for Extraventricular Drain Placement. Kirby Vosburgh, Jason White. In current clinical practice, extraventricular drains (EVD) are inserted though the brain into a ventricle to release excess pressure in cerebral spinal fluid. They are placed manually, generally perpendicular to the skull at Kocher's Point. Inaccurate initial placement is common, and iatrogenic morbidity is evident in a few percent of cases. Published data from our team, prior collaborations, and a few other investigators, is limited and not entirely consistent, but there is general agreement that the procedure should be improved, but only if the new method is inexpensive and rapidly and easily used. Dr. Vosburgh, with collaborators at MGH and BWH, has pursued a variety of approaches to EVD placement, such as the Smart Stylet, with the goal of replacing today’s freehand technique. Recently, working with Jason White, PhD and consulting with William Gormley, MD at BWH, various ultrasound-based Extra-Ventricular Drain guidance concepts have been explored. To reduce these inventions to practice, we need a more accurate understanding of the geometrical factors governing accurate EVD placement in a significant sample of likely patients. Under IRB approval, we propose to extract from the BWH archive pre-procedure CT data sets for patients who then received an EVD placement. Among the questions we will explore are: 1) how often will orthogonal insertion at Kocher’s point penetrate the target in the lateral ventricle? 2) What is the range of final placements, assuming strict orthogonality is achieved? 3) How accurately must the location of Kocher’s point be determined? 4) In what fraction of the patients are the ventricles distorted or displaced? 5) What is the likely B-scan ultrasound signal profile through the Kocher’s point burr hole, and through other commonly used probe insertion sites on the skull? If transcranial imaging is used, what are skull thicknesses and other \ anatomic factors. 6) What is the range of depths from the dura to the nearest appropriate ventricular access point? To answer these and related questions, we propose to use 3D Slicer and PLUS to measure and record these types of data for each CT image set. Our Project this week consists of getting this analysis software up and running on MacBooks. Kirby will supply some CT Data (such as used clinically) to work with. Once data reduction is completed, the data and results will be published and posted on line.
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