CT fluoroscopy: novel application for the treatment of ventricular pathologies

Abstract

Recent advances in multidetector CT imaging (MDCT) provide real-time "fluoroscopic-like" capabilities with excellent spatial resolution. MDCT fluoroscopy expands our ability to perform image-guided interventions in anatomically complex locations. Although MDCT fluoroscopy is currently used at our institution for a variety of procedures ranging from spinal nerve blocks to RFA ablation, we believe these same techniques can be used to navigate within the ventricles of the central nervous system to treat conditions requiring placement of intraventricular catheters, depth electrodes, or potentially stents for the relief of CSF outlet obstruction. Using three fresh, unfrozen human cadavers, we studied the feasibility of using MDCT fluoroscopy for intraventricular catheter placement and to stent the aqueduct of Sylvius. The ventricles were entered via a single needle pass and catheters were placed over the wire. Contrast agent was then injected to visualize the distribution. To stent the aqueduct of Sylvius, a wire was passed into the 4th ventricle and a coronary stent was then inserted over the wire and deployed. Based on our success with these procedures, we believe this technique can be used to limit complications and improve efficacy of a number of neurosurgical procedures.