Virtual placement of frontal ventricular catheters using frameless neuronavigation: an unbloody training for young neurosurgeons

Objective: To evaluate virtually the reliability of freehand puncture of the anterior horn of the lateral ventricle and to provide realistic, but unbloody training for young neurosurgeons. Methods: Virtual placement of ventricular catheters was performed repeatedly by neurosurgical doctors and thereafter controlled by neuronavigation. With the help of a frameless stereotactic navigation device they virtually had to hit the anterior horn of the lateral ventricle on the MRI of 29 brains with normal ventricular sizes and 60 pathological ventricles, respectively. The catheter placement was simulated using the pointer of the navigation system (EasyGuide Neuro). The monitor screen was blinded, so that on-line control was impossible. Virtual elongation of the pointer tip was performed on the workstation and the position of the virtual catheter was evaluated on a printout. Results: Virtual freehand catheter placement was performed 145 times into the MRIs of the normal brains. In 66 cases (45%) the site of the catheter tip was judged as accurate as shown by the navigation system. No difference concerning the number of correctly placed catheters was observed when comparing more and less experienced doctors. The results in the 60 pathological MRIs of patients differed with respect to the size of the ventricles: in narrow ventricles an accurate placement succeeded in 7 of 22 cases (32%), moderately enlarged ventricles were accurately hit in 15 out of 32 cases (46%) and wide ventricles in 5 of 6 attempts (83%), respectively. Conclusion: This setup is a simple, practicable tool for neurosurgical education. The virtual freehand placement of ventricular drains controlled by neuronavigation provides an unbloody training of a routine neurosurgical procedure in a realistic setting without the risk of injuring a patient. Neuronavigation systems can serve therefore as a link between learning from observation and handling the real situation.