Individualized ventriculostomy in hydrocephalus: an intravital anatomical study.

BACKGROUND: Ventriculostomy is a common neuroendoscopic operation but one with disastrous complications in rare cases. AIMS: The aim of this study was to perform an intravital analysis of the configuration at the floor of the third ventricle as a possible basis for selection of the ventriculostomy site. MATERIALS AND METHODS: The study population consisted of 32 patients who underwent ventriculostomy for the treatment of hydrocephalus. Perforation of the floor of the third ventricle was carried out on an individual basis following evaluation of the anatomic situation. Video material and magnetic resonance images (MRI) were analyzed. RESULTS: A classification system including three major groups was developed using the inner distance of the mamillary bodies as the key criterion. It was defined as narrow for values between 0 and 1 mm (observed range: 0-0.5 mm), medium for values between 1.1 and 3.4 mm (range 1.1-3.4 mm) and large for values greater than 3.4 mm (range: 3.8-6.9 mm). Statistical analysis of MR and video measurements revealed a good correlation. The ventriculostomy site was rostral of the mamillary bodies in 23 of the patients (n=27) and slightly occipital in four. The ventriculostomy site was located more to the left in 22 patients and more to the right in five. CONCLUSION: As a conclusion the ventriculostomy site has to be chosen in each case following a careful review of all available information. A classification system for the anatomical variations as well as the exact size and site of ventriculostomy should be introduced.

A program of microsurgical training for young medical students: are younger students better?

In the European countries there is a lack of young doctors. This shortage limits the possibilities for recruiting skilled surgeons for the microsurgical disciplines. Complicating the situation is the fact that most students do not decide on their area of specialization until the late clinical semesters. The authors present a new program of microsurgical training that dispenses completely with animal training. In addition, a scoring system is presented that enables instructors to compare the microsurgical skills of different students for the purpose of further statistical analysis. This scoring system could be used for the evaluation of potential microsurgical candidates as well as for other purposes, e.g. scientific projects. A total of 36 students with an average age of 24.2 were trained, with good-to-excellent results. Microsurgical training of young students can be recommended. A point worth exploring in the future is whether there are different learning curves for different age groups.