Use of the Brainlab Disposable Stylet for endoscope and peel-away navigation.

BACKGROUND: Neuronavigation, the ability to perform real-time intra-operative guidance during cranial and/or spinal surgery, has increased both accuracy and safety in neurosurgery [2]. Cranial navigation of existing surgical instruments using Brainlab requires the use of an instrument adapter and clamp, which in our experience renders an endoscope 'top-heavy', difficult to manipulate, and the process of registration of the adapter quite time-consuming. METHODS: A Brainlab Disposable Stylet was used to navigate fenestration of an entrapped temporal horn in a pediatric case. Accuracy was determined by target visualization relative to neuronavigation targeting. Accuracy was also calculated using basic trigonometry to establish the maximum tool tip inaccuracy for the disposible stylet inserted into a peel-away (Codman) and endoscope. RESULTS: The Brainlab Disposable Stylet was easier to use, more versatile, and as accurate as use of an instrument adapter and clamp. The maximum tool-tip inaccuracy for the endoscope was 0.967 mm, and the Codman peel-away 0.489 mm. A literature review did not reveal any reports of use of the Brainlab Disposable Stylet in this way, and we are unaware of this being used in common neurosurgical practice. CONCLUSIONS: We would recommend this technique in endoscopic cases that require use of Brainlab navigation.

Simulation in neurosurgical training: a blueprint and national approach to implementation for initial years trainees.

Simulation has played an increasing role in surgical training in recent years, this follows from various reports such as the Chief Medical Officer annual report and Sir John Temple's 'Time for Training' and also from other factors such as increasing focus on efficiency and transparency within the healthcare system. Evidence has shown that simulation can develop and improve technical, clinical, communication and management skills. With technological advances, the quality of simulation has also improved with more realistic models and environment. We have undertaken a review of recent drivers for simulation training in the UK, current techniques and have focused on the application of simulation training within the current UK Neurosurgical curriculum for newly appointed trainees.

Comparison of infection rate with the use of antibiotic-impregnated vs standard extraventricular drainage devices: a prospective, randomized controlled trial.

BACKGROUND: External ventricular drainage (EVD) catheters provide reliable and accurate means of monitoring intracranial pressure and alleviating elevated pressures via drainage of cerebrospinal fluid (CSF). CSF infections occur in approximately 9% of patients. Antibiotic-impregnated (AI) EVD catheters were developed with the goal of reducing the occurrence of EVD catheter-related CSF infections and their associated complications. OBJECTIVE: To present an international, prospective, randomized, open-label trial to evaluate infection incidence of AI vs standard EVD catheters. METHODS: Infection was defined as (1) proven infection, positive CSF culture and positive Gram stain or (2) suspected infection: (A) positive CSF culture with no organisms identified on initial Gram stain; (B) negative CSF culture with a gram-positive or -negative stain; (C) CSF leukocytosis with a white blood cell/red blood cell count >0.02. RESULTS: Four hundred thirty-four patients underwent implantation of an EVD catheter. One hundred seventy-six patients in the AI-EVD cohort and 181 in the standard EVD catheter cohort were eligible for evaluation of infection. The 2 groups were similar in all clinical characteristics. Proven infection was documented in 9 (2.5%) patients (AI: 4 [2.3%] vs standard: 5 [2.8%], P = 1.0). Suspected infection was documented in 31 (17.6%) patients receiving AI and 37 (20.4%) patients receiving standard EVD catheters, P = .504. Duration of time to suspected infection was prolonged in the AI cohort (8.8 ± 6.1 days) compared with the standard EVD cohort (4.6 ± 4.2 days), P = .002. CONCLUSION: AI-EVD catheters were associated with an extremely low rate of catheter-related infections. AI catheters were not associated with risk reduction in EVD infection compared to standard catheters. Use of AI-EVD catheters is a safe option for a wide variety of patients requiring CSF drainage and monitoring, but the efficacy of AI-EVD catheters was not supported in this trial.