ACCURACY OF FREEHAND VENTRICULAR CANNULATION USING KOCHER’S AND KEEN’S POINTS IN HYDROCEPHALUS PATIENTS AT A TERTIARY INSTITUTION IN GHANA

Abstract

BACKGROUND Cerebrospinal fluid diversionary procedures are life-saving procedures in neurosurgical practice. It is also one of the most common procedures performed. Accuracy of ventricular cannulation as part of the diversionary procedure is of utmost importance as it reduces complications significantly, more so when some of the procedures like the ventriculoperitoneal shunting is lifelong. There have been various methods applied including freehand and image guided ventricular cannulation. AIM This study aims to determine how accurate the freehand cannulation of lateral ventricle is in patients with hydrocephalus using at Kocher’s and Keen’s points. METHODOLOGY This is a cross-sectional study of patients with hydrocephalus undergoing CSF diversion (external ventricular drain or ventriculoperitoneal shunt placement) in the Neuroscience unit of Korle Bu Teaching Hospital. A consecutive sampling method was used to select patients who presented to the emergency unit and outpatient department with hydrocephalus requiring CSF diversion. A total of 54 participants were recruited for this study. CT scan of the head was taken after CSF diversion using Kocher’s point of Keen’s point and catheter tip position was graded. The data collection was done using questionnaires and analysed with the Excel spread sheet and the IBM SPSS version 21 and 24. Patient’s demographic characteristics, the size of the dilated ventricles were obtained and Evan’s ratio calculated using the radiological imaging available, aetiology and type of hydrocephalus were also obtained and analyzed using descriptive statistics. The primary outcome which is accuracy grade was categorized as accurate and coded 1 or inaccurate and coded 0. Multivariable logistic regression was used to identify correlation of factors that may influence accuracy. RESULTS Out of the 54 participants, 61.1% were males and 38.9% were female with a mean age of 22.6 with a standard deviation of 26.01. Tumour was the commonest cause of hydrocephalus (38.9%) followed by congenital causes (27.8%). Post infectious causes accounted for the least (9.3%). Accuracy of the ventricle cannulation using Kocher’s point was 78.3% while that of Keen’s point was 25.8%. There was no statistically significant relationship between the Evans index (p=0.836) and accuracy and level of experience of surgeon and accuracy of ventricular catheter placement (p=0.437). vi CONCLUSION Freehand ventricular cannulation was more accurate using Kocher’s point than using Keen’s point. There was no significant correlation between the Evans ratio and level of experience of surgeon with the accuracy rate of ventricular cannulation using the Kocher’s and Keen’s point. Ventricular catheter placement can be significantly improved using a modification of technique (especially for Keen’s point access) in order to optimize outcome.