gms | German Medical Science

Objective: Modern pediatric intensive care enables survival of premature infants. These patients often require ventricular drainages for posthemorrhagic hydrocephalus. However, the exact insertion of a catheter for CSF drainage in premature infants is a challenge because of the small anatomical structures. Ultrasound guided catheter placement could be a simple method to overcome these problems. Here, we report our experience in 5 cases of ultrasound-guided catheter implantations.

Methods: Sonographic imaging was performed in 4 patients using an 8-MHz curved-array-probe. In a patient with a small fontanel, we used a 4-MHz sector-probe. 3 patients suffered from a post hemorrhagic hydrocephalus, one patient from a Chiari malformation. 3 of the premature infants weighed about 700 grams, whereas one weighed 1,300 grams. In one case the patient was 6 months old, but an optimal catheter positioning was necessary for subsequent intrathecal chemotherapy.

Results: Correct catheter implantation was possible in all cases. A pitfall was a too small working area. In order to have an adequate acoustic window, the fontanel must be included into the depicted sterile area. A fundamental aspect is the prior sonographic determination of the length of the catheter. This was possible in all cases.

Conclusions: Especially in cases of premature infants with hydrocephalus, implantation of ventricular catheters under ultrasound navigation represents a substantial advantage. A malpositioning of the catheter may be immediately corrected or avoided. Even with more specific indications, i.e. catheter implantation for intrathecal chemotherapy the intraoperative ultrasound control is not essential but helpful.