• Neurosurgery · Aug 2018

    Randomized Controlled Trial Multicenter Study

    GAVCA Study: Randomized, Multicenter Trial to Evaluate the Quality of Ventricular Catheter Placement with a Mobile Health Assisted Guidance Technique.

    • Ulrich-Wilhelm Thomale, Andreas Schaumann, Florian Stockhammer, Henrik Giese, Dhani Schuster, Stefanie Kästner, Alexander Sebastian Ahmadi, Manolis Polemikos, Hans-Christoph Bock, Leonie Gölz, Johannes Lemcke, Elvis Hermann, Martin U Schuhmann, Thomas Beez, Michael Fritsch, Berk Orakcioglu, Peter Vajkoczy, Veit Rohde, and Georg Bohner.
    • Pediatric Neurosurgery and Department of Neurosurgery, Campus Virchow Klini-kum, Charité Universitätsmedizin Berlin, Berlin, Germany.
    • Neurosurgery. 2018 Aug 1; 83 (2): 252-262.

    BackgroundFreehand ventricular catheter placement may represent limited accuracy for the surgeon's intent to achieve primary optimal catheter position.ObjectiveTo investigate the accuracy of a ventricular catheter guide assisted by a simple mobile health application (mhealth app) in a multicenter, randomized, controlled, simple blinded study (GAVCA study).MethodsIn total, 139 eligible patients were enrolled in 9 centers. Catheter placement was evaluated by 3 different components: number of ventricular cannulation attempts, a grading scale, and the anatomical position of the catheter tip. The primary endpoint was the rate of primary cannulation of grade I catheter position in the ipsilateral ventricle. The secondary endpoints were rate of intraventricular position of the catheter's perforations, early ventricular catheter failure, and complications.ResultsThe primary endpoint was reached in 70% of the guided group vs 56.5% (freehand group; odds ratio 1.79, 95% confidence interval 0.89-3.61). The primary successful puncture rate was 100% vs 91.3% (P = .012). Catheter perforations were located completely inside the ventricle in 81.4% (guided group) and 65.2% (freehand group; odds ratio 2.34, 95% confidence interval 1.07-5.1). No differences occurred in early ventricular catheter failure, complication rate, duration of surgery, or hospital stay.ConclusionThe guided ventricular catheter application proved to be a safe and simple method. The primary endpoint revealed a nonsignificant improvement of optimal catheter placement among the groups. Long-term follow-up is necessary in order to evaluate differences in catheter survival among shunted patients.

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