Electromagnetic-guided neuronavigation for safe placement of intraventricular catheters in pediatric neurosurgery

Clinical article

View More View Less
  • Department of Neurosurgery, Medical School Hannover, Germany
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Ventricular catheter shunt malfunction is the most common reason for shunt revision. Optimal ventricular catheter placement can be exceedingly difficult in patients with small ventricles or abnormal ventricular anatomy. Particularly in children and in premature infants with small head size, satisfactory positioning of the ventricular catheter can be a challenge. Navigation with electromagnetic tracking technology is an attractive and innovative therapeutic option. In this study, the authors demonstrate the advantages of using this technology for shunt placement in children.

Methods

Twenty-six children ranging in age from 4 days to 14 years (mean 3.8 years) with hydrocephalus and difficult ventricular anatomy or slit ventricles underwent electromagnetic-guided neuronavigated intraventricular catheter placement in a total of 29 procedures.

Results

The single-coil technology allows one to use flexible instruments, in this case the ventricular catheter stylet, to be tracked at the tip. Head movement during the operative procedure is possible without loss of navigation precision. The intraoperative catheter placement documented by screenshots correlated exactly with the position on the postoperative CT scan. There was no need for repeated ventricular punctures. There were no operative complications. Postoperatively, all children had accurate shunt placement. The overall shunt failure rate in our group was 15%, including 3 shunt infections (after 1 month, 5 months, and 10 months) requiring operative revision and 1 distal shunt failure. There were no proximal shunt malfunctions during follow-up (mean 23.5 months).

Conclusions

The electromagnetic-guided neuronavigation system enables safe and optimal catheter placement, especially in children and premature infants, alleviating the need for repeated cannulation attempts for ventricular puncture. In contrast to stereotactic techniques and conventional neuronavigation, there is no need for sharp head fixation using a Mayfield clamp. This technique may present the possibility of reducing proximal shunt failure rates and costs for hydrocephalus treatment in this age cohort.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Elvis J. Hermann, M.D., Department of Neurosurgery, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. email: hermann.elvis@mh-hannover.de.

Please include this information when citing this paper: published online August 10, 2012; DOI: 10.3171/2012.7.PEDS11369.

  • 1

    Abu-Serieh B, , Ghassempour K, , Duprez T, & Raftopoulos C: Stereotactic ventriculoperitoneal shunting for refractory idiopathic intracranial hypertension. Neurosurgery 60:10391044, 2007

    • Search Google Scholar
    • Export Citation
  • 2

    Aufdenblatten CA, & Altermatt S: Intraventricular catheter placement by electromagnetic navigation safely applied in a paediatric major head injury patient. Childs Nerv Syst 24:10471050, 2008

    • Search Google Scholar
    • Export Citation
  • 3

    Azeem SS, & Origitano TC: Ventricular catheter placement with a frameless neuronavigational system: a 1-year experience. Neurosurgery 60:4 Suppl 2 243248, 2007

    • Search Google Scholar
    • Export Citation
  • 4

    Barszcz S, , Roszkowski M, , Daszkiewicz P, , Jurkiewicz E, & Maryniak A: Accuracy of intraoperative registration during electromagnetic neuronavigation in intracranial procedures performed in children. Neurol Neurochir Pol 41:122127, 2007

    • Search Google Scholar
    • Export Citation
  • 5

    Behjati S, , Emami-Naeini P, , Nejat F, & El Khashab M: Incidence of hydrocephalus and the need to ventriculoperitoneal shunting in premature infants with intraventricular hemorrhage: risk factors and outcome. Childs Nerv Syst 27:985989, 2011

    • Search Google Scholar
    • Export Citation
  • 6

    Clark S, , Sangra M, , Hayhurst C, , Kandasamy J, , Jenkinson M, & Lee M, : The use of noninvasive electromagnetic neuronavigation for slit ventricle syndrome and complex hydrocephalus in a pediatric population. Clinical article. J Neurosurg Pediatr 2:430434, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Cochrane DD, & Kestle JR: The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg 38:295301, 2003

    • Search Google Scholar
    • Export Citation
  • 8

    Dickerman RD, , McConathy WJ, , Morgan J, , Stevens QE, , Jolley JT, & Schneider S, : Failure rate of frontal versus parietal approaches for proximal catheter placement in ventriculoperitoneal shunts: revisited. J Clin Neurosci 12:781783, 2005

    • Search Google Scholar
    • Export Citation
  • 9

    Gil Z, , Siomin V, , Beni-Adani L, , Sira B, & Constantini S: Ventricular catheter placement in children with hydrocephalus and small ventricles: the use of a frameless neuronavigation system. Childs Nerv Syst 18:2629, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Hayhurst C, , Beems T, , Jenkinson MD, , Byrne P, , Clark S, & Kandasamy J, : Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study. Clinical article. J Neurosurg 113:12731278, 2010

    • Search Google Scholar
    • Export Citation
  • 11

    Hayhurst C, , Byrne P, , Eldridge PR, & Mallucci CL: Application of electromagnetic technology to neuronavigation: a revolution in image-guided neurosurgery. Technical note. J Neurosurg 111:11791184, 2009

    • Search Google Scholar
    • Export Citation
  • 12

    Huyette DR, , Turnbow BJ, , Kaufman C, , Vaslow DF, , Whiting BB, & Oh MY: Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans. J Neurosurg 108:8891, 2008

    • Search Google Scholar
    • Export Citation
  • 13

    Kanev PM, & Park TS: The treatment of hydrocephalus. Neurosurg Clin N Am 4:611619, 1993

  • 14

    Kang JK, & Lee IW: Long-term follow-up of shunting therapy. Childs Nerv Syst 15:711717, 1999

  • 15

    Kast J, , Duong D, , Nowzari F, , Chadduck WM, & Schiff SJ: Timerelated patterns of ventricular shunt failure. Childs Nerv Syst 10:524528, 1994

    • Search Google Scholar
    • Export Citation
  • 16

    Kestle JR, , Drake JM, , Cochrane DD, , Milner R, , Walker ML, & Abbott R III, : Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg 98:284290, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Krauss JK, , Droste DW, , Vach W, , Regel JP, , Orszagh M, & Borremans JJ, : Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular and deep white matter lesions. Neurosurgery 39:292300, 1996

    • Search Google Scholar
    • Export Citation
  • 18

    Krombach G, , Ganser A, , Fricke C, , Rohde V, , Reinges M, & Gilsbach J, : Virtual placement of frontal ventricular catheters using frameless neuronavigation: an “unbloody training” for young neurosurgeons. Minim Invasive Neurosurg 43:171175, 2000

    • Search Google Scholar
    • Export Citation
  • 19

    Mangano FT, , Limbrick DD Jr, , Leonard JR, , Park TS, & Smyth MD: Simultaneous image-guided and endoscopic navigation without rigid cranial fixation: application in infants: technical case report. Neurosurgery 58:4 Suppl 2 ONS-E377, 2006

    • Search Google Scholar
    • Export Citation
  • 20

    McMillen JL, , Vonau M, & Wood MJ: Pinless frameless electromagnetic image-guided neuroendoscopy in children. Childs Nerv Syst 26:871878, 2010

    • Search Google Scholar
    • Export Citation
  • 21

    Mirzayan MJ, , Luetjens G, , Borremans JJ, , Regel JP, & Krauss JK: Extended long-term (> 5 years) outcome of cerebrospinal fluid shunting in idiopathic normal pressure hydrocephalus. Neurosurgery 67:295301, 2010

    • Search Google Scholar
    • Export Citation
  • 22

    Notarianni C, , Vannemreddy P, , Caldito G, , Bollam P, , Wylen E, & Willis B, : Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions. Clinical article. J Neurosurg Pediatr 4:547552, 2009

    • Search Google Scholar
    • Export Citation
  • 23

    Paulsen AH, , Lundar T, & Lindegaard KF: Twenty-year outcome in young adults with childhood hydrocephalus: assessment of surgical outcome, work participation, and health-related quality of life. Clinical article. J Neurosurg Pediatr 6:527535, 2010

    • Search Google Scholar
    • Export Citation
  • 24

    Piatt JH Jr: Cerebrospinal fluid shunt failure: late is different from early. Pediatr Neurosurg 23:133139, 1995

  • 25

    Piatt JH Jr, & Garton HJ: Clinical diagnosis of ventriculoperitoneal shunt failure among children with hydrocephalus. Pediatr Emerg Care 24:201210, 2008

    • Search Google Scholar
    • Export Citation
  • 26

    Reddy GK, , Bollam P, , Shi R, & Guthikonda B: Management of adult hydrocephalus with ventriculoperitoneal shunts: longterm single institution experience. Neurosurgery 69:774781, 2011

    • Search Google Scholar
    • Export Citation
  • 27

    Reig AS, , Stevenson CB, & Tulipan NB: CT-based, fiducial-free frameless stereotaxy for difficult ventriculoperitoneal shunt insertion: experience in 26 consecutive patients. Stereotact Funct Neurosurg 88:7580, 2010

    • Search Google Scholar
    • Export Citation
  • 28

    Rodt T, , Köppen G, , Lorenz M, , Majdani O, , Leinung M, & Bartling S, : Placement of intraventricular catheters using flexible electromagnetic navigation and a dynamic reference frame: a new technique. Stereotact Funct Neurosurg 85:243248, 2007

    • Search Google Scholar
    • Export Citation
  • 29

    Rosenow JM, & Sootsman WK: Application accuracy of an electromagnetic field-based image-guided navigation system. Stereotact Funct Neurosurg 85:7581, 2007

    • Search Google Scholar
    • Export Citation
  • 30

    Sainte-Rose C, , Piatt JH, , Renier D, , Pierre-Kahn A, , Hirsch JF, & Hoffman HJ, : Mechanical complications in shunts. Pediatr Neurosurg 17:29, 1992

    • Search Google Scholar
    • Export Citation
  • 31

    Sangra M, , Clark S, , Hayhurst C, & Mallucci C: Electromagneticguided neuroendoscopy in the pediatric population. Clinical article. J Neurosurg Pediatr 3:325330, 2009

    • Search Google Scholar
    • Export Citation
  • 32

    Schichor C, , Witte J, , Schöller K, , Tanner P, , Uhl E, & Goldbrunner R, : Magnetically guided neuronavigation of flexible instruments in shunt placement, transsphenoidal procedures, and craniotomies. Neurosurgery 63:1 Suppl 1 ONS121ONS128, 2008

    • Search Google Scholar
    • Export Citation
  • 33

    Schubert F, , Fijen BP, & Krauss JK: Laparoscopically assisted peritoneal shunt insertion in hydrocephalus: a prospective controlled study. Surg Endosc 19:15881591, 2005

    • Search Google Scholar
    • Export Citation
  • 34

    Schukfeh N, , Tschan CA, , Kuebler JF, , Hermann EJ, , Nustede R, & Krauss JK, : Laparoscopically assisted ventriculoperitoneal shunt placement in infants with previous multiple abdominal operations. Eur J Pediatr Surg 19:168170, 2009

    • Search Google Scholar
    • Export Citation
  • 35

    Sciubba DM, , Noggle JC, , Carson BS, & Jallo GI: Antibiotic-impregnated shunt catheters for the treatment of infantile hydrocephalus. Pediatr Neurosurg 44:9196, 2008

    • Search Google Scholar
    • Export Citation
  • 36

    Sprung C, , Schlosser HG, , Lemcke J, , Meier U, , Messing-Jünger M, & Trost HA, : The adjustable proGAV shunt: a prospective safety and reliability multicenter study. Neurosurgery 66:465474, 2010

    • Search Google Scholar
    • Export Citation
  • 37

    Toma AK, , Camp S, , Watkins LD, , Grieve J, & Kitchen ND: External ventricular drain insertion accuracy: is there a need for change in practice?. Neurosurgery 65:11971201, 2009

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 308 169 4
Full Text Views 120 23 2
PDF Downloads 146 18 3
EPUB Downloads 0 0 0