Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

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  • Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Object

The objective of this study was to compare the accuracy of 3 methods of ventricular catheter placement during CSF shunt operations: the freehand technique using surface anatomy, ultrasonic guidance, and stereotactic neuronavigation.

Methods

This retrospective cohort study included all patients from a single institution who underwent a ventricular CSF shunting procedure in which a new ventricular catheter was placed between January 2005 and March 2010. Data abstracted for each patient included age, sex, diagnosis, method of ventricular catheter placement, site and side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic studies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision through December 2011. Statistical analysis was then performed comparing the 3 methods of ventricular catheter placement and to determine risk factors for inaccurate placement.

Results

There were 249 patients included in the study; 170 ventricular catheters were freehand passed, 51 were placed using stereotactic neuronavigation, and 28 were placed under intraoperative ultrasonic guidance. There was a statistically significant difference between freehand catheters and stereotactic-guided catheters (p < 0.001), as well as between freehand catheters and ultrasound-guided catheters (p < 0.001). The only risk factor for inaccurate placement identified in this study was use of the freehand technique. The use of stereotactic neuronavigation and ultrasonic guidance reduced proximal shunt failure rates (p < 0.05) in comparison with a freehand technique.

Conclusions

Stereotactic- and ultrasound-guided ventricular catheter placements are significantly more accurate than freehand placement, and the use of these intraoperative guidance techniques reduced proximal shunt failure in this study.

Abbreviations used in this paper:EVD = external ventricular drain; VP = ventriculoperitoneal.

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Contributor Notes

Address correspondence to: Stephen E. Sullivan, M.D., Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Room 3552 TC, Ann Arbor, Michigan 48109-5338. email: ssulliva@umich.edu.

Please include this information when citing this paper: published online January 18, 2013; DOI: 10.3171/2012.11.JNS111384.

  • 1

    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
  • 2

    Chandler WF, , Knake JE, , McGillicuddy JE, , Lillehei KO, & Silver TM: Intraoperative use of real-time ultrasonography in neurosurgery. J Neurosurg 57:157163, 1982

    • Search Google Scholar
    • Export Citation
  • 3

    Farahmand D, , Hilmarsson H, , Högfeldt M, & Tisell M: Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients. J Neurol Neurosurg Psychiatry 80:12481253, 2009

    • Search Google Scholar
    • Export Citation
  • 4

    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
  • 5

    Korinek AM, , Fulla-Oller L, , Boch AL, , Golmard JL, , Hadiji B, & Puybasset L: Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study. Neurosurgery 68:985995, 2011

    • Search Google Scholar
    • Export Citation
  • 6

    Lind CR, , Tsai AM, , Lind CJ, & Law AJ: Ventricular catheter placement accuracy in non-stereotactic shunt surgery for hydrocephalus. J Clin Neurosci 16:918920, 2009

    • Search Google Scholar
    • Export Citation
  • 7

    Naftel RP, , Argo JL, , Shannon CN, , Taylor TH, , Tubbs RS, & Clements RH, : Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases. Clinical article. J Neurosurg 115:151158, 2011

    • Search Google Scholar
    • Export Citation
  • 8

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

    • Search Google Scholar
    • Export Citation
  • 9

    Theodosopoulos PV, , Abosch A, & McDermott MW: Intraoperative fiber-optic endoscopy for ventricular catheter insertion. Can J Neurol Sci 28:5660, 2001

    • Search Google Scholar
    • Export Citation
  • 10

    Villavicencio AT, , Leveque JC, , McGirt MJ, , Hopkins JS, , Fuchs HE, & George TM: Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters. Surg Neurol 59:375380, 2003

    • Search Google Scholar
    • Export Citation
  • 11

    Whitehead WE, , Jea A, , Vachhrajani S, , Kulkarni AV, & Drake JM: Accurate placement of cerebrospinal fluid shunt ventricular catheters with real-time ultrasound guidance in older children without patent fontanelles. J Neurosurg 107:5 Suppl 406410, 2007

    • Search Google Scholar
    • Export Citation

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