Image-Guided Navigation Systems (IGNS) Improve Accuracy of Catheter Placement in Shunted Hydrocephalus Patients

Abstract

The most common surgical complication associated with shunt placement in Hydrocephalus patients is obstruction causing shunt malfunction. The primary cause of obstruction is incorrect placement of the catheter tip, most notably in the choroid plexus. To investigate the clinical and economic value of IGNS use in the accurate placement of catheters in Hydrocephalus patients. A search of the Embase and PubMed electronic databases was conducted to identify studies evaluating the accuracy, effectiveness, quality-of-life (QOL) and economic aspects of IGNS in patients with Hydrocephalus. No language restrictions were applied. We conducted a meta-analysis of studies reporting accuracy of ventricular catheter placement in patients with hydrocephalus undergoing shunt placement with stereotactic IGNS versus freehand technique. The definition of accurate catheter placement was similar in all studies. The meta-analysis showed the odds of achieving an accurate catheter placement for surgeons who utilize IGNS was almost 6 times higher (odds ratio 5.55,95% CI [2.84,10.85], P<0.00001) than surgeons who used freehand placement techniques. Furthermore, accurate placement of the catheter tip was associated with fewer shunt failures, as demonstrated in 9 clinical studies investigating accurate catheter placement using the AxiEM™ IGNS (Medtronic Inc). In addition to being costly, studies showed shunt revision surgery was associated with significant morbidity and lower long-term QOL. In a study of 80 paediatric Hydrocephalus patients, investigators found that patients with a history of two or more shunt revision surgeries had a significantly worse QOL (p<0.02), as measured by the Hydrocephalus Outcomes Questionnaire (HOQ). The use of IGNS significantly increases the accuracy of ventricular catheter placement compared to freehand techniques in hydrocephalus patients undergoing ventricular shunt insertion. Clinical studies have shown the use of IGNS in shunt placement surgery results in lower shunt failure rates, which improve QOL and lowers the economic impact to payers.