Accuracy Of Ventricular Catheter Placement Research Articles

Relationship of the Location of the Ventricular Catheter Tip and Function of the Ventriculoperitoneal Shunt

Object: The objective of this study was to determine the relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt.
 Methods: This prospective observational study included 140 patients from a single institution who underwent a ventriculoperitoneal shunt procedure in which a new ventricular catheter was placed between September, 2013 and September 2016. Data abstracted for each patient included age, sex, diagnosis, site and side of ventricular catheter placement. Postoperative CT scan images were reviewed for accuracy of ventricular catheter placement. Patients were followed up over 2 ½ to 4 ½ years.63 patients were available for follow up. We lost communication with rest of the patients. The relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt was analyzed in 63 patients.
 Results: There were 140 patients included in the study; accuracy ventricular catheter tip placement were 55 (39.28%) using freehand technique. VP shunt functioned well in 43 (68.25%) of 63 patients. Among the 43 patients with well functioning shunt ,19 were in accurate group ,7 were in suboptimal group and 17 were in inaccurate group.26 patients (41.27%) had good outcome with normal development and normal IQ
 Conclusions: Mechanical malfunction and infection are the most significant problems associated with shunts for the treatment of hydrocephalus. Above all, a significant proportion of shunt failure was due to obstruction of the ventricular catheter, and accurate placement of the shunt catheter is highly important to reduce the incidence of shunt malfunction.
 Bang. J Neurosurgery 2019; 9(1): 16-21

Accuracy of Ventricular Catheter Tip Placement Using Freehand Placement

Background: Inaccurate placement of VP shunt catheter is related to shunt failure.
 Objective: The objective of this study was to determine the accuracy of ventricular catheter placement during ventriculoperitoneal shunt operations using the freehand technique.
 Methodology: This prospective observational study included all patients from a single institution who underwent a ventriculoperitoneal shunt procedure in which a new ventricular catheter was placed between September 2013 and August 2016 for a period of three (03) years. Data abstracted for each patient included age, sex, diagnosis, site and side of ventricular catheter placement. Postoperative CT scan images were reviewed for accuracy of ventricular catheter placement.
 Results: There were 140 patients included in the study; accuracy ventricular catheter tip placement were 55 (39.28%) using freehand technique.
 Conclusion: Mechanical malfunction and infection are the most significant problems associated with shunts for the treatment of hydrocephalus.
 Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 59-63

Utility of Preoperative Simulation for Ventricular Catheter Placement via a Parieto-Occipital Approach in Normal-Pressure Hydrocephalus.

Freehand ventricular catheter placement has been reported to have poor accuracy. To investigate whether preoperative computational simulation using diagnostic images improves the accuracy of ventricular catheter placement. This study included 113 consecutive patients with normal-pressure hydrocephalus (NPH), who underwent ventriculoperitoneal shunting via a parieto-occipital approach. The locations of the ventricular catheter placement in the last 48 patients with preoperative virtual simulation on the 3-dimensional workstation were compared with those in the initial 65 patients without simulation. Catheter locations were classified into 3 categories: optimal, suboptimal, and poor placements. Additionally, slip angles were measured between the ventricular catheter and optimal direction. All patients with preoperative simulations had optimally placed ventricular catheters; the mean slip angle for this group was 2.8°. Among the 65 patients without simulations, 46 (70.8%) had optimal placement, whereas 10 (15.4%) and 9 (13.8%) had suboptimal and poor placements, respectively; the mean slip angle for the nonsimulation group was 8.6°. The slip angles for all patients in the preoperative simulation group were within 7°, whereas those for 31 (47.7%) and 10 (15.4%) patients in the nonsimulation group were within 7° and over 14°, respectively. All patients with preoperative simulations experienced improved symptoms and did not require shunt revision during the follow-up period, whereas 5 patients (7.7%) without preoperative simulations required shunt revisions for different reasons. Preoperative simulation facilitates accurate placement of ventricular catheters via a parieto-occipital approach. Minimally invasive and precise shunt catheter placement is particularly desirable for elderly patients with NPH.

Calvarial slope affecting accuracy of Ghajar Guide technique for ventricular catheter placement.

OBJECT The Ghajar Guide technique is used to direct a ventricular catheter at a 90° angle to the skull surface at Kocher's point. However, the human calvaria is not completely spherical. Lateral to the sagittal midline, the calvaria slopes downward with individual variation and thereby affects the accuracy of ventricular catheter placement. Accordingly, the authors investigated the accuracy of the orthogonal catheter trajectory using radiographic simulation and examined the effect of the calvarial slope on this accuracy. METHODS A catheter trajectory orthogonal to the skull surface at Kocher's point and the ideal catheter trajectory to the foramen of Monro were drawn bilaterally on coronal head images of 52 patients with hydrocephalus. The correction angle, the difference between the 2 catheter trajectories, was then measured. Meanwhile, the calvarial slope was measured around Kocher's point by using a coronal head image. The correlation between the correction angle and factors such as the calvarial slope and bicaudate index was then assessed using a Pearson correlation analysis. RESULTS The ventricular catheter trajectory orthogonal to the skull at Kocher's point in the patients with hydrocephalus led to a catheter trajectory into the ipsilateral (70.2%) or contralateral (29.8%) lateral ventricles. The correction angles ranged from -3.3° to 16.4° (mean ± SD 5.7° ± 3.7°). In 87 (83.7%) head sides, lateral deviation from the orthogonal trajectory was required to approximate the ideal trajectory, and the correction angle ranged from 2.0° to 16.4° (mean 6.7° ± 2.9°). The calvarial slope in the 104 head sides ranged from 15.6° to 32.5° (mean 24.2° ± 3.1°). Pearson correlation analysis revealed a strong positive correlation (r = 0.733) between the calvarial slope and the correction angle. CONCLUSIONS The accuracy of ventricular catheter placement using the Ghajar Guide technique is affected primarily by the calvarial slope around Kocher's point. A radiographic analysis of a preoperative coronal head image can be used to estimate the accuracy of ventricular catheter placement and enable adjustment to approximate the ideal catheter trajectory.

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

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.

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

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. 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. 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. 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.

Factors affecting the accuracy of ventricular catheter placement

Despite technological improvements, ventriculoperitoneal (VP) shunts are still often complicated by malfunction, predominantly with proximal catheter obstruction. There is evidence that accurate placement of the ventricular catheter is significantly related to shunt survival. To identify possible risk factors that might lead to suboptimal shunt placement, we retrospectively reviewed the demographic data and radiological scans of 141 patients who underwent a VP shunt operation from 2005 to 2008 at our institution. We developed and validated a novel scale to assess catheter placement. Almost half (47.9%) of the catheters were “excellently” placed with the entire tip located in the cerebrospinal fluid, and the position of 25% was considered “good”. However, 26.8% were less than optimally placed (“poor”, “fair” or “moderate”), with 8.5% (“poor”) lying entirely outside the ventricular system. Statistical analysis demonstrated that the preoperative size of the ventricles and the age of the patient at shunt insertion were the most important predictors in determining the quality of ventricular catheter placement. Further studies are required to evaluate frameless stereotaxy in optimizing shunt placement in patients with smaller ventricles.

The accuracy of ventricular catheter placement: does it influence shunt revision rates?

Background Ventricular catheter blockage is the commonest indication for shunt revision. Placement of a ventricular catheter in a region free of choroid plexus prolongs catheter survival. Positioning the tip of the ventricular catheter in the ipsilateral frontal horn anterior to the foramen of Munro is commonly considered the optimum position and is the standard position for catheter placement in our unit. Yet ventricular catheter placement is performed blindly and often misses the optimum position. In this study we aim to see how accurate we are in the placement of ventricular catheters and see whether the good positioning can reduce the rate of shunt revision.