Introduction: The majority of VP shunt malfunctions are due to proximal catheter failure. Ideal placement of Ommaya reservoirs is desired to avoid toxicity from inadvertent intraparenchymal chemotherapy infusion. We assess whether stereotactic placement of ventricular catheters improves the rate of proximal VP shunt malfunction and Ommaya reservoir complications.
Methods: A review of a prospectively collected database identified all patients undergoing stereotactic guided placement of ventriculo-peritoneal (VP) shunts and Ommaya reservoirs. All procedures were performed by a single surgeon between November, 2007 and November, 2010. Navigation was used to preset a surgical plan. Real time navigation was used to place the ventricular catheters. Post-op CT scans and clinical follow up were assessed.
Results: 100 patients (mean age 44.6 years) underwent 78 VP shunt and 22 Ommaya placement procedures. Rigid cranial fixation was used in all cases. All catheters were placed with a single pass. Mean operative time was 58 minutes. Mean follow up is 22 months. No proximal malfunctions have been seen. One patient required repositioning of an Ommaya reservoir as post-op CT showed poor placement (1 %). One patient with cryptococcal meningitis developed an abdominal abscess and required removal of his entire shunt. One patient suffered an asymptomatic hemorrhage along the shunt catheter; no intervention was needed.
Conclusions: We present the largest series to date of stereotactic guided ventricular catheter placements. This technique appears safe and effective with no proximal catheter failures thus far. Actual operative time is comparable to non-navigation procedures. Longer term follow up is needed to assess the longevity of our positive short-term results; however, with a mean follow up time of 24 months, the results do seem promising.
Patient Care: Hope to encourage others to employ our technique to mimimize proximal catheter malfunction
Learning Objectives: By the conclusion of this session, participants should be able to
1) Describe the technique of stereotactic placement of ventricular catheters
2) Emphasize that this method seems safe and effective for VP shunts and Ommaya reservoir placement
3) Describe that this techniques decreases proximal catheter malfunction