Introduction: Despite the large number of shunts placed, shunt-related complication and ventricular catheter revision rates remain high (30-40%). Satisfactory ventricular catheter positioning based only on anatomical landmarks and surgical experience is frequently challenging. This retrospective study was conducted to determine whether navigated-shunt placement improves technical and clinical outcomes compared with standard blind shunt placement.
Methods: Forty-two standard shunts (SS) and forty-eight BrainLab neuronavigation system image-guided shunts (IGS) were placed in an adult population. Procedure duration, number of passes required for cannulation, intra- and post-operative complications, CT-determined ventricular catheter location, symptom improvement, and shunt revision rates were recorded. Continuous measures (duration) were compared with independent sample t-test, while all other outcome parameters were compared using Pearson’s Chi-Square method.
Results: Mean induction to incision time was significantly higher in IGS than SS group (64.6±4.9 min versus 52.0± 7.2 min, p=0.0051). Mean incision to closure time and entire procedure time from induction were not significantly different between the two groups (p = 0.507 and 0.103, respectively). The catheter tip was optimally positioned in 79% of IGS compared with 57% of SS (p=0.024). The number of passes was not significantly different between both groups (p=0.71). Complication rate was significantly lower in the IGS group (10.42% versus 28.57%, p= 0.028), reducing revision rate from 31.0% in SS to 10.4% in IGS group (p=0.015). One IGS case and 3 SS cases were complicated by early shunt infection. No Mayfield-related complications were noted.
Conclusions: IGS surgery improves shunt placement and complication rate significantly, decreasing shunt revision rate.
Patient Care: By showing everybody how to do image-guided shunt placement, they can improve the quality of VP shunt placement and so, decrease the rate of complications.
Learning Objectives: To learn how image guidance may improve the quality of care and success rate of shunt placement and therefore decrease the rate of complications.