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  • Image Guidance for Ventricular Shunt Surgery: an Analysis of Ventricular Size and Proximal Revision Rates

    Final Number:

    Nickalus Khan MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Image guidance is a promising technology that could lead to lower rates of premature shunt failure by decreasing the rate of inaccurate proximal catheter placement. The objective of the study was to perform a detailed radiographic analysis of ventricular size using 3 well-described methods and compare proximal revision rates.

    Methods: Our shunt surgery research database was queried to identify procedures (new placement or revision) where frameless stereotactic electromagnetic neuronavigation was used (January 2010–June 2016). A randomly selected cohort of surgeries done without image guidance during the same time period served as the comparison group. A radiographic analysis utilizing the following indices was used to classify ventricular size: bifrontal, bicaudate, and frontal-occipital horn ratio. The primary outcome was shunt failure due specifically to proximal catheter malfunction at 90 and 180 days.

    Results: A total of 108 stereotactic and 95 free-hand cases were identified. Overall, there was no difference in ventricular size between the 2 groups. Neuro-navigation yielded improved accuracy rates (73% grade 1; p<0.001). Although there was no statistically significant difference in proximal revision rates when all patients were analyzed, there was a clinically beneficial reduction in the 90 and 180-day failure rates across all radiographic indices in children with small-to-moderate ventricular sizes when using image guidance.

    Conclusions: Electromagnetic neuronavigation results in more accurate placement of catheters, but did not result in an overall reduction in proximal shunt failure at 90 and 180-days after the index surgery. However, subgroup analysis suggests a clinically important benefit in those patients with harder to cannulate ventricles.

    Patient Care: It will inform neurosurgeons of the potential benefit in neuronavigation in different patient populations.

    Learning Objectives: Ventricular size is important when evaluating proximal revision rates. Patients with harder to cannulate ventricles likely have the most benefit from electromagnetic neuronavigation.

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