Comment: how do I do it? Real-time three-dimensional robotic C-arm navigation for ventriculoperitoneal shunting

Abstract

I read with interest the technical note of Lee et al. describing the use of an intraoperative robotic C-arm navigation to aid in correct ventricular placement.The authors have already described this as a novel technique in 2023 [1].Although technically a basic procedure, ventricular catheter placements can be challenging, particularly in Idiopathic Intracranial Hypertension patients, patients with abnormal anatomy or patients who had multiple previous revisions.A broad range of techniques and tools have been developed to aid correct ventricular placement, with Augmented Reality more recently added to the neurosurgical armamentarium [3]. However only real-time imaging can confirm correct final placement, some of the techniques described include intraoperative fluoroscopic imaging, endoscopy, ultrasonography and intraoperative CT [2,4].In 2022 we described a similar technique as Lee et al., but using the O-arm instead of a robotic C-arm [2], which itself is just another application for a technique widely described for biopsies and DBS. Although the real-time images can be used to visualize the ventricles, we have found this challenging in patients with slit ventricles with the imaging quality often being suboptimal. Merging the newly obtained images with a preoperative MRI or CT can easily overcome this.Unfortunately the authors didn't mention that this technique can be applied to every intraoperative fluoroscopy linked to a navigation system, as such potentially missing a broader audience.Author contribution JVDV wrote the comment. Data availabilityNo datasets were generated or analysed during the current study. DeclarationsEthical approval Not applicable.