Factors affecting the accuracy of ventricular catheter placement

Wan, Kong-Wah; Toy, Jennifer Ah; Wolfe, Rory; Danks, Andrew

doi:10.1016/j.jocn.2010.06.018

Cited by 53 publications

(46 citation statements)

References 40 publications

(73 reference statements)

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“…1 Approximately 30% to 50% of shunt surgeries for hydrocephalus require shunt revision within the first 12 months. [2][3][4][5] The most common cause of shunt failure is obstruction of the ventricular catheter by debris from the choroid plexus and ependyma. 3,6 Correct placement of the catheter tip is essential for long-term VP shunt function.…”

Section: Introductionmentioning

confidence: 99%

Relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt

Yamada

Kitagawa

Teramoto

2013

Journal of Clinical Neuroscience

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Section: Introductionmentioning

confidence: 99%

Relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt

Yamada

Kitagawa

Teramoto

2013

Journal of Clinical Neuroscience

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“…Although these accuracy rates are low, they are similar to accuracy rates previously reported for other techniques. 5,7,8,15,17 There appear to be 2 main reasons that the ultrasound technique failed to achieve the desired level of accuracy. The first involves surgeons targeting the wrong area of the ventricle intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…These techniques result in favorable catheter placement in approximately one-third to two-thirds of cases. 1,5,7,8,13,17 Intraoperative ultrasound with a bur hole transducer allows visualization of the ventricular compartments and choroid plexus prior to placement of the catheter (Fig. 1).…”

mentioning

confidence: 99%

No significant improvement in the rate of accurate ventricular catheter location using ultrasound-guided CSF shunt insertion: a prospective, controlled study by the Hydrocephalus Clinical Research Network

Whitehead

Riva-Cambrin

Wellons

et al. 2013

PED

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Object Cerebrospinal fluid shunt ventricular catheters inserted into the frontal horn or trigone are associated with prolonged shunt survival. Developing surgical techniques for accurate catheter insertion could, therefore, be beneficial to patients. This study was conducted to determine if the rate of accurate catheter location with intraoperative ultrasound guidance could exceed 80%. Methods The authors conducted a prospective, multicenter study of children (< 18 years) requiring first-time treatment for hydrocephalus with a ventriculoperitoneal shunt. Using intraoperative ultrasound, surgeons were required to target the frontal horn or trigone for catheter tip placement. An intraoperative ultrasound image was obtained at the time of catheter insertion. Ventricular catheter location, the primary outcome measure, was determined from the first postoperative image. A control group of patients treated by nonultrasound surgeons (conventional surgeons) were enrolled using the same study criteria. Conventional shunt surgeons also agreed to target the frontal horn or trigone for all catheter insertions. Patients were triaged to participating surgeons based on call schedules at each center. A pediatric neuroradiologist blinded to method of insertion, center, and surgeon determined ventricular catheter tip location. Results Eleven surgeons enrolled as ultrasound surgeons and 6 as conventional surgeons. Between February 2009 and February 2010, 121 patients were enrolled at 4 Hydrocephalus Clinical Research Network centers. Experienced ultrasound surgeons (> 15 cases prior to study) operated on 67 patients; conventional surgeons operated on 52 patients. Experienced ultrasound surgeons achieved accurate catheter location in 39 (59%) of 66 patients, 95% CI (46%–71%). Intraoperative ultrasound images were compared with postoperative scans. In 32.7% of cases, the catheter tip moved from an accurate location on the intraoperative ultrasound image to an inaccurate location on the postoperative study. This was the most significant factor affecting accuracy. In comparison, conventional surgeons achieved accurate location in 24 (49.0%) of 49 cases (95% CI [34%–64%]). The shunt survival rate at 1 year was 70.8% in the experienced ultrasound group and 66.9% in the conventional group (p = 0.66). Ultrasound surgeons had more catheters surrounded by CSF (30.8% vs 6.1%, p = 0.0012) and away from the choroid plexus (72.3% vs 58.3%, p = 0.12), and fewer catheters in the brain (3% vs 22.4%, p = 0.0011) and crossing the midline (4.5% vs 34.7%, p < 0.001), but they had a higher proportion of postoperative pseudomeningocele (10.1% vs 3.8%, p = 0.30), wound dehiscence (5.8% vs 0%, p = 0.13), CSF leak (10.1% vs 1.9%, p = 0.14), and shunt infection (11.6% vs 5.8%, p = 0.35). Conclusions Ultrasound-guided shunt insertion as performed in this study was unable to consistently place catheters into the frontal horn or trigone. The technique is safe and achieves outcomes similar to other conventional shunt insertion techniques. Further efforts to improve accurate catheter location should focus on prevention of catheter migration that occurs between intraoperative placement and postoperative imaging. Clinical trial registration no.: NCT01007786 (ClinicalTrials.gov).

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“…The optimal position of the catheter tip was focused to reduce potential occlusion of proximal catheter by ventricular parenchyma or choroidal tissues1,4,12). Many studies including Tuli et al22) have shown that a ventricular catheter tip surrounded by cerebrospinal fluid (CSF) could decrease the risk of shunt failure25).…”

Section: Introductionmentioning

confidence: 99%

“…So recently, many studies have validated accuracy in VP shunt with the development of frameless neuronavigation in the field of neurosurgery2,25). However, it has not clearly proven that the role of the catheter position using navigation system on failure rates.…”

Section: Introductionmentioning

confidence: 99%

Effect of Electromagnetic Navigated Ventriculoperitoneal Shunt Placement on Failure Rates

Jung

Kim

2013

J Korean Neurosurg Soc

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ObjectiveTo evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement.MethodsAll patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma.ResultsA total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test).ConclusionThe use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.

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Factors affecting the accuracy of ventricular catheter placement

Cited by 53 publications

References 40 publications

Relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt

Relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt

No significant improvement in the rate of accurate ventricular catheter location using ultrasound-guided CSF shunt insertion: a prospective, controlled study by the Hydrocephalus Clinical Research Network

Effect of Electromagnetic Navigated Ventriculoperitoneal Shunt Placement on Failure Rates

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