Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Abstract

Background: Idiopathic intracranial hypertension (IIH) is characterized by increased cerebrospinal fluid (CSF) pressure and normal or slit ventricles. Lumboperitoneal shunting had been favored by many investigators for CSF diversion in IIH for decades; however, it has been associated with various side effects. Because of the small ventricular size adequate positioning of a ventricular catheter is challenging. Objectives: Here, we investigated the usefulness of electromagnetic (EM)-guided ventricular catheter placement for ventriculoperitoneal shunting in IIH. Methods: Eighteen patients with IIH were included in this study. The age of patients ranged from 5 to 58 years at the time of surgery (mean age: 31.8 years; median: 29 years). There were 2 children (5 and 11 years old) and 16 adults. Inclusion criteria for the study were an established clinical diagnosis of IIH, lack of improvement with medication, and the presence of small ventricles. In all patients EM-navigated placement of the ventricular catheter was performed using real-time tracking of the catheter tip for exact positioning close to the foramen of Monro. Postoperative CT scans were correlated with intraoperative screen shots to validate the position of the catheter. Results: In all patients EM-navigated ventricular catheter placement was achieved with a single pass. There were no intraoperative or postoperative complications. Postoperative imaging confirmed satisfactory positioning of the ventricular catheter. No proximal shunt failure was observed during the follow-up at a mean of 41.5 months (range: 7-90 months, median: 40.5 months). Conclusions: EM-navigated ventricular catheter placement in shunting for IIH is a safe and straightforward technique. It obviates the need for sharp head fixation, the head of the patient can be moved during surgery, and it may reduce the revision rate during follow-up.

Challenges in cerebrospinal fluid shunting in patients with glioblastoma

“…Shift of anatomical landmarks as a result of perifocal edema, tumor growth, or distention of the resection cavity during the course of treatment can make the implantation of the proximal catheter technically more challenging in some instances [ 37 – 40 ] resulting in a higher risk for misplaced catheters [ 34 ]. In cases of poor accessibility to the ventricular system, neuronavigation is a valuable tool for achieving adequate placement of ventricular catheter [ 16 , 17 ]. In cases of multiple CSF-filled compartments, insertion of separate catheters or even separate shunt systems is sometimes necessary.…”

“…Microsurgical resection for tumor removal was performed according to standard surgical techniques for tumors not involving eloquent areas of the brain. Depending on tumor localization, neuronavigation, electrophysiological mapping, and/or 5-aminolevulinic acid (5-ALA) were applied intraoperatively [ 16 , 17 ]. Gross total microsurgical resection was achieved when the neurosurgeon determined that all areas of visible tumor were resected intraoperatively.…”

“…Two patients received a medium pressure CSF-flow control valve system (Medtronic, Minneapolis, MN, USA). Due to poor accessibility of the ventricle system, a neuronavigation system was used for insertion of the ventricular catheter in three patients [ 16 , 17 ].…”

Hydrocephalus and Spasticity in Motor Area AVM, a Case Report

“…[11,4] Ventricular catheter was inserted using neuronavigation (Stealth Medtronic) through a left frontal burr hole [15]. Placement of the ventricular catheter into the lateral ventricles is navigated mainly because of narrow ventricles in idiopathic intracranial hypertension [8]. Neuronavigation (Figure 4) was used to choose with accuracy the placement of the burrhole and corticotomy in respect of dilated cortical veins, because of venous hypertension.…”

Stenting Pada Sinus Venosus Serebral Dengan Hipertensi Intrakranial Idiopatik

“…9 McGirt dkk, melaporkan hasil penelitian pada 42 pasien HII yang telah dilakukan prosedur operasi pemasangan pirai, sebanyak 95% mengalami perbaikan nyeri kepala, walaupun 86% prosedur mengalami kegagalan. 11 El-Saadany dkk, melaporkan adanya perbaikan terhadap keluhan nyeri kepala sebesar 86% dan perbaikan pada edema papil sebesar 82% pada 22 pasien yang dilakukan operasi pemasangan pirai lumboperitoneal. 12 Dalam penelitian ini juga dilaporkan 9% infeksi pada alat pirai, 27% obstruksi saluran pirai, dan 13% risiko drainase berlebihan.…”