Ventricular catheter placement accuracy in non-stereotactic shunt surgery for hydrocephalus

Lind, Christopher; Tsai, Amy; Lind, Christina J.; Law, Andrew

doi:10.1016/j.jocn.2008.09.015

Cited by 47 publications

(25 citation statements)

References 16 publications

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“…In their study, Theodosopoulos et al 9 found that only 38% of catheters were optimally placed and 53% would have been considered accurate accord ing to the definition used in our study. Similarly, Lind et al 6 found that 56% of catheters were placed accurately in their study. Our data, together with theirs, suggest that we likely underestimate the rate of catheter misplacement using the freehand technique.…”

Section: Discussionmentioning

confidence: 69%

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Wilson¹,

Stetler²,

Al-Holou³

et al. 2013

JNS

120

108

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Object. The objective of this study was to compare the accuracy of 3 methods of ventricular catheter placement during CSF shunt operations: the freehand technique using surface anatomy, ultrasonic guidance, and stereotactic neuronavigation.Methods. This retrospective cohort study included all patients from a single institution who underwent a ven tricular CSF shunting procedure in which a new ventricular catheter was placed between January 2005 and March 2010. Data abstracted for each patient included age, sex, diagnosis, method of ventricular catheter placement, site and side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic stud ies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision through December 2011. Statistical analysis was then performed comparing the 3 methods of ventricular catheter placement and to determine risk factors for inaccurate placement.Results. There were 249 patients included in the study; 170 ventricular catheters were freehand passed, 51 were placed using stereotactic neuronavigation, and 28 were placed under intraoperative ultrasonic guidance. There was a statistically significant difference between freehand catheters and stereotactic-guided catheters (p < 0.001), as well as between freehand catheters and ultrasound-guided catheters (p < 0.001). The only risk factor for inaccurate place ment identified in this study was use of the freehand technique. The use of stereotactic neuronavigation and ultrasonic guidance reduced proximal shunt failure rates (p < 0.05) in comparison with a freehand technique.Conclusions. Stereotactic-and ultrasound-guided ventricular catheter placements are significantly more accu rate than freehand placement, and the use of these intraoperative guidance techniques reduced proximal shunt failure in this study.

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Section: Discussionmentioning

confidence: 69%

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Wilson¹,

Stetler²,

Al-Holou³

et al. 2013

JNS

120

108

View full text Add to dashboard Cite

show abstract

“…We believe that this underrepresentation of ideal placements is the norm in practice, and has been noted in other published reports that tabulated the accuracy of freehand catheter placements. 10,13 Moreover, we demonstrated that placement accuracy is highly correlated with long-term shunt survival to at least 3 years, and that use of intraoperative confirmatory imaging improves the accuracy of placement.…”

Section: Discussionmentioning

confidence: 73%

“…Although both approaches are possible for many patients, more bad outcomes occurred using the posterior approach, which is probably due to the more limited angle of approach and less tolerance for error. 12,13 It is possible that because our center has preferred the anterior approach for many decades, we may not be as experienced with posterior approaches as surgeons in centers that generally use that approach.…”

Section: Discussionmentioning

confidence: 99%

Improvement in clinical outcomes following optimal targeting of brain ventricular catheters with intraoperative imaging

Janson

Romanova²,

Rudser

et al. 2014

JNS

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Object The accurate placement of cerebral ventricular shunt catheters in hydrocephalus is an important clinical problem. Malfunction of shunts remains their most common complication and greatest liability, and the influence of catheter position on shunt function remains poorly defined. The objectives of this study were as follows: 1) determine the accuracy of intraventricular catheter placement with respect to a historically favored target, defined as a 1-cm radius sphere at the anterior lip of the ipsilateral foramen of Monro; 2) confirm that this target represents a satisfactory site for frontal and occipital catheter placement by examining whether inaccuracy is associated with more shunt failures; and 3) determine whether catheter trajectory, use of image confirmation, or other factors are associated with either the accuracy or the longevity of shunts. Methods A retrospective cohort analysis was conducted on 236 patients with 426 ventricular shunts placed or revised at the University of Minnesota over a 10-year period. Results Accuracy of shunt placement was optimal in 43.9% of patients and suboptimal or poor in 56.1% of patients. Time to failure was significantly affected by the accuracy of catheter placement with respect to the ipsilateral foramen of Monro, with a 57% higher risk of failure with suboptimal placement (hazard ratio [HR] 1.57, 95% CI 1.26–1.96; p < 0.001) and a 66% higher risk with poor placement (HR 1.66, 95% CI 1.45–1.89; p < 0.001) relative to optimal placement. The odds of highly suboptimal or unacceptable placement were significantly increased by lack of any intraoperative imaging (OR 5.89, 95% CI 2.36–14.65; p < 0.001). Use of a nonfrontal posterior trajectory also showed a trend toward poor placement (OR 1.64, p = 0.138). Conclusions The historical target for catheter tip placement within 1 cm of the foramen of Monro in the ipsilateral lateral ventricle was associated with significantly longer revision-free survival compared with other locations. This effect remained significant after adjusting for age and whether there was a prior history of shunting. The accuracy of catheter placement in both pediatric and adult patients was strongly associated with use of intraoperative fluoroscopic confirmation. In analyses comparing intraoperative fluoroscopy and no imaging, there was a non–statistically significant difference in the 3-year time to failure, but the worst-case scenario of catastrophic short-term failure was almost completely avoided with fluoroscopy. The authors conclude that accuracy of placement is critical for shunt survival, and that use of intraoperative imaging confirmation may optimize outcomes by avoiding the majority of unacceptable placements.

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“…12 Lind et al previously found that 44% of catheters were placed inaccurately versus 47% in a study by Theodosopoulos et al (with accuracy defined by the same standards as our current study). 5,10 This underestimation of inaccurate catheter placement may lead to underestimation of the need for intraoperative guidance. By further adding to the data suggesting a high rate of inaccurate catheter placement, we hope to increase recognition of the value of intraoperative guidance.…”

mentioning

confidence: 99%

Comparison of the accuracy and proximal shunt failure rate of freehand placement versus intraoperative guidance in parietooccipital ventricular catheter placement

Wilson

McCoy

Al-Holou

et al. 2016

FOC

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OBJECTIVE The aim of this paper is to compare the accuracy of the freehand technique versus the use of intraoperative guidance (either ultrasound guidance or frameless stereotaxy) for placement of parietooccipital ventricular catheters and to determine factors associated with reduced proximal shunt failure. METHODS This retrospective cohort study included all patients from 2 institutions who underwent a ventricular cerebrospinal fluid (CSF) shunting procedure in which a new parietooccipital ventricular catheter was placed between January 2005 and December 2013. Data abstracted for each patient included age, sex, method of ventricular catheter placement, side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic studies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision. Standard statistical methods were used for analysis. RESULTS A total of 257 patients were included in the study: 134 from the University of Michigan and 123 from Washington University in St. Louis. Accurate ventricular catheter placement was achieved in 81.2% of cases in which intraoperative guidance was used versus 67.3% when the freehand technique was used. Increasing age reduced the likelihood of accurate catheter placement (OR 0.983, 95% CI 0.971–0.995; p = 0.005), while the use of intraoperative guidance significantly increased the likelihood (OR 2.809, 95% CI 1.406–5.618; p = 0.016). During the study period, 108 patients (42.0%) experienced shunt failure, 79 patients (30.7%) had failure involving the proximal catheter, and 53 patients (20.6%) had distal failure (valve or distal catheter). Increasing age reduced the likelihood of being free from proximal shunt failure (OR 0.983, 95% CI 0.970–0.995; p = 0.008), while both the use of intraoperative guidance (OR 2.385, 95% CI 1.227–5.032; p = 0.011), and accurate ventricular catheter placement (OR 3.424, 95% CI 1.796–6.524; p = 0.009) increased the likelihood. CONCLUSIONS The use of intraoperative guidance during parietooccipital ventricular catheter placement as part of a CSF shunt system significantly increases the likelihood of accurate catheter placement and subsequently reduces the rate of proximal shunt failure.

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Ventricular catheter placement accuracy in non-stereotactic shunt surgery for hydrocephalus

Cited by 47 publications

References 16 publications

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Improvement in clinical outcomes following optimal targeting of brain ventricular catheters with intraoperative imaging

Comparison of the accuracy and proximal shunt failure rate of freehand placement versus intraoperative guidance in parietooccipital ventricular catheter placement

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