J Korean Neurosurg Soc.  2013 Mar;53(3):150-154. 10.3340/jkns.2013.53.3.150.

Effect of Electromagnetic Navigated Ventriculoperitoneal Shunt Placement on Failure Rates

• Jung N
• Kim D

• KMID: 2190743
• DOI: http://doi.org/10.3340/jkns.2013.53.3.150

Abstract

OBJECTIVE
To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement.
METHODS
All 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.
RESULTS
A 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).
CONCLUSION
The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.

Keyword

Hydrocephalus; Neuronavigation; Ventriculoperitoneal shunt; Revision

MeSH Terms

Catheters
Choroid
Humans
Hydrocephalus
Hypogonadism
Magnets
Mitochondrial Diseases
Neuronavigation
Ophthalmoplegia
Retrospective Studies
Ventriculoperitoneal Shunt
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Figure

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  Fig. 1 The operation with electromagnetic navigation system. A noninvasive dynamic reference frame applied to the scalp is shown to identify the location of anatomy within the frame of reference. The bur hole and catheter trajectory were planned preoperatively in three planes to achieve optimal catheter tip position. The navigation stylet is used as the catheter trocar.

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  Fig. 2 Grading of ventricular catheter position (three-point scales). 1) Grade I; optimal catheter tip position free-floating in CSF. 2) Grade II; catheter tip touching choroid plexus or ventricular lining wall. 3) Grade III; tip within parenchyma or failure to reach the intraventricular space. CSF : cerebrospinal fluid.

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  Fig. 3 Grade of shunt catheter placement. This paragraph demonstrates that EM-navigated group can get the optimal catheter tip position within ventricle. EM : electromagnetic.

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  Fig. 4 Comparison of revision rate between grades. All cases in grade 3 required shunt revision surgery.

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