Author:
Krause Matthias,Lagumdzija Jasmina,Enzinger Simon,Wittig Jörn,Gaggl Alexander,Metzger Roman P.,Griessenauer Christoph J.
Abstract
AbstractVentriculoperitoneal (VP) shunt placement, essential for managing hydrocephalus, often risks catheter malpositioning, especially in patients with small ventricles. We present a novel technique combining neuronavigation with intraoperative cone-beam computed tomography using the BrainLab system and Loop-X mobile imaging unit. This approach enables real-time verification of catheter placement by integrating preoperative MRI data with intraoperative CT imaging. In a 12-year-old boy with therapy-refractory idiopathic intracranial hypertension, neuronavigation was guided by the BrainLab Skull Fix and Cushing canula, ensuring precise catheter insertion into the right frontal horn. Post-placement, Loop-X facilitated immediate verification of the catheter’s trajectory and positioning, corroborated by postoperative MRI. This technique demonstrated high precision and minimized radiation exposure, emphasizing its utility in reducing revision rates due to suboptimal catheter placement.
Funder
Paracelsus Medical University
Publisher
Springer Science and Business Media LLC
Reference10 articles.
1. Kemp J, Flannery AM, Tamber MS, Duhaime AC (2014) Systematic literature review and evidence-based guidelines. Part 9: effect of ventricular entry point and position. J Neurosurg (Suppl) 14:72–76
2. Wilson TJ, Stetler WR, Al-Holou WN, Sullivan SE (2013) Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation. J Neurosurg 119:66–70
3. Whitehead WE, Jea A, Vachhrajani S, Kulkarni AV, Drake JM (2007) Accurate placement of cerebrospinal fluid shunt ventricular catheters with real-time ultrasound guidance in older children without patent fontanelles. Technical note. J Neurosurg 107(5 Suppl):406–410
4. Whitehead WE et al (2017) Ventricular catheter entry site and not catheter tip location predicts shunt survival: a secondary analysis of 3 large pediatric hydrocephalus studies. J Neurosurg Pediatr 9(2):157–167
5. Hayhurts et al (2010) Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study. J Neurosurg 113(6):1273–1278