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The effect of image-guided ventricular catheter placement on shunt failure: a systematic review and meta-analysis

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Abstract

Introduction

Cerebrospinal fluid (CSF) diversion for the treatment of hydrocephalus is one of the most common neurosurgical procedures. Over the years, the development of the neuronavigation system has allowed the surgeon to be guided in real time during the procedures. Nevertheless, to date, the revision rate remains as high as 30–40%. The aim of this study was to investigate the role of intraoperative image guidance in the prevention of shunt failure. We herein report the first literature meta-analysis of image guidance and shunt revision rate in the pediatric population.

Methods

Principal online databases were searched for English-language articles published between January, 1980, and December, 2021. Analysis was limited to articles that included patients younger than 18 years of age at the time of primary V-P shunt. Articles reporting combined results of free-hand and image-guided placement of ventricular catheter (VC) were included. The main outcome measure of the study was the revision rate in relation to the intraoperative tools. Secondary variables collected were the age of the patient and ventricle size. Statistical analyses and meta-analysis plots were done via R and RStudio. Heterogeneity was formally assessed using Q, I2, and τ2 statistics. To examine publication bias was performed a funnel plot analysis.

Result

A total of 9 studies involving 2017 pediatric patients were included in the meta-analysis. 55.9% of procedures were carried out with the aid of intraoperative tools, while 44.1% procedures were conducted free hand. The intraoperative tools used were ultrasound (9.1%), electromagnetic neuronavigation (21.07%), endoscope (67.32%), and combined images (2.4%).The image-guided placement of VC was not statistically associated with a lower revision rate. The pooled OR was 0.97 [CI 95% 0.88–1.07] with an I2 statistics of 34%, t2 of 0.018 and a p-value of 0.15 at heterogeneity analysis.

Conclusion

Our analysis suggest images guidance during VC shunt placement does not statistically affect shunt survival. Nevertheless, intraoperative tools can support the surgeon especially in patients with difficult anatomy, slit ventricles or complex loculated hydrocephalus.

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Authors and Affiliations

  1. Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Pietro Spennato, Francesca Vitulli, Nicola Onorini, Alessia Imperato, Giuseppe Mirone, Claudio Ruggiero & Giuseppe Cinalli

  2. Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II” University of Naples, Naples, Italy

    Francesca Vitulli

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  1. Pietro Spennato
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Spennato, P., Vitulli, F., Onorini, N. et al. The effect of image-guided ventricular catheter placement on shunt failure: a systematic review and meta-analysis. Childs Nerv Syst 38, 1069–1076 (2022). https://doi.org/10.1007/s00381-022-05547-y

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