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Freehand stereotactic ventricular catheter insertion for ventriculoperitoneal shunts based on individualized radio-anatomical landmarks

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Abstract

Introduction

The accurate placement of the ventricular catheter (VC) is critical in reducing the incidence of proximal failure of ventriculoperitoneal shunts (VPSs). The standard freehand technique is based on validated external anatomical landmarks but remains associated with a relatively high rate of VC malposition. Already proposed alternative methods have all their specific limitations. Herein, we evaluate the accuracy of our adapted freehand technique based on an individualized radio-anatomical approach. Reproducing the preoperative imaging on the patient’s head using common anatomical landmarks allows to define stereotactic VC coordinates to be followed at surgery.

Material and methods

Fifty-five consecutive patients treated with 56 VPS between 11/2005 and 02/2020 fulfilled the inclusion criteria of this retrospective study. Burr hole coordinates, VC trajectory, and length were determined in all cases on preoperative computed tomography (CT) scan and were accurately reported on patients’ head. The primary endpoint was to evaluate VC placement accuracy. The secondary endpoint was to evaluate the rate and nature of postoperative VC-related complications.

Results

Our new technique was applicable in all patients and no VC-related complications were observed. Postoperative imaging showed VC optimally placed in 85.7% and sub-optimally placed in 14.3% of cases. In all procedures, all the holes on the VC tip were found in the ventricular system.

Conclusions

This simple individualized technique improves the freehand VC placement in VPS surgery, making its accuracy comparable to that of more sophisticated and expensive techniques. Further randomized controlled studies are required to compare our results with those of the other available techniques.

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Authors and Affiliations

  1. Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Brussels, Belgium

    Julien Spitaels, Matteo Riva, Olivier Dewitte & Michaël Bruneau

  2. Department of Neurosurgery, Mont-Godinne Hospital, UCL Namur, Yvoir, Belgium

    Matteo Riva

  3. Department of Radiology, Erasme Hospital, ULB, Brussels, Belgium

    Isabelle Delpierre

Authors
  1. Julien Spitaels
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  2. Matteo Riva
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  3. Isabelle Delpierre
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  4. Olivier Dewitte
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  5. Michaël Bruneau
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Corresponding author

Correspondence to Michaël Bruneau.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors confirm that the study was approved by the institutional ethics committee of Erasme Hospital and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

According to ethic committee agreement, patient’s informed consent was deemed not necessary given the retrospective nature of the study.

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Comments

Optimal placement of ventricular catheters lowers the risk of shunt dysfunction and surgical techniques to improve accuracy of the implantation procedure are therefore interesting for clinicians treating patients with hydrocephalus. In recent years, focus has been centered on neuro-navigation or ultrasound guidance, which has disadvantages and might not be available in all centers. In this single-center study, the authors present a technique involving patient-specific radio-anatomical landmarks (available on standard radiological investigations) to guide free-hand insertion of the ventricular catheter via a parietal approach. In their series of 55 patients using the technique, no catheters were placed in the brain parenchyma and 86% were optimally places inside the ventricular system. The results need to by other groups, but the technique seems simple and straight-forward and might supplement other available measures to improve accuracy of ventricular catheter placement.

Alexander Lilja-Cyron

Copenhagen, Denmark

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Julien Spitaels and Matteo Riva co-first Authors

This article is part of the Topical Collection on CSF Circulation

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Spitaels, J., Riva, M., Delpierre, I. et al. Freehand stereotactic ventricular catheter insertion for ventriculoperitoneal shunts based on individualized radio-anatomical landmarks. Acta Neurochir 163, 1103–1112 (2021). https://doi.org/10.1007/s00701-020-04702-1

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  • DOI: https://doi.org/10.1007/s00701-020-04702-1

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