Conventional Versus Neuro-Navigation Guided Shunt Surgery
Kulwant Singh, Janak Raj and Divye Prakash Tiwari
World Journal of Medical Research 2013, 2:6
The aim of study is to evaluate the efficacy of ventricular catheter placement through neuro-navigation versus conventional technique.
All patients undergone ventriculo-peritoneal shunt from August 2011 to September 2013 were included in this study. Total sixty cases were included and divided into two groups. The first group comprised of shunt surgery using conventional method of shunt placement as per anatomical landmarks. The second group had proximal end placement with help of Frameless Neuronavigation System. The relationship between proximal ventricular catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale: 1) Grade I; Position of tip is anterior to foramina of monro , free-floating in cerebrospinal fluid, 2) Grade II; touching choroid plexus or ventricular wall, tip is posterior to foramina of monro 3) Grade III; tip within parenchyma, crossing to opposite side.
Sixty patients were considered, and divided into two groups: 1.Ventricular end insertion through conventional technique, 2. Neuronavigation assisted ventricular end insertion. There were 30 patients in each group. In conventionally treated study group, 20 patients (66.66%) revealed grade 1 placement of ventricular end,8patients (26.66%) had grade 2, and 2 patients(6.66%) showed grade 3 in post operative CT scan. Neuronavigation study group had 28 patients (93.33%) in grade 1 placement and 2 patients (6.66%) in grade 2 while none was in grade 3 on post operative CT scan. Infection rate was same in both groups.
Despite technological improvements, ventriculoperitoneal shunts are still often complicated by malfunction, predominantly with proximal catheter obstruction.Significant proportion of shunt fail¬ures were due to obstruction of the ventricular catheter, and accurate placement of the shunt catheter is highly important to reduce the incidence of shunt malfunction. Frameless navigation is a valuable tool to optimize the trajectory and final position of shunt catheter. The use of navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates thus the incidence of revision will go down.
Neuronavigation, Hydrocephalus, Ventriculoperitoneal shunt.