title: Image-guided cerebrospinal fluid shunting in children: catheter accuracy and shunt survival.
abstract: OBJECTIVE
  Cerebrospinal fluid shunt placement has a high failure rate, especially in patients with small ventricles. Frameless stereotactic electromagnetic image guidance can assist ventricular catheter placement. The authors studied the effects of image guidance on catheter accuracy and shunt survival in children.
  
  
  METHODS
  Pediatric patients who underwent placement or revision of a frontal ventricular CSF shunt were retrospectively evaluated. Catheters were placed using either anatomical landmarks or image guidance. Preoperative ventricular size and postoperative catheter accuracy were quantified. Outcomes of standard and image-guided groups were compared.
  
  
  RESULTS
  Eighty-nine patients underwent 102 shunt surgeries (58 initial, 44 revision). Image guidance was used in the placement of 56 shunts and the standard technique in 46. Shunt failure rates were not significantly different between the standard (22%) and image-guided (25%) techniques (p = 0.21, log-rank test). Ventricular size was significantly smaller in patients in the image-guided group (p < 0.02, Student t-test) and in the surgery revision group (p < 0.01). Small ventricular size did not affect shunt failure rate, even when controlling for shunt insertion technique. Despite smaller average ventricular size, the accuracy of catheter placement was significantly improved with image guidance (p < 0.01). Shunt accuracy did not affect shunt survival.
  
  
  CONCLUSIONS
  The use of image guidance improved catheter tip accuracy compared with a standard technique, despite smaller ventricular size. Failure rates were not dependent on shunt insertion technique, but an observed selection bias toward using image guidance for more at-risk catheter placements showed failure rates similar to initial surgeries.
authors: Seattle Children's Hospital, Department of Neurological Surgery, 4800 Sand Point Way NE, Seattle, Washington 98105, USA.
authors: Michael R
authors: MR
authors: Levitt
authors: Brent R
authors: BR
authors: O'Neill
authors: Gisele E
authors: GE
authors: Ishak
authors: Paritosh C
authors: PC
authors: Khanna
authors: Nancy R
authors: NR
authors: Temkin
authors: Richard G
authors: RG
authors: Ellenbogen
authors: Jeffrey G
authors: JG
authors: Ojemann
authors: Samuel R
authors: SR
authors: Browd
mesh_terms: D057785:Catheters; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D002675:Child, Preschool; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D038361:Neuronavigation; D012086:Reoperation; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D013997:Time Factors