title: Electromagnetic-guided neuronavigation for safe placement of intraventricular catheters in pediatric neurosurgery.
abstract: OBJECTIVE
  Ventricular catheter shunt malfunction is the most common reason for shunt revision. Optimal ventricular catheter placement can be exceedingly difficult in patients with small ventricles or abnormal ventricular anatomy. Particularly in children and in premature infants with small head size, satisfactory positioning of the ventricular catheter can be a challenge. Navigation with electromagnetic tracking technology is an attractive and innovative therapeutic option. In this study, the authors demonstrate the advantages of using this technology for shunt placement in children.
  
  
  METHODS
  Twenty-six children ranging in age from 4 days to 14 years (mean 3.8 years) with hydrocephalus and difficult ventricular anatomy or slit ventricles underwent electromagnetic-guided neuronavigated intraventricular catheter placement in a total of 29 procedures.
  
  
  RESULTS
  The single-coil technology allows one to use flexible instruments, in this case the ventricular catheter stylet, to be tracked at the tip. Head movement during the operative procedure is possible without loss of navigation precision. The intraoperative catheter placement documented by screenshots correlated exactly with the position on the postoperative CT scan. There was no need for repeated ventricular punctures. There were no operative complications. Postoperatively, all children had accurate shunt placement. The overall shunt failure rate in our group was 15%, including 3 shunt infections (after 1 month, 5 months, and 10 months) requiring operative revision and 1 distal shunt failure. There were no proximal shunt malfunctions during follow-up (mean 23.5 months).
  
  
  CONCLUSIONS
  The electromagnetic-guided neuronavigation system enables safe and optimal catheter placement, especially in children and premature infants, alleviating the need for repeated cannulation attempts for ventricular puncture. In contrast to stereotactic techniques and conventional neuronavigation, there is no need for sharp head fixation using a Mayfield clamp. This technique may present the possibility of reducing proximal shunt failure rates and costs for hydrocephalus treatment in this age cohort.
authors.affiliation: Department of Neurosurgery, Medical School Hannover, Germany. hermann.elvis@mh-hannover.de
authors.forename: Elvis J
authors.initials: EJ
authors.lastname: Hermann
authors.forename: Hans-Holger
authors.initials: HH
authors.lastname: Capelle
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Tschan
authors.forename: Joachim K
authors.initials: JK
authors.lastname: Krauss
mesh_terms: D000293:Adolescent; D002408:Catheters, Indwelling; D002552:Cerebral Ventricles / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D055590:Electromagnetic Phenomena; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome