title: A novel technique for ventriculoperitoneal shunting by flat panel detector CT-guided real-time fluoroscopy.
abstract: BACKGROUND
  Surgical placement of a ventriculoperitoneal shunt (VPS) is the main strategy to manage hydrocephalus. However, the failure rate associated with placement of ventricular catheters remains high.
  
  
  METHODS
  A hybrid operating room, equipped with a flat-panel detector digital subtraction angiography system containing C-arm cone-beam computed tomography (CB-CT) imaging, has recently been developed and utilized to assist neurosurgical procedures. We have developed a novel technique using intraoperative fluoroscopy and a C-arm CB-CT system to facilitate accurate placement of a VPS.
  
  
  RESULTS
  Using this novel technique, 39 consecutive ventricular catheters were placed accurately, and no ventricular catheter failures were experienced during the follow-up period. Only two patients experienced obstruction of the VPS, both of which occurred in the extracranial portion of the shunt system.
  
  
  CONCLUSIONS
  Surgical placement of a VPS assisted by flat panel detector CT-guided real-time fluoroscopy enabled accurate placement of ventricular catheters and was associated with a decreased need for shunt revision.
authors.affiliation: Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Mutoh
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hikichi
authors.forename: Akifumi
authors.initials: A
authors.lastname: Suzuki