title: Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation.
abstract: OBJECTIVE
  The objective of this study was to compare the accuracy of 3 methods of ventricular catheter placement during CSF shunt operations: the freehand technique using surface anatomy, ultrasonic guidance, and stereotactic neuronavigation.
  
  
  METHODS
  This retrospective cohort study included all patients from a single institution who underwent a ventricular CSF shunting procedure in which a new ventricular catheter was placed between January 2005 and March 2010. Data abstracted for each patient included age, sex, diagnosis, method of ventricular catheter placement, site and side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic studies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision through December 2011. Statistical analysis was then performed comparing the 3 methods of ventricular catheter placement and to determine risk factors for inaccurate placement.
  
  
  RESULTS
  There were 249 patients included in the study; 170 ventricular catheters were freehand passed, 51 were placed using stereotactic neuronavigation, and 28 were placed under intraoperative ultrasonic guidance. There was a statistically significant difference between freehand catheters and stereotactic-guided catheters (p<0.001), as well as between freehand catheters and ultrasound-guided catheters (p<0.001). The only risk factor for inaccurate placement identified in this study was use of the freehand technique. The use of stereotactic neuronavigation and ultrasonic guidance reduced proximal shunt failure rates (p<0.05) in comparison with a freehand technique.
  
  
  CONCLUSIONS
  Stereotactic- and ultrasound-guided ventricular catheter placements are significantly more accurate than freehand placement, and the use of these intraoperative guidance techniques reduced proximal shunt failure in this study.
authors: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109-5338, USA.
authors: Thomas J
authors: TJ
authors: Wilson
authors: William R
authors: WR
authors: Stetler
authors: Wajd N
authors: WN
authors: Al-Holou
authors: Stephen E
authors: SE
authors: Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods / Q000592:standards; D002552:Cerebral Ventricles / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D018084:Ultrasonography, Interventional / Q000379:methods*; D017287:Ventriculoperitoneal Shunt / Q000379:methods* / Q000592:standards*