title: Intraoperative ultrasound guidance for the placement of permanent ventricular cerebrospinal fluid shunt catheters: a single-center historical cohort study.
abstract: OBJECTIVE
  Despite the frequency with which ventriculoperitoneal shunts are placed, ventricular catheter revision rates remains as high as 30%-40% at 1 year. Many neurosurgeons place ventricular catheters "blindly" depending on anatomical landmarks and personal experience. To determine whether intraoperative ultrasonography is beneficial for ventricular catheter placement, we performed a historical cohort study comparing shunts placed with intraoperative ultrasound (US) guidance to those placed blindly.
  
  
  METHODS
  We reviewed all shunts placed by the Department of Neurosurgery at the University of Virginia from January 2005 to January 2007. During that time 211 patients underwent 242 shunts, with US use determined by surgeon's preference. Ninety-two shunts were placed by the use of US guidance, and 150 were placed without US. Adults received 176 shunts, 56 with US. Children received 66 shunts, 36 with US. Mean follow-up was 21.6 months. The primary end points examined were shunt revision, ventricular catheter revision (VCR), and acute VCR (revision within 1 week for an improperly-placed catheter).
  
  
  RESULTS
  The use of US was associated with a statistically significant decrease in shunt revisions (odds ratio 0.492; 95% confidence interval 0.253-0.958). Of the shunts placed with US guidance, 21.7% required revision, compared with 29.3% without US. VCRs and acute VCRs occurred in 9.8% and 2.2%, respectively, for US shunts, compared with 14% and 5.3% without US. Pediatric revision rates were 30.6% with US versus 53.3% without, whereas adult rates were 16.1% and 23.3%, respectively. The benefit of US was more profound for occipital shunts.
  
  
  CONCLUSIONS
  The use of US for the placement of permanent cerebrospinal fluid shunt catheters is associated with a decreased risk of shunt revision.
authors: Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA. Electronic address: webster.crowley@bnaneuro.net.
authors: R Webster
authors: RW
authors: Crowley
authors: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors: Aaron S
authors: AS
authors: Dumont
authors: Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
authors: Ashok R
authors: AR
authors: Asthagiri
authors: Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.
authors: James C
authors: JC
authors: Torner
authors: Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors: Ricky
authors: R
authors: Medel
authors: Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors: John A
authors: JA
authors: Jane
authors: Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors: John A
authors: JA
authors: Jane
authors: Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors: Neal F
authors: NF
authors: Kassell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation; D012307:Risk Factors; D018084:Ultrasonography, Interventional / Q000379:methods*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: Cerebrospinal fluid shunts; Hydrocephalus; Image-guided surgery