title: Effect of electromagnetic navigated ventriculoperitoneal shunt placement on failure rates.
abstract: OBJECTIVE
  To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement.
  
  
  METHODS
  All patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma.
  
  
  RESULTS
  A total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test).
  
  
  CONCLUSIONS
  The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.
authors: Department of Neurosurgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.
authors: Nayoung
authors: N
authors: Jung
authors: Dongwon
authors: D
authors: Kim
keywords: Hydrocephalus; Neuronavigation; Revision; Ventriculoperitoneal shunt
references: Childs Nerv Syst. 1990 Sep;6(6):346-9
references: 2257549
references: Neurosurgery. 2007 Apr;60(4 Suppl 2):243-7; discussion 247-8
references: 17415159
references: J Neurosurg. 1978 Apr;48(4):609-13
references: 632885
references: J Neurosurg. 2003 Feb;98(2):284-90
references: 12593612
references: Pediatr Neurosurg. 1990-1991;16(6):287-91
references: 2134737
references: Pediatr Neurosurg. 1999 Nov;31(5):231-6
references: 10681676
references: J Neurosurg. 2000 Jan;92(1):31-8
references: 10616079
references: Pediatr Neurol. 2006 Feb;34(2):83-92
references: 16458818
references: Neurosurgery. 1999 Dec;45(6):1329-33; discussion 1333-5
references: 10598700
references: Childs Nerv Syst. 1998 Jun;14(6):271-5
references: 9694339
references: Neurosurgery. 2010 Sep;67(3 Suppl Operative):ons131-5; discussion ons135
references: 20679938
references: J Neurosurg. 1994 Apr;80(4):750-5
references: 8151359
references: J Clin Neurosci. 2011 Apr;18(4):485-8
references: 21256029
references: Dev Med Child Neurol Suppl. 1969;20:42-8
references: 5263250
references: Childs Nerv Syst. 2002 Feb;18(1-2):26-9
references: 11935240
references: Neurosurgery. 1997 Mar;40(3):632-7; discussion 638
references: 9055308
references: J Neurosurg. 2010 Dec;113(6):1273-8
references: 20397892
references: Childs Nerv Syst. 1985;1(4):194-9
references: 4064018
references: J Neurosurg Pediatr. 2008 Jan;1(1):40-7
references: 18352802
references: Neurosurgery. 1998 Jul;43(1):175-6; discussion 176-7
references: 9657208
references: J Clin Neurosci. 2005 Sep;12(7):781-3
references: 16165363
references: J Neurosurg. 1982 Mar;56(3):411-6
references: 7057239
references: Childs Nerv Syst. 1999 Nov;15(11-12):755-7
references: 10603018
references: Childs Nerv Syst. 1999 Nov;15(11-12):711-7
references: 10603012