Does CT wand guidance improve shunt placement in patients with hydrocephalus?
OBJECTIVE
To evaluate the effectiveness of stereotactic navigation in enhancing the accuracy of ventricular shunt placement in patients with hydrocephalus.


METHODS
A retrospective cohort study at a single institution by a single surgeon was performed. Consecutive patients who underwent implantation of a ventricular shunt for the management of hydrocephalus between July 2001 and December 2011 were included in the study, totaling 535 patients. Patients were classified as either having optimal or sub-optimal placement of the shunt into the ventricle. Multiple logistic regression analysis was used.


RESULTS
Overall, 93.8% of patients were found to have optimal shunt placement. On multivariate analysis, navigation use was not significantly associated with improved accuracy of shunt placement (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.19-1.54; p = 0.25). Pseudotumor cerebri diagnosis was significantly associated with increased odds of sub-optimal shunt placement (OR = 6.41; 95% CI = 1.90-21.59; p=0.003).


CONCLUSIONS
CT guided navigation did not significantly improve the accuracy of ventricular shunt placement in adults with hydrocephalus for an experienced surgeon. Further studies are required to assess the utility of CT guided navigation for less experienced surgeons and patients with small or dysmorphic ventricles.
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, USA.
Dane
D
Moran
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, USA.
Thomas A
TA
Kosztowski
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, USA.
Ignacio
I
Jusué-Torres
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, USA.
Dennis
D
Orkoulas-Razis
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, USA.
Ayobami
A
Ward
Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Kathryn
K
Carson
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, USA.
Jamie
J
Hoffberger
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, USA.
Benjamin D
BD
Elder
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, USA.
C Rory
CR
Goodwin
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, USA. Electronic address: dr@jhmi.edu.
Daniele
D
Rigamonti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*; D055815:Young Adult
Frameless stereotaxy; Hydrocephalus; Neuronavigation; Pseudotumor cerebri; Ventriculoperitoneal shunt