title: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 3: Endoscopic computer-assisted electromagnetic navigation and ultrasonography as technical adjuvants for shunt placement.
abstract: OBJECTIVE
  This systematic review was undertaken to answer the following question: Do technical adjuvants such as ventricular endoscopic placement, computer-assisted electromagnetic guidance, or ultrasound guidance improve ventricular shunt function and survival?
  
  
  METHODS
  The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of cerebrospinal fluid shunts for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been delineated a priori were then examined, and data were abstracted and compiled in evidentiary tables. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations.
  
  
  RESULTS
  The search yielded 163 abstracts, which were screened for potential relevance to the application of technical adjuvants in shunt placement. Fourteen articles were selected for full-text review. One additional article was selected during a review of literature citations. Eight of these articles were included in the final recommendations concerning the use of endoscopy, ultrasonography, and electromagnetic image guidance during shunt placement, whereas the remaining articles were excluded due to poor evidence or lack of relevance. The evidence included 1 Class I, 1 Class II, and 6 Class III papers. An evidentiary table of relevant articles was created. CONCLUSIONS/RECOMMENDATION: There is insufficient evidence to recommend the use of endoscopic guidance for routine ventricular catheter placement.
  
  
  METHODS
  Level I, high degree of clinical certainty.
  
  
  CONCLUSIONS
  The routine use of ultrasound-assisted catheter placement is an option.
  
  
  METHODS
  Level III, unclear clinical certainty.
  
  
  CONCLUSIONS
  The routine use of computer-assisted electromagnetic (EM) navigation is an option.
  
  
  METHODS
  Level III, unclear clinical certainty.
authors.affiliation: Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Flannery
authors.affiliation: Department of Pediatric Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
authors.forename: Ann-Christine
authors.initials: AC
authors.lastname: Duhaime
authors.affiliation: Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Tamber
authors.affiliation: Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
authors.forename: Joanna
authors.initials: J
authors.lastname: Kemp
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D002648:Child; D055590:Electromagnetic Phenomena; D019317:Evidence-Based Medicine; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D044583:Neuroendoscopy; D038361:Neuronavigation / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods; D014463:Ultrasonography; D014481:United States
keywords: AANS = American Association of Neurological Surgeons; CNS = Congress of Neurological Surgeons; EM = electromagnetic; ETV = endoscopic third ventriculostomy; cerebrospinal fluid shunt; computer-assisted navigation; electromagnetic guidance; endoscopy; hydrocephalus; image-guided navigation; practice guidelines; ultrasonography; ventricular catheter; ventricular shunt