OBJECT: As many as 40% of shunts fail in the first year, mainly due to proximal obstruction. The role of catheter position on failure rates has not been clearly demonstrated. The authors conducted a prospective cohort study of navigated shunt placement compared with standard blind shunt placement at 3 European centers to assess the effect on shunt failure rates. METHODS: All adult and pediatric patients undergoing de novo ventriculoperitoneal shunt placement were included (patients with slit ventricles were excluded). The first cohort underwent standard shunt placement using anatomical landmarks. All centers subsequently adopted electromagnetic (EM) navigation for routine shunt placements, forming the second cohort. Catheter position was graded on postoperative CT in both groups using a 3-point scale developed for this study: (1) optimal position free-floating in CSF; (2) touching choroid or ventricular wall; or (3) intraparenchymal. Episodes and type of shunt revision were recorded. Early shunt failure was defined as that occurring within 30 days of surgery. Patients with shunts were followed-up for 12 months in the standard group, for a median of 6 months in the EM-navigated group, or until shunt failure. RESULTS: A total of 75 patients were included in the study, 41 with standard shunts and 34 with EM-navigated shunts. Seventy-four percent of navigated shunts were Grade 1 compared with 37% of the standard shunts (p=0.001, chi-square test). There were no Grade 3 placements in the navigated group, but 8 in the standard group, and 75% of these failed. Early shunt failure occurred in 9 patients in the standard group and in 2 in the navigated group, reducing the early revision rate from 22 to 5.9% (p=0.048, Fisher exact test). Early shunt failures were due to proximal obstruction in 78% of standard shunts (7 of 9) and in 50% of EM-navigated shunts (1 of 2). CONCLUSIONS: Noninvasive EM image guidance in shunt surgery reduces poor shunt placement, resulting in a significant decrease in the early shunt revision rate.
OBJECT: As many as 40% of shunts fail in the first year, mainly due to proximal obstruction. The role of catheter position on failure rates has not been clearly demonstrated. The authors conducted a prospective cohort study of navigated shunt placement compared with standard blind shunt placement at 3 European centers to assess the effect on shunt failure rates. METHODS: All adult and pediatric patients undergoing de novo ventriculoperitoneal shunt placement were included (patients with slit ventricles were excluded). The first cohort underwent standard shunt placement using anatomical landmarks. All centers subsequently adopted electromagnetic (EM) navigation for routine shunt placements, forming the second cohort. Catheter position was graded on postoperative CT in both groups using a 3-point scale developed for this study: (1) optimal position free-floating in CSF; (2) touching choroid or ventricular wall; or (3) intraparenchymal. Episodes and type of shunt revision were recorded. Early shunt failure was defined as that occurring within 30 days of surgery. Patients with shunts were followed-up for 12 months in the standard group, for a median of 6 months in the EM-navigated group, or until shunt failure. RESULTS: A total of 75 patients were included in the study, 41 with standard shunts and 34 with EM-navigated shunts. Seventy-four percent of navigated shunts were Grade 1 compared with 37% of the standard shunts (p=0.001, chi-square test). There were no Grade 3 placements in the navigated group, but 8 in the standard group, and 75% of these failed. Early shunt failure occurred in 9 patients in the standard group and in 2 in the navigated group, reducing the early revision rate from 22 to 5.9% (p=0.048, Fisher exact test). Early shunt failures were due to proximal obstruction in 78% of standard shunts (7 of 9) and in 50% of EM-navigated shunts (1 of 2). CONCLUSIONS: Noninvasive EM image guidance in shunt surgery reduces poor shunt placement, resulting in a significant decrease in the early shunt revision rate.
Authors: Elvis J Hermann; Ioannis Petrakakis; Friedrich Götz; Götz Lütjens; Josef Lang; Makoto Nakamura; Joachim K Krauss Journal: Neurosurg Rev Date: 2015-02-10 Impact factor: 3.042
Authors: Maged D Fam; Daniel Hanley; Agnieszka Stadnik; Hussein A Zeineddine; Romuald Girard; Michael Jesselson; Ying Cao; Lynn Money; Nichol McBee; Amanda J Bistran-Hall; W Andrew Mould; Karen Lane; Paul J Camarata; Mario Zuccarello; Issam A Awad Journal: Neurosurgery Date: 2017-11-01 Impact factor: 4.654
Authors: Elvis J Hermann; Majid Esmaeilzadeh; Philipp Ertl; Manolis Polemikos; Peter Raab; Joachim K Krauss Journal: Childs Nerv Syst Date: 2015-05-02 Impact factor: 1.475
Authors: Issam A Awad; Sean P Polster; Julián Carrión-Penagos; Richard E Thompson; Ying Cao; Agnieszka Stadnik; Patricia Lynn Money; Maged D Fam; Janne Koskimäki; Romuald Girard; Karen Lane; Nichol McBee; Wendy Ziai; Yi Hao; Robert Dodd; Andrew P Carlson; Paul J Camarata; Jean-Louis Caron; Mark R Harrigan; Barbara A Gregson; A David Mendelow; Mario Zuccarello; Daniel F Hanley Journal: Neurosurgery Date: 2019-06-01 Impact factor: 4.654
Authors: Herbert I Fried; Barnett R Nathan; A Shaun Rowe; Joseph M Zabramski; Norberto Andaluz; Adarsh Bhimraj; Mary McKenna Guanci; David B Seder; Jeffrey M Singh Journal: Neurocrit Care Date: 2016-02 Impact factor: 3.210