Image Guidance for Ventricular Shunt Surgery: An Analysis of Ventricular Size and Proximal Revision Rates

Khan, Nickalus R.; DeCuypere, Michael; Vaughn, Brandy; Klimo, Paul

doi:10.1093/neuros/nyy074

Cited by 18 publications

(6 citation statements)

References 52 publications

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“…Accessing them, therefore, can present significant technical challenges. The advent and wide adoption of frameless stereotaxy systems within cranial neurosurgical practices significantly aid accurate placement of the ventricular catheter [ 41 , 46 , 47 , 48 ]. These systems provide an excellent level of accuracy, are routine to use, and do not substantially alter the operating time [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review

Sunderland

Jenkinson

Conroy

et al. 2021

Life

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The prevalence of idiopathic intracranial hypertension (IIH), a complex disorder, is increasing globally in association with obesity. The IIH syndrome occurs as the result of elevated intracranial pressure, which can cause permanent visual impairment and loss if not adequately managed. CSF diversion via ventriculoperitoneal and lumboperitoneal shunts is a well-established strategy to protect vision in medically refractory cases. Success of CSF diversion is compromised by high rates of complication; including over-drainage, obstruction, and infection. This review outlines currently used techniques and technologies in the management of IIH. Neurosurgical CSF diversion is a vital component of the multidisciplinary management of IIH.

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Section: Resultsmentioning

confidence: 99%

Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review

Sunderland

Jenkinson

Conroy

et al. 2021

Life

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“…However, with the advent of frameless image-guided stereotactic shunt placement techniques, accurate VPS placement is now feasible in the majority of cases even with small ventricles. 49 The presence of cerebellar tonsillar descent on neuroimaging studies is a contraindication for an LP shunt. All patients are evaluated with a CT of the head and shunt series to confirm optimal catheter placement.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Shunting for Idiopathic Intracranial Hypertension: A Systematic Review, Meta-Analysis, and Implications for a Modern Management Protocol

et al. 2022

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BACKGROUND: Cerebrospinal fluid (CSF) shunting is widely used in refractory idiopathic intracranial hypotension (IIH). Although multiple reviews have assessed its efficacy compared with other surgical treatments, there is no detailed analysis that evaluates the clinical outcomes after CSF shunting. OBJECTIVE: To conduct a meta-analysis of the clinical impact of CSF shunting for refractory IIH and use this in conjunction with existing information on other treatment modalities to develop a modern management protocol. METHODS: PubMed and Embase were systematically searched for studies describing CSF shunting for medically refractory IIH. Relevant information including study characteristics, patient demographics, clinical outcomes, periprocedural complications, and long-term outcomes were subjected to meta-analysis. RESULTS: Fifteen studies published between 1988 and 2019 met our inclusion and exclusion criteria, providing 372 patients for analysis. The mean age was 31.2 years (range 0.5-71) with 83.6% being female. The average follow-up was 33.9 months (range 0-278 months). The overall rate of improvement in headache, papilledema, and visual impairment was 91% (95% CI 84%-97%), 96% (95% CI 85%-100%), and 85% (95% CI 72%-95%), respectively. Of 372 patients, 155 had 436 revisions; the overall revision rate was 42% (95% CI 26%-59%). There was no significant correlation between average follow-up duration and revision rates in studies (P = .627). Periprocedural low-pressure headaches were noted in 74 patients (20%; 95% CI 11%-32%). CONCLUSION: CSF shunting for IIH is associated with significant improvement in clinical symptoms. Shunting rarely causes periprocedural complications except overdrainagerelated low-pressure headache. However, CSF shunting has a relatively high revision rate.

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“…For image-guided cannulations, retrospective studies have documented their superiority in placing better-positioned catheters. 17-24 However, 2 meta-analyses that reviewed the use of intraoperative ultrasound or stereotaxy observed no clear benefit for shunt survival. 25,26 As for endoscopic-assisted catheterization, a randomized controlled trial also showed that both accuracy and shunt survival were not improved compared with freehand techniques.…”

Section: Discussionmentioning

confidence: 99%

A Morphometric Analysis of Commonly Used Craniometric Approaches for Freehand Ventriculoperitoneal Shunting

Woo

Wong

Yuan

et al. 2021

Operative Neurosurgery

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BACKGROUND: Ventricular catheter tip position is a predictor for ventriculoperitoneal shunt survival. Cannulation is often performed freehand, but there is limited consensus on the best craniometric approach. OBJECTIVE: To determine the accuracy of localizing craniometric entry sites and to identify which is associated with optimal catheter placement. METHODS: This is a retrospective analysis of adult patients who underwent ventriculoperitoneal shunting. The approaches were categorized as Kocher's, Keen's, Frazier's and Dandy's points as well as the parieto-occipital point. An accurately sited burr hole was within 10 mm from standard descriptions. Optimal catheter tip position was defined as within the ipsilateral frontal horn. RESULTS: A total of 110 patients were reviewed, and 58% (65/110) of burr holes were accurately sited. Keen's point was the most correctly identified (65%, 11/17), followed by Kocher's point (65%, 37/57) and Frazier's point (60%, 3/5). Predictors for accurate localization were Keen's point (odds ratio 0.3; 95% CI: 01-0.9) and right-sided access (odds ratio 0.4; 95% CI: 0.1-0.9). Sixty-three percent (69/110) of catheters were optimally placed with Keen's point (adjusted odds ratio 0.04; 95% CI: 0.01-0.67), being the only independent factor. Thirteen patients (12%) required shunt revision at a mean duration of 10 ± 25 mo. Suboptimal catheter tip position was the only independent determinant for revision (adjusted odds ratio 0.11; 95% CI: 0.01-0.98). CONCLUSION: This is the first study to compare the accuracy of freehand ventricular cannulation of standard craniometric entry sites for adult patients. Keen's point was the most accurately sited and was a predictor for optimal catheter position. Catheter tip location, not the entry site, predicted shunt survival.

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Image Guidance for Ventricular Shunt Surgery: An Analysis of Ventricular Size and Proximal Revision Rates

Cited by 18 publications

References 52 publications

Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review

Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review

Cerebrospinal Fluid Shunting for Idiopathic Intracranial Hypertension: A Systematic Review, Meta-Analysis, and Implications for a Modern Management Protocol

A Morphometric Analysis of Commonly Used Craniometric Approaches for Freehand Ventriculoperitoneal Shunting

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