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Updated: Jan 30, 2026

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Intraoperative Computed Tomography Versus Fluoroscopy for Ventriculoperitoneal Shunt Placement
Stefan Wanderer1, Daniel Coluccia1, Javier Añon2
1Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
Intraoperative computed tomography (iCT) did not improve accuracy for ventriculoperitoneal shunt placement compared to fluoroscopy. Fluoroscopy remains the preferred method for assessing catheter position, reducing malposition and revisions.
Area of Science:
- Neurosurgery
- Medical Imaging
Background:
- Catheter malposition is a common cause of ventriculoperitoneal (VP) shunt dysfunction.
- Intraoperative fluoroscopy has proven effective in reducing catheter malposition and revision rates.
Purpose of the Study:
- To evaluate the accuracy of intraoperative computed tomography (iCT) in decreasing cranial catheter misplacement compared to intraoperative fluoroscopy for VP shunt placement.
Main Methods:
- Retrospective analysis of 152 patients undergoing VP shunt placement.
- Comparison of catheter placement accuracy between iCT (n=48), biplane fluoroscopy (n=57), and a control group without intraoperative imaging (n=47).
Main Results:
- Fluoroscopy demonstrated higher accuracy in ventricular catheter placement (45/57) compared to iCT (24/48) and the control group (23/47).
- The iCT group had a higher rate of persistent malpositioned catheters after intraoperative revision (4/48) compared to the fluoroscopy group (0/57).
- iCT was associated with longer procedure times and higher radiation exposure per patient.
Conclusions:
- Intraoperative fluoroscopy is the preferred method for assessing ventricular catheter positioning during VP shunt surgery.
- iCT did not improve the accuracy of catheter placement or reduce early revisions for VP shunt procedures in this study.
- Fluoroscopy offers a more accurate and efficient approach for intraoperative assessment of VP shunt catheter placement.
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