Improving the Accuracy of Ventriculoperitoneal Shunt Using Artificial Landmarks in Preoperative CT: A Technical Note

Ventriculoperitoneal shunts (VPS) are one of the most common neurosurgical procedures. Inaccurate shunt placements negatively impact shunt failure rates and revision rates. Although historical landmarks are the mainstay to determine the shunt entry point and trajectory, they are all based on the accurate determination of inion on the occipital bone for posterior shunt placements. In cases where the inion cannot be reliably palpated, it is a challenge to plan the shunt trajectory, especially in resource-limited institutions where image guidance is not available. This can be circumvented by using artificial anatomical landmarks such as fiducials or previous burr holes on a preoperative computed tomography (CT) scan to serve as an anatomical base point, from which the shunt entry point and trajectory be reliably planned preoperatively.