Use of Intraoperative Fluoroscopy for Brain Ventricular Catheter Insertion: Poor Man's Navigation

Area of Science:

• Neurosurgery
• Medical Imaging
• Shunt Technology

Background:

• Ventricular catheter (VC) misplacement is a primary cause of ventriculoperitoneal (VP) shunt malfunction.
• Current VC placements often rely on the freehand method, increasing risks.
• Intraoperative assessment of VC placement is crucial for shunt success.

Purpose of the Study:

• To evaluate the efficacy of intraoperative fluoroscopy in assessing ventricular catheter placement.
• To determine if fluoroscopy reduces shunt malfunction due to misplacement.
• To compare VC placement accuracy with and without intraoperative fluoroscopy.

Main Methods:

• A study involving 70 hydrocephalus patients requiring cerebrospinal fluid diversion.
• Patients were divided into a control group (no intraoperative fluoroscopy) and a test group (intraoperative fluoroscopy).
• VP shunt insertion was performed using the standard Keen's point technique.

Main Results:

• Optimal VC positioning was achieved in 40 patients, with significantly better outcomes in the test group.
• Gross malpositioning occurred in seven patients (four in the test group, three in the control group).
• All malpositioned VCs in the test group were corrected intraoperatively; fewer VCs crossed the midline in the test group.

Conclusions:

• Intraoperative fluoroscopy is a simple, cost-effective tool for assessing VC position.
• This method aids in preventing revision surgeries caused by VC misplacement.
• Fluoroscopy enhances the accuracy and success rate of VP shunt procedures.