Accuracy, outcome and complication of Free-hand VP shunt catheter placement

There has been continued use of the free-hand technique for ventriculoperitoneal (VP) shunt placement. However, few studies have evaluated the accuracy of this technique. We conducted a retrospective study of patients who underwent free-hand VP shunt placement between 2011 and 2020. We assessed the accuracy of the entry point. The catheter tip was classified as being in a "good" location if it was situated in the ipsilateral frontal horn or the body of the lateral ventricle. Surgical complications and revision rates were analyzed. A total of 242 cases were included (Kocher's point: 12.0%, Keen's point: 88.0%). A good ventricular tip position was achieved in 62.1% of Kocher's cases and 19.2% of Keen's cases. Early and late shunt revisions were required in 10.3% and 13.8% of Kocher's cases and in 6.1% and 3.8% of Keen's cases. The deviation from the intended entry point was significantly greater for Keen's point compared to Kocher's (p = 0.001). In Keen's point cases, greater deviation was significantly associated with a malpositioned catheter tip (p = 0.02), but not in Kocher's point cases(p = 0.982). Additionally, longer catheter length was significantly associated with bad tip positioning only in Keen's point insertions (p < 0.001). Malpositioned catheter tips were not significantly associated with higher early or late revision rates in either group. Our study demonstrates that the free-hand technique for ventricular catheter placement provides suboptimal accuracy. However, neither the precision of the entry point nor the final catheter tip location correlated significantly with the need for revision.