Real-time three-dimensional robotic C-arm navigation for ventriculoperitoneal shunt placement: a single-center...

To evaluate the accuracy, safety, and clinical outcomes of ventriculoperitoneal (VP) shunt placement using real-time three-dimensional (3D) robotic C-arm navigation in adults with hydrocephalus.

A retrospective review was conducted on 82 patients who underwent VP shunt placement in a hybrid operating room between September 2018 and December 2022. All procedures utilized intraoperative 3D robotic C-arm navigation for ventricular catheter placement. Data included demographics, operative details, postoperative imaging, and complications. Catheter tip position was graded, and patients were followed for at least three years.

First-pass ventricular access was achieved in all cases. Optimal tip positioning (Grade 1) was observed in 79% of patients, Grade 2 in 20%, and Grade 3 in 1%. The mean operative time was 76.6 ± 20.6 min. Postoperative complications occurred in 7% of patients, primarily related to distal catheter issues; no cerebrospinal fluid-side revisions were required during follow-up.

Real-time 3D robotic C-arm navigation enables precise ventricular catheter placement with high first-pass success, and low complication rates. This technique may reduce mechanical shunt failure and warrants prospective comparative studies to confirm its benefits and cost-effectiveness.