Related Experiment Video
Updated: Jun 5, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Comparison of Free-Hand Technique and Neuronavigation in Intraventricular Shunt Catheter Placement
Ümit Kocaman1, Durmuş O Karakoyun1, Emre Çavuşoğlu2
1İzmir Bakİrçay University, School of Medicine, Neurosurgery Department, İzmir, Türkiye.
Objective:
To compare the accuracy and clinical outcomes of proximal catheter placement using neuronavigation guidance versus the traditional free-hand technique in patients undergoing ventriculoperitoneal shunt (VPS) surgery.
Methods:
We performed a single-surgeon, before-after cohort study: free-hand cases (2013-2019) and neuronavigation cases (2020-2024). Ethics approval was obtained (İzmir Bakİrçay University; Approval No. 2407; 20 Aug 2025). The primary endpoint was a composite of first-attempt ventricular entry and absence of postoperative day-1 (POD1) Grade-3 malposition. Secondary endpoints included grades, 12-month proximal tip dysfunction, and operative duration.
Results:
Fifty-two patients were included (neuronavigation N = 24; free-hand N = 28). Composite success was 100% (24/24) with neuronavigation versus 64.3% (18/28) free-hand (RR 1.54, 95% CI 1.16-2.03; p = 0.00095), risk difference +35.7% (NNT≈3). Grade-3 malposition occurred in 0% (0/24) versus 32.1% (9/28) (p = 0.002); Grades 1-2 (no Grade-3) were 100% versus 67.9% (RR 1.46, 95% CI 1.12-1.89). Optimal (Grade-1) placement was 70.8% versus 32.1% (RR 2.20, 95% CI 1.21-4.00; p = 0.0115). Twelve-month proximal tip dysfunction occurred in 8.3% versus 25.0% (RR 0.33, 95% CI 0.08-1.46). Operative time was longer with neuronavigation by +10.49 minutes (95% CI +7.40 to +13.58).
Conclusion:
In this before-after, single-surgeon series, neuronavigation improved first-pass success and eliminated malposition, with an approximate 10-minute time penalty; multicenter confirmation is warranted. Given the retrospective, historically controlled design, residual confounding and time-related practice changes may persist; nonetheless, the magnitude of effect supports considering neuronavigation when resources and workflow allow in routine practice.
