Related Experiment Video
Updated: Jul 10, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Stereotactic Navigation and Intracranial Hemorrhage Risk Following Ventricular Catheter Placement: A Single-Center
Daniel N de Souza1,2, Spencer Frome1, Eric A Grin1
1Department of Neurosurgery, New York University Langone Health, New York, New York, USA.
Background And Objectives:
Cerebrospinal fluid shunting is a common treatment for hydrocephalus. Several techniques for ventricular catheter placement exist, yet comparative safety data remain limited. This study evaluated whether stereotactic navigation-assisted ventricular catheter placement is associated with reduced 30-day postoperative intracranial hemorrhage (ICH) rates.
Methods:
This was a retrospective analysis of adults who underwent frontal or occipital shunt placement for hydrocephalus between 2014 and 2023. The primary exposure variable was the use of stereotactic navigation for ventricular catheter placement. The primary outcomes were hospital length of stay (LOS) and 30-day postoperative ICH.
Results:
A total of 541 shunt placements were included (median age 72.5 years; 51.6% male). Normal pressure hydrocephalus represented the most common underlying diagnosis (60.3%). Stereotactic navigation was used in 221 cases (40.9%) and was more frequently employed in younger patients (66.0 vs 73.9 years; P < .001), more recent years (median 2021 vs 2019; P < .001), and cases involving non-normal pressure hydrocephalus diagnoses (P < .001). Overall, 12 patients (2.2%) developed ICH within 30 days of surgery. The 30-day ICH rate was significantly lower with stereotactic navigation (0.5% vs 3.4%; odds ratio 0.13, 95% CI 0.02-1.00; P = .033), corresponding to an absolute risk reduction of 2.99% and a number needed to treat of 34. Kaplan-Meier analysis demonstrated superior hemorrhage-free survival with navigation-assisted placement (log-rank P = .021), with most events occurring within the first 14 days postoperatively. Propensity-matched analysis demonstrated a similar effect size but fell short of statistical significance. Navigation use was not independently associated with LOS or any other complications.
Conclusion:
Stereotactic navigation-assisted ventricular catheter placement was associated with lower rates of 30-day postoperative ICH compared with non-navigation-assisted placement, with a number needed to treat of 34. Given the absence of adverse effects on LOS or overall complication rates, these findings support routine consideration of neuronavigation during shunt placement when available.
