Electromagnetic Navigation and Ventricular Catheter Placement: A Propensity-Score-Matched Analysis of Early Proximal...

Ventricular catheter placement is fundamental to hydrocephalus management, but freehand techniques carry risk of malplacement and early revision. Single-center electromagnetic (EM) versus freehand comparisons are often confounded. We assessed whether EM guidance is associated with lower early revision and misplacement using propensity-score matching.

We reviewed 1847 ventricular catheter placements at Erasmus MC (2017-2023). The primary endpoint was 10-day proximal revision in a variable-ratio propensity score matching cohort targeting up to four controls per EM placement (exact match on etiology and age category; propensity score on age, sex, and entry point). Secondary endpoints included 30-day revision, Hayhurst grade, and a ventricle-adjusted ordinal model. Sensitivity analyses added for this revision and an E-value were computed. A parallel prospective cohort (N = 16) served as a Post-Market Clinical Follow-up pilot.

After propensity score matching (N = 401), 10-day revision occurred in 5.5% of EM-guided versus 17% of freehand placements (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12-0.82, P=0.018); in pediatric patients, revision was 3.8% versus 25% (OR 0.12, 0.02-0.80, P=0.028). Thirty-day revision was 14% versus 28% (OR 0.45, 0.21-0.94, P=0.034), and Grade 3 misplacement was 3.1% versus 16% (OR 0.16, P=0.004). Ventricle-size-adjusted ordinal modeling was consistent (OR 0.56, P=0.056). Sensitivity analyses were directionally consistent (OR 0.21-0.32); the E-value was 3.01 for the point estimate and 1.45 for the confidence limit. The prospective pilot showed 75% Grade 1 and no device-related serious adverse events.

EM-guided placement was associated with lower odds of early revision and parenchymal misplacement in a propensity-matched analysis. A multicenter randomized trial is warranted before routine universal adoption.