A survey of surgical techniques for catheterising the cerebral lateral ventricles

The objective of this paper is to characterise the frequency of different surgical techniques for targeting the lateral ventricle in shunt surgery and the attitudes of Australasian neurosurgeons and advanced neurosurgical trainees to stereotactic adjuncts. Secondarily, we aim to learn from and collate the practical experiences of neurosurgeons for those attempting to improve their operative success. A survey of all practising and training members of the Neurosurgical Society of Australasia (NSA) was conducted. One hundred and eleven surveys were completed generating an overall response rate of 57%. Of those 108 performing shunt surgery, 10 (9%) preferred a frontal approach and 70 (65%) a posterior approach to the frontal horn. Twenty-seven neurosurgeons (25%) preferred the posterior approach to the atrium or body of the lateral ventricle. A wide range of burr hole sites and targeting landmarks were described and are discussed. There was no consistent pattern for neurosurgeons changing their preferred approach during their careers. Seventy-five per cent of respondents make adjustments to measurements for children by a wide range of methods. Frameless or frame-based stereotaxy is used at times by about half of all neurosurgeons. Posterior approaches to the lateral ventricle using freehand techniques are preferred among NSA members and their trainees but there are a wide variety of landmarks used. Many of these techniques have been developed over years of operative experience and could be modelled with planning software to assess their theoretical merits. There is no evidence of the uptake of generic accuracy guides but there is evidence of significant exposure to frameless stereotactic techniques that may grow in popularity as the technology improves.