Full Length ArticleComparison of electromagnetic neuronavigation system and free-hand method for ventricular catheter placement in internal shunt

•Ventriculoperitoneal shunt placement is a very common intervention for the treatment of hydrocephalus.•The misplacement of ventricular catheters can be responsible for morbidity.•The use of neuronavigation system leads to a decrease risk of non-optimal catheter.

ObjectiveOptimal ventricular catheter positioning is able to reduce the risk of catheter dysfunction, and subsequently the risk of multiple revision surgery. The objective of our study was to compare the proportion of optimal ventricular catheter placements in a cohort of patients operated for ventriculoperitoneal (VP) shunt between a free-hand group and a neuronavigated group.Patients and methodsTwenty patients with hydrocephalus requiring VP shunt were prospectively included in this study. Patients were divided into two groups; the ventricular catheter was positioned using free-hand method (n = 10) or magnetic navigation system (n = 10). For the two groups, clinical baseline characteristics, etiology of hydrocephaly and initial ventricular size were assessed. The main judgment criterion was the proportion of optimal catheter placements defined by the presence of all catheter holes in the ventricle, evaluated on post-operative CT scan.ResultsThere was no initial difference between the two groups in terms of hydrocephalus etiology or initial ventricular size. The number of optimal catheter placements was 6/10 in the neuronavigated group versus 1/10 in the free-hand group (p < 0.05). There were no complications during post-operative period in either cohort.ConclusionIn patients suffering from hydrocephaly, the use of an electromagnetic neuronavigation system for ventricular catheter placement significantly improved the proportion of optimal catheter placements. Long-term follow-up is necessary to evaluate the number of revision surgeries and the cost in each group.