TY - JOUR
T1 - Does CT wand guidance improve shunt placement in patients with hydrocephalus?
AU - Moran, Dane
AU - Kosztowski, Thomas A.
AU - Jusué-Torres, Ignacio
AU - Orkoulas-Razis, Dennis
AU - Ward, Ayobami
AU - Carson, Kathryn
AU - Hoffberger, Jamie
AU - Elder, Benjamin D.
AU - Goodwin, C. Rory
AU - Rigamonti, Daniele
N1 - Publisher Copyright:
© 2015 Elsevier B.V. All rights reserved.
PY - 2015/5
Y1 - 2015/5
N2 - Object To evaluate the effectiveness of stereotactic navigation in enhancing the accuracy of ventricular shunt placement in patients with hydrocephalus. Methods A retrospective cohort study at a single institution by a single surgeon was performed. Consecutive patients who underwent implantation of a ventricular shunt for the management of hydrocephalus between July 2001 and December 2011 were included in the study, totaling 535 patients. Patients were classified as either having optimal or sub-optimal placement of the shunt into the ventricle. Multiple logistic regression analysis was used. Results Overall, 93.8% of patients were found to have optimal shunt placement. On multivariate analysis, navigation use was not significantly associated with improved accuracy of shunt placement (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.19-1.54; p = 0.25). Pseudotumor cerebri diagnosis was significantly associated with increased odds of sub-optimal shunt placement (OR = 6.41; 95% CI = 1.90-21.59; p = 0.003). Conclusions CT guided navigation did not significantly improve the accuracy of ventricular shunt placement in adults with hydrocephalus for an experienced surgeon. Further studies are required to assess the utility of CT guided navigation for less experienced surgeons and patients with small or dysmorphic ventricles.
AB - Object To evaluate the effectiveness of stereotactic navigation in enhancing the accuracy of ventricular shunt placement in patients with hydrocephalus. Methods A retrospective cohort study at a single institution by a single surgeon was performed. Consecutive patients who underwent implantation of a ventricular shunt for the management of hydrocephalus between July 2001 and December 2011 were included in the study, totaling 535 patients. Patients were classified as either having optimal or sub-optimal placement of the shunt into the ventricle. Multiple logistic regression analysis was used. Results Overall, 93.8% of patients were found to have optimal shunt placement. On multivariate analysis, navigation use was not significantly associated with improved accuracy of shunt placement (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.19-1.54; p = 0.25). Pseudotumor cerebri diagnosis was significantly associated with increased odds of sub-optimal shunt placement (OR = 6.41; 95% CI = 1.90-21.59; p = 0.003). Conclusions CT guided navigation did not significantly improve the accuracy of ventricular shunt placement in adults with hydrocephalus for an experienced surgeon. Further studies are required to assess the utility of CT guided navigation for less experienced surgeons and patients with small or dysmorphic ventricles.
KW - Frameless stereotaxy
KW - Hydrocephalus
KW - Neuronavigation
KW - Pseudotumor cerebri
KW - Ventriculoperitoneal shunt
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U2 - 10.1016/j.clineuro.2015.02.007
DO - 10.1016/j.clineuro.2015.02.007
M3 - Article
C2 - 25746318
AN - SCOPUS:84924120397
SN - 0303-8467
VL - 132
SP - 26
EP - 30
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
ER -