Does CT wand guidance improve shunt placement in patients with hydrocephalus?

Dane Moran, Thomas A. Kosztowski, Ignacio Jusué-Torres, Dennis Orkoulas-Razis, Ayobami Ward, Kathryn Anne Carson, Jamie Hoffberger, Benjamin D. Elder, C. Rory Goodwin, Daniele Rigamonti

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)26-30
Number of pages5
JournalClinical Neurology and Neurosurgery
Volume132
DOIs
StatePublished - 2015

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Hydrocephalus
Odds Ratio
Confidence Intervals
Pseudotumor Cerebri
Cohort Studies
Multivariate Analysis
Retrospective Studies
Logistic Models
Regression Analysis
Surgeons

Keywords

  • Frameless stereotaxy
  • Hydrocephalus
  • Neuronavigation
  • Pseudotumor cerebri
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Does CT wand guidance improve shunt placement in patients with hydrocephalus? / Moran, Dane; Kosztowski, Thomas A.; Jusué-Torres, Ignacio; Orkoulas-Razis, Dennis; Ward, Ayobami; Carson, Kathryn Anne; Hoffberger, Jamie; Elder, Benjamin D.; Goodwin, C. Rory; Rigamonti, Daniele.

In: Clinical Neurology and Neurosurgery, Vol. 132, 2015, p. 26-30.

Research output: Contribution to journalArticle

Moran, D, Kosztowski, TA, Jusué-Torres, I, Orkoulas-Razis, D, Ward, A, Carson, KA, Hoffberger, J, Elder, BD, Goodwin, CR & Rigamonti, D 2015, 'Does CT wand guidance improve shunt placement in patients with hydrocephalus?', Clinical Neurology and Neurosurgery, vol. 132, pp. 26-30. https://doi.org/10.1016/j.clineuro.2015.02.007
Moran, Dane ; Kosztowski, Thomas A. ; Jusué-Torres, Ignacio ; Orkoulas-Razis, Dennis ; Ward, Ayobami ; Carson, Kathryn Anne ; Hoffberger, Jamie ; Elder, Benjamin D. ; Goodwin, C. Rory ; Rigamonti, Daniele. / Does CT wand guidance improve shunt placement in patients with hydrocephalus?. In: Clinical Neurology and Neurosurgery. 2015 ; Vol. 132. pp. 26-30.
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abstract = "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.",
keywords = "Frameless stereotaxy, Hydrocephalus, Neuronavigation, Pseudotumor cerebri, Ventriculoperitoneal shunt",
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AU - Moran, Dane

AU - Kosztowski, Thomas A.

AU - Jusué-Torres, Ignacio

AU - Orkoulas-Razis, Dennis

AU - Ward, Ayobami

AU - Carson, Kathryn Anne

AU - Hoffberger, Jamie

AU - Elder, Benjamin D.

AU - Goodwin, C. Rory

AU - Rigamonti, Daniele

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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.

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