Compared with conventional procedures performed via the occipital horn, an intraoperative navigation system for ventriculoperitoneal shunting improves outcomes in patients with hydrocephalus

Background: Ventriculoperitoneal shunting (VPS) is a common neurosurgical procedure used to treat hydrocephalus. Catheter obstruction is one of the most common factors that influences patient prognosis. We therefore evaluated the accuracy of proximal catheter placement and explored the probable relationship between ventricular catheter obstruction and both symptom grade and postoperative Evans index between an intraoperative navigation system for VPS and conventional surgery via the occipital horn. Methods: We performed a retrospective study of 33 patients with VPS (the navigation surgery group) and 26 patients with VPS (the conventional surgery group) seen between January 2012 and August 2018. The clinical data, follow-up times, catheterization accuracy, postoperative outcomes, cumulative survival times and correlations between catheter placement and obstruction, symptom grade and the postoperative Evans index were analyzed. Results: Thirty-one patients experienced optimal ventricular catheter placement (grade 1), 2 experienced suboptimal placement (grade 2), and none experienced poor ventricular catheter placement (grade 3) in the navigation surgery group, whereas 6, 14, and 6 patients, respectively, had these results in the conventional surgery group. Greater improvement was observed in postoperative symptoms (P=0.017), including less catheter readjustment (P<0.001), in the navigation surgery group. A Kaplan-Meier survival analysis showed that the cumulative catheter obstruction-free survival time was longer in the navigation surgery group than in the conventional surgery group (P=0.028). Moreover, catheter placement was significantly correlated with catheter obstruction (P<0.001). In addition, catheter obstruction was significantly correlated with the symptom grade (P=0.001) and postoperative Evans index (P<0.001). Conclusions: An intraoperative navigation system for VPS improved patient outcomes and the accuracy of ventricular catheter placement. Catheter obstruction-free survival times were longer in the navigation surgery group, and catheter placement was significantly correlated with catheter obstruction.

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