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

Abstract

Background

Ventriculoperitoneal shunting (VPS) is a common neurosurgical procedure used to treat hydrocephalus. Although the use of a navigation system in VPS achieves superior results compared with conventional surgery, the relationships among clinical symptoms, ventricular catheter placement, catheter obstruction, and the postoperative Evans index have not been clearly reported.

Methods

We performed a retrospective study of 40 patients with VPS (the navigation surgery group) and 31 patients with VPS (the conventional surgery group). 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-seven patients experienced optimal ventricular catheter placement (grade 1), three experienced suboptimal placements (grade 2), and none experienced poor ventricular catheter placement (grade 3) in the navigation surgery group. Greater improvement in postoperative symptoms (p < 0.001), including less catheter readjustment (p < 0.001), was observed in the navigation surgery group. A Kaplan–Meier analysis showed that the cumulative catheter obstruction-free survival time was longer in the navigation surgery group (p = 0.016). Moreover, catheter placement was significantly correlated with catheter obstruction (p < 0.001). Additionally, catheter obstruction was significantly correlated with the symptom grade (p < 0.001) and postoperative Evans index (p = 0.002).

Conclusion

VPS for hydrocephalus via the occipital horn with a navigation system is superior to the conventional surgical procedure in terms of clinical outcomes, the precision of ventricular catheterization, and the occurrence of complications. Catheter obstruction-free survival times were longer in the navigation surgery group and catheter placement was significantly correlated with catheter obstruction.

Keywords:

• Hydrocephalus
• ventriculoperitoneal shunt
• intraoperative navigation
• ventricle catheter obstruction

Authors’ contributions

AiJun Peng, MingYang, YongKang Wu, and Yi Zhao were involved in the study design and data collection. The manuscript was written by AiJun Peng and Ming Yang. AiJun Peng and Hai Zhao were responsible for the statistical analyses and interpretation of study results. LiangXue Zhou served as principal investigator for the study, contributed data and participated in data interpretation as well as in the development of the manuscript. All authors have made substantial contributions to this study and approved submission to this journal.

Acknowledgements

We thank the staff of the Neurosurgery department at the Affiliated Hospital of Yangzhou University, who generously assisted with the VPS in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Sichuan Provincial Human Resources and the Social Security Department [Grant Number 0040205301G04].