Available online 12 January 2013
Publication year: 2013
Source:World Neurosurgery
Objective Despite the frequency with which ventriculoperitoneal shunts are placed, ventricular catheter revision rates remains as high as 30-40% at one year. Many neurosurgeons place ventricular catheters "blindly", depending on anatomical landmarks and personal experience. To determine if intra-operative ultrasonography is beneficial for ventricular catheter placement, we performed a historical cohort study comparing shunts placed with intra-operative ultrasound (U/S) guidance to those placed blindly. Methods We reviewed all shunts placed by the Department of Neurosurgery at the University of Virginia from January 2005 to January 2007. During that time 211 patients underwent 242 shunts, with U/S use determined by surgeon preference. Ninety-two shunts were placed using U/S-guidance, and 150 were placed without U/S. Adults received 176 shunts, 56 with U/S. Children received 66 shunts, 36 with U/S. Mean follow-up was 21.6 months. The primary endpoints examined were shunt revision, ventricular catheter revision (VCR), and acute VCR (revision within 1-week for an improperly-placed catheter). Results Ultrasound use was associated with a statistically significant decrease in shunt revisions (OR=0.492;95% CI,0.253-0.958). Of the shunts placed with U/S-guidance, 21.7% required revision, compared to 29.3% without U/S. VCR's and acute VCR's occurred in 9.8% and 2.2%, respectively, for U/S shunts, compared to 14% and 5.3% without U/S. Pediatric revision rates were 30.6% with U/S versus 53.3% without, while adult rates were 16.1% and 23.3%, respectively. The benefit of U/S was more profound for occipital shunts. Conclusions Ultrasound use for the placement of permanent CSF-shunt catheters is associated with a decreased risk of shunt revision.
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