gms | German Medical Science

Objective: Ventricular catheter shunt malfunction is the most common cause for shunt revision. Optimal ventricular catheter placement can be exceedingly difficult in patients with small ventricles or abnormal ventricular anatomy. Especially in children and in premature babies with a small head size, satisfactory positioning of the ventricular catheter can be a challenge. Here we demonstrate the advantages of navigation with electromagnetic (EM) tracking technology for shunt placement in children.

Methods: 26 children (aged between 4 days and 14 years, mean age: 3.5 years) with hydrocephalus and difficult ventricular anatomy or slit ventricles underwent EM-guided neuronavigated intraventricular catheter placement (29 procedures).

Results: There were no operative complications. There was no need for repeated ventricular punctures. The intraoperative catheter placement documented by screen shots correlated exactly with the position in the postoperative CT scan. Head movement during the operative procedure is possible without loss of navigation precision. In our follow-up (mean 24 months) we have no malfunction of the proximal catheter. There were 3 shunt infections (after 1 month, 5 months and 10 months) needing operative revision.

Conclusions: The EM navigation system allows safe and optimal catheter placement in children and especially in premature babies by avoiding repeated cannulation attempts for ventricular puncture. In contrast to stereotactic techniques and conventional neuronavigation, there is no need for sharp head fixation. This technique raises hope for reducing proximal shunt failure rates and costs for hydrocephalus treatment in this age cohort.