gms | German Medical Science

Objective: The mainstay of surgical treatment of idiopathic intracranial hypertension (IIH) is ventriculoperitoneal (VP) shunting. Because of the typical small and sometimes even slit ventricular size adequate positioning of the ventricular catheter is challenging. Here, we investigated the usefulness of electromagnetic (EM) guided ventricular catheter placement for shunting in IIH.

Methods: Twelve patients with IIH were selected for EM-navigated placement of a ventricular catheter for VP-shunting. The age of patients ranged from 5 to 56 years at the time of surgery (mean age: 27.4 years; median: 24 years). There were two children (5 and 11 years old) and 10 adults. Inclusion criteria for the study were patients with confirmal and medically refractory IIH. Patients underwent preoperative continuous epidural ICP-monitoring for 2 days to support diagnosis. In all patients EM–navigated placement of the ventricular catheter was performed using realtime traking of the catheter tip for exact positioning close to the foramen of Monro. Postoperative CT scans were correlated to intraoperative screen shots to validate the position of the catheter.

Results: In all patients EM-navigated ventricular catheter placement was achieved, except in one in whom navigation accuracy was lost during surgery by accidental displacement of the dynamic reference frame (DRF). There were no intraoperative or postoperative complications. In all cases satisfactory positioning of the ventricular catheter was achieved. No proximal shunt failure was observed during follow-up at a mean of 33.7 months (range 2.5 – 76 months, median 30 months).

Conclusion: EM-navigated ventricle catheter placement in shunting for IIH is a safe and straight forward technique. It obviates the need for sharp head fixation allowing shunt placement with care.