A novel technique for ventriculoperitoneal shunting by flat panel detector CT-guided real-time fluoroscopy

BACKGROUND: Surgical placement of a ventriculoperitoneal shunt (VPS) is the main strategy to manage hydrocephalus. However, the failure rate associated with placement of ventricular catheters remains high. METHODS: A hybrid operating room, equipped with a flat-panel detector digital subtraction angiography system containing C-arm cone-beam computed tomography (CB-CT) imaging, has recently been developed and utilized to assist neurosurgical procedures. We have developed a novel technique using intraoperative fluoroscopy and a C-arm CB-CT system to facilitate accurate placement of a VPS. RESULTS: Using this novel technique, 39 consecutive ventricular catheters were placed accurately, and no ventricular catheter failures were experienced during the follow-up period. Only two patients experienced obstruction of the VPS, both of which occurred in the extracranial portion of the shunt system. CONCLUSION: Surgical placement of a VPS assisted by flat panel detector CT-guided real-time fluoroscopy enabled accurate placement of ventricular catheters and was associated with a decreased need for shunt revision.