The impact of real-time ultrasound guidance on ventricular catheter placement in cerebrospinal fluid shunts – a single-center study

Abstract

Purpose

Misplacement of ventricular catheters during shunt surgery occurs in 40% of cases using a freehand technique and therefore represents a risk for early shunt failure. The goal of this retrospective, single-center study is to analyze the impact of real-time ultrasound guidance on ventricular catheter positioning and early outcome of shunt survival.

Materials and Methods

We analyzed the charts and images of all patients who underwent shunt surgery from 09/2017 to 12/2022 and compared the position of the ventricular catheter using the freehand technique and real-time ultrasound guidance. Central catheter position was graded as grade I (optimal), II (contact with ventricle structures or contralateral), and III (misplacement).

Results

A ventricular catheter was placed in 244 patients using real-time US guidance and in 506 patients using a freehand technique. The mean age (53.4 and 53.6 years, respectively) and the preoperative frontal occipital horn ratio (FOHR; 0.47 versus 0.44) were almost equal in both groups. In the study group, grade I catheter position was achieved in 64% of cases, grade II in 34%, and grade III in 2%. The control group showed grade I position in 45%, grade II in 32%, and grade III in 23% of cases (p<0.05). An early central catheter failure rate was the highest in grade III (40.5%) compared to 4% in grade I.

Conclusion

Our data demonstrate that real-time US guidance leads to a significant improvement in ventricular catheter placement. Consequently, early shunt revisions decrease significantly. Further prospective, randomized, and controlled studies comparing the standard method to real-time ultrasound catheter placement are required.

Zusammenfassung

Hintergrund

Eine fehlerhafte Platzierung von Ventrikelkathetern bei einer Shunt-Operation tritt in 40% der Fälle auf, wenn die Freihandtechnik verwendet wird, und stellt daher ein Risiko für ein frühzeitiges Shunt-Versagen dar. Ziel dieser retrospektiven Single-Center-Studie ist es, die Auswirkungen der Echtzeit-Ultraschallführung auf die Positionierung des Ventrikelkatheters und das frühe Outcome der Shunt-Funktion zu analysieren.

Material und Methoden

Wir analysierten die Diagramme und Bilder aller Patienten, die sich zwischen 09/2017 und 12/2022 einer Shunt-Operation unterzogen, und verglichen die Position des Ventrikelkatheters bei Einsatz der Freihandtechnik und der Echtzeit-Ultraschallführung. Die zentrale Katheterposition wurde als Grad I (optimal), II (Kontakt mit Ventrikelstrukturen oder kontralateral) und III (Fehlplatzierung) eingestuft.

Ergebnisse

Ventrikelkatheter wurde bei 244 Patienten unter Echtzeit-Ultraschallführung und bei 506 Patienten mittels Freihandtechnik platziert. Das Durchschnittsalter (53,4 bzw. 53,6 Jahre) und die präoperative „Frontal and Occipital Horn Ratio“ (FOHR; 0,47 bzw. 0,44) waren in beiden Gruppen nahezu gleich. In der Studiengruppe wurde in 64% der Fälle Katheterposition Grad I erreicht, in 34% Grad II und in 2% Grad III. In der Kontrollgruppe wurde in 4% der Fälle Katheterposition Grad I erzielt, in 32% der Fälle Grad II und in 23% der Fälle Grad III (p<0,05). Die Rate des frühen Katheterversagens war bei Grad III am höchsten (40,5%), im Vergleich zu 4% bei Grad I.

Schlussfolgerung

Unsere Daten zeigen, dass die Echtzeit-Ultraschallführung zu einer signifikanten Verbesserung der Platzierung von Ventrikelkathetern führt. Folglich gehen frühe Shunt-Revisionen signifikant zurück. Weitere prospektive, randomisierte und kontrollierte Studien, in denen die Standardmethode mit der Platzierung des Katheters in Echtzeit-Ultraschall verglichen wird, sind erforderlich.

Keywords

shunt - US-guided - ventricular catheter

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