Efficacy of Ventriculoperitoneal Shunting Using Keen's Point Versus Frazier's Point in Patients With Hydrocephalus: A Non-Randomized Controlled Trial From Pakistan

Background The ventriculoperitoneal (VP) shunt is crucial for draining excess cerebrospinal fluid, preventing complications like elevated intracranial pressure. Common points for the procedure, such as Keen's and Frazier's points, are established, with emerging interest in Choudhary's point. Despite advancements, the challenge remains, as studies reveal cases with incorrectly placed catheter tips, emphasizing the ongoing need for improved ventriculostomy techniques. Objective To assess and compare the efficacy of VP shunting utilizing Keen's point versus Frazier's point in individuals diagnosed with hydrocephalus. Methodology From February to August 2022, this non-randomized controlled trial was conducted at Unit II, Department of Neurosurgery, Lahore General Hospital, Lahore. The study included 438 patients divided into two groups (Group A with Frazier's point and Group B with Keen's point), with 219 patients in each group, allocated based on the attending surgeon's preference. Effectiveness was evaluated post-procedure in the post-surgical ward using CT scans, focusing on factors such as optimal ventricular catheter tip position and minimal brain parenchymal damage. Data analysis utilized IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results In the Frazier's point group, the mean age was 18.47±9.21 years, while in the Keen's point group, it was 19.06±10.43 years. The duration of symptoms was 2.59±1.189 months in Frazier's point group and 2.65±1.237 months in Keen's point group. Gender distribution showed 42.5% males and 57.5% females in Frazier's point group and 40.6% males and 59.4% females in Keen's point group. The effectiveness of the VP shunting procedure was observed in 175 (79.9%) cases in Frazier's point group and 133 (60.7%) in Keen's point group (p <0.0001). Conclusion The study concludes that VP shunting at Frazier's point demonstrates superior effectiveness compared to Keen's point, supporting its consideration for hydrocephalus management across pediatric and adult populations.