Freehand ventricular catheter placement in ventriculoperitoneal shunt surgery is associated with higher rates of proximal catheter failure compared to image guidance

Ventricular catheter (VC) revision due to proximal catheter failure is a well-known but potentially avoidable complication of ventriculoperitoneal shunting (VPS). Anatomical “freehand” VC placement is still commonplace, despite image guidance availability. We sought to determine the impact of freehand versus image-guided VC placement on accuracy and consequent revision rates. We conducted a retrospective review of all consecutive adult VPS procedures performed at a single hospital during a two-year period. Only frontal shunts and first-time cannulations of a ventricle were included. Accuracy was measured by linear distance from the catheter tip to the Foramen of Monro (Tip to Foramen, TTF) and Kakarla Grade (KG). Sixty patients met inclusion criteria, with a mean age of 54.1 ± 15.9 years. Most VCs were placed with the freehand technique ( n = 40, 66.7 %), with all revisions (100 %) placed using freehand technique. Use of image guidance significantly increased accurate VC placement by TTF (7.6 ± 6.0 mm vs. 16.1 ± 8.2 mm, p < 0.001) and KG (KG1; 85 % vs. 35 %, p = 0.001), without increasing procedure length (74.8 ± 24.1min vs. 82.3 ± 38.7min, p = 0.219). Four shunts (6.67 %) required VC revision, all within 10 days of surgery. VCs requiring revision were placed significantly less accurately (26.8 ± 9.6 mm vs. 12.02 ± 7.46 mm, p < 0.001). VCs with TTF >2 cm had a significantly higher rate of proximal revision (30 % vs. 2.0 %, p = 0.001). Image-guided placement increases accuracy of proximal shunt catheter placement without sacrificing operative efficiency. VC revision is associated with inaccurate placement and highly inaccurate VCs (>2 cm TTF) are more likely to require revision in the immediate post-operative period.