Accuracy of catheter placement in ventriculoperitoneal shunt surgery with optical navigation: A retrospective comparative study

Background: Ventriculoperitoneal (VP) shunt surgery is the standard procedure for managing hydrocephalus. This study retrospectively compared catheter placement accuracy and clinical utility in VP shunt surgery using an optical navigation system versus freehand techniques. Methods: This study retrospectively included patients from Juntendo University Hospital (January 2015 to March 2025). Only cases with postoperative computed tomography (CT) within 7 days were analyzed. Patients were divided into navigation-assisted and freehand groups. Catheter tip position was classified into four CT-based grades. Statistical comparisons used the Mann–Whitney U test and Fisher’s exact test. Results: Forty-two patients (mean age 48.3 ± 25.5 years; 24 males [57.1%]) were analyzed. The navigation-assisted and freehand groups each comprised 21 patients. There were no significant intergroup differences in age (54.8 ± 21.2 vs. 41.7 ± 28.2 years, P = 0.16), sex ratio (62.5% vs. 37.5% male, P = 0.12), or median operative time (60 vs. 62 min, P = 0.98). Postoperative CT revealed that all cases in the navigation-assisted group achieved grade 1 placement (100%), whereas in the freehand group, 16 (76.2%) were grade 1, 3 (14.3%) were grade 2, and 2 (9.5%) were grade 3. Malposition (grades 2–4) occurred only in the freehand group (23.8%), with a significant difference between the groups ( P < 0.05). Conclusion: In this limited retrospective series, optical navigation-assisted VP shunt surgery appeared to improve the accuracy of ventricular catheter placement compared with the freehand technique. Larger prospective studies are required to determine whether this improved accuracy translates into better long-term clinical outcomes.