Paediatric Ventriculoperitoneal Shunt – Is Free Hand Placement of Ventricular Catheter Still Acceptable?

Background: Ventriculoperitoneal (VP) shunt insertion is a common procedure in neurosurgical practice, different techniques have been described to improve the accuracy of ventricular catheter insertion including neuronavigation, endoscopic and ultrasound guidance. Surgeon’s experience is not usually taken into consideration as a parameter of accurate ventricular catheter placement. We report our experience in free-hand paediatric ventricular catheter insertion in experienced surgeons’ hands. Patients and Methods: A prospective cohort study of twenty-eight free hand VP shunt insertion in paediatric patients undertaken by experienced surgeons between 2010 and 2014. Minimum follow up period was 12 months or until shunt failed. All patients had a follow up CT scan on which we observed the burr hole site, Ventricular Catheter (VC) length and VC tip position (which we graded from grades 1-5). If the shunt failed, we recorded cause of failure and duration of shunt survival. Results: The median age of patients was 3 months and twelve (42.9%) of them were males. Hydrocephalus was congenital in nineteen (67.9%) patients. Eighteen (64.3%) of the cases were de novo shunts. Twenty-five (89.3%) of the ventricles were tapped at first attempt. Twenty-seven patients (96.4%) had an anatomically accepted entry point and VC tips were intraventricular (grade 1 or 2) in twenty three (82.1 %) cases. All the twenty one (75%) shunts at the “ideal” cranio-caudal antero-posterior survived. Conclusion: Free-handed technique tailored according to the head and ventricular configuration based on pre-operative CT brain can give satisfactory ventricular catheter position, especially in the hands of an experienced surgeon.