# Navigation-Assisted Ventriculoperitoneal Shunt Placement in Pediatric Hydrocephalus: Improved Catheter Positioning and Reduced Revision Rates

## TL;DR

Using navigation tools during VP shunt surgery in children improves catheter placement and reduces the need for revisions.

## Contribution

The study demonstrates that navigation-assisted VP shunt placement improves catheter positioning and reduces revision rates in pediatric patients.

## Key findings

- Navigation-assisted VP shunt placement achieved a significantly higher optimal catheter placement rate (81.25%) compared to conventional methods (60.34%).
- The navigation-assisted group had a significantly lower revision rate (16.67%) compared to the conventional group (38.79%).
- Patients in the navigation-assisted group had a shorter mean hospital stay (7.85 days) compared to the conventional group (10.20 days).

## Abstract

Objective: This study aimed to compare the clinical outcomes of navigation-assisted and conventional (freehand) ventriculoperitoneal (VP) shunt placement in pediatric hydrocephalus patients. Methods: A retrospective review was conducted of 164 patients under the age of 18 who underwent VP shunt placement for hydrocephalus between 2015 and 2023 and had a minimum postoperative follow-up of 12 months. The conventional technique was used in 116 patients. The navigation-assisted technique (intraoperative ultrasonography or frameless neuronavigation) was used in 48 patients. Demographic data, hydrocephalus etiology, catheter tip position (Yim classification), revision rates, infection, complications, and length of hospital stay were recorded. Catheter tip position was assessed on postoperative imaging by two independent investigators. Results: No significant differences were found between the groups in terms of age, sex, and hydrocephalus etiology. The optimal catheter placement rate was significantly higher in the navigation-assisted group compared to the conventional technique (81.25% vs. 60.34%, p = 0.017). The revision rate was significantly lower in the navigation-assisted group (16.67% vs. 38.79%, p = 0.010). The mean hospital stay was shorter in the navigation-assisted group (7.85 ± 3.97 days vs. 10.20 ± 3.70 days, p < 0.001). The groups were similar in terms of infection (2.08% vs. 9.48%, p = 0.183) and overall complication rates (14.58% vs. 16.38%, p = 0.959). Conclusions: Navigation-assisted VP shunt placement in pediatric hydrocephalus patients is associated with a high rate of optimal catheter position, a low revision rate, and a short hospital stay. These findings support the use of navigation technology in pediatric hydrocephalus surgery, but also reveal that infection and complications are unassociated with the surgical technique.