The impact of real-time ultrasound guidance for ventricular catheter placement in cerebrospinal fluid shunts - a single center study.

Purpose Misplacement of ventricular catheters in shunt surgery occurs in 40% with freehand technique and represents therefore a risk for early shunt failure. The goal of this retrospective, single center study is to analyze the impact of real-time ultrasound guidance on ventricular catheter positioning and early outcome of shunt survival. Materials and Methods We analyzed the charts and images of all patients who underwent shunt surgery from 09/2017 to 12/2022 and compared the position of ventricular catheter by using the freehand technique and real-time ultrasound guidance. Central catheter position was graded as grade I (optimal), II (contact with ventricle structures or contralateral) and III (misplacement). Results Ventricular catheter was placed in 244 patients using real-time US-guidance and in 506 patients using freehand technique. The mean age (53.4 and 53.6 years respectively) and the preoperative frontal occipital horn ratio (FOHR; 0.47 versus 0.44) were almost equal in both groups. In the study group, grade I catheter position was achieved in 64%, grade II in 34% and grade III in 2%. The control group showed grade I position in 45%, grade II in 32% and grade III in 23% of cases (p<0.05). Early central catheter failure rate was the highest in grade III (40.5%) compared to 4% in grade I. Conclusion Our data demonstrate that real-time US-guidance lead to a significant improvement of ventricular catheter placement. In consequence early shunt revisions decrease significantly. Further prospective, randomized, and controlled studies comparing standard method to a real-time ultrasound catheter placement are required.