Ventricular catheter placement in children with hydrocephalus and small ventricles: the use of a frameless neuronavigation system

Object: Accurate placement of ventricular catheters in children with small ventricles can be difficult. Too often, shunt catheters are misplaced with regard to optimal postion and trajectory. The objective of this study was to determine whether neuronavigation-guided free-hand placement of ventricular catheters is an effective adjunct for children with hydrocephalus and small ventricles. Methods: Nine children with hydrocephalus (ages 1-12 years) participated in this study. Four children were diagnosed as suffering from slit ventricle syndrome and 5 children had small to mildly dilated ventricles. Of the 9 shunted children, 6 underwent previous shunt placements, and 1 child previously underwent an endoscopic third ventriculostomy. In 8 children the primary procedure was insertion of ventricular catheters using a frameless neuronavigation system. In I child, the neuronavigation system was used after failure to insert the ventricular catheter using a standard technique. All children showed significant improvement of their symptoms and signs following the procedure and none of them required shunt revision during the follow up period (mean 8 5 months). Conclusion: The usage of a neuronavigation system is safe and may be beneficial for optimal postioning and trajectory of ventricular catheters in children with small ventricles or an abnormal ventricular anatomy.