Intraoperative fiber-optic endoscopy for ventricular catheter insertion

Objective: Ventricular catheter placement is a common neurosurgical procedu re often resulting in inaccurate intraventricular positioning. We conducted a comparison of the accuracy of endoscopic and conventional ventricular ca theter placement in adults. Methods: A retrospective analysis of data was p erformed on 37 consecutive patients undergoing ventriculo-peritoneal shunt (VPS) insertion with endoscopy and 40 randomly selected, unmatched patients undergoing VPS insertion without endoscopy, for the treatment of hydroceph alus of varied etiology, A grading system for catheter tip position was dev eloped consisting of five intraventricular zones, V1-V5, and three intrapar enchymal zones,A, B, C. Zones V1 for the frontal approaches and V1 or V2 fo r the occipital approaches were the optimal catheter tip locations. Postope rative scans of each patient were used to grade the accuracy of ventricular catheter placement. Results: Seventy-six percent of all endoscopic ventric ular catheters were in zone V1 and 100% were within zones V1-V3, No endosco pically inserted catheters were observed in zones V4, V5 or intraparenchyma lly, Thirty-eight percent of the conventionally placed catheters were in zo ne V1, 53% in zones V1-3 and 15% intraparenchymally. There was a statistica lly significant difference in the percentage of catheters in optimal locati on versus in any other location, favoring endoscopic guidance (p<0.001). Co nclusion: We conclude that endoscopic ventricular catheter placement provid es improved positioning accuracy than conventional techniques.