The Efficacy of VP Shunt Entry Area Recommender (VPSEAR) in Keen’s Point VP Shunt using Computer Simulation and 15 3D Skull Models
Keywords:
VP shunt, program, accuracy, simulation, 3D skullAbstract
Objective: The accuracy of the free-hand technique in VP shunt catheter placement is not high due to patients’ dissimilarities and different severity of hydrocephalus. Although navigator-assisted VP shunt is more accurate, not every neurosurgical center can afford neuronavigation. Therefore, we developed a software named VP Shunt Entry Area Recommender (VPSEAR), using computer science combined with neurosurgery knowledge to provide each patient’s recommended entry and ventricular catheter length. Here, we conducted an evaluation of our program efficacy in simple hydrocephalus patients.
Methods: Fifty hydrocephalus cases were randomly chosen from our medical records. Patient data, including age, sex, cause of hydrocephalus, and hydrocephalus severity, were collected. VP shunt simulation was evaluated by two methods: 1) computer simulation and 2) fifteen 3D skull model simulations to compare the VPSEAR recommended entry point at the parietal region vs. the theoretical Keen’s point. Locations of ventricular catheter tips were recorded and categorized into proper and improper locations.
Result: One hundred samples (50 cases, both sides) were evaluated. VPSEAR achieved a proper location of ventricular catheter tip for 86/100 (86%). In Keen’s point, three different lengths of ventricular catheter tip were evaluated and showed a proper location in 86/100 (86%), 46/100 (46%), and 6/100 (6%) for ventricular catheter lengths of 6, 7, and 8 cm respectively. In 92% of VPSEAR’s group, the majority of catheters were in the ventricle, and in only 8 cases, the majority of catheters were in the brain, while 86% of the majority of catheters in Keen’s group were in the ventricle. VPSEAR recommended ventricular catheter length was 64.92 ±10.21 mm. The mean displacement from the VPSEAR entry point to Keen’s point was 21.29 ± 16.12 mm. Regarding the 3D skull model simulation, our study showed the angle of deviation from the theoretical perpendicular trajectory was 8.64 ± 3.38 degrees.
Conclusion: Our VPSEAR is a promising, inexpensive option for locating ventricular entry points using computer science and neurosurgery knowledge. VPSEAR showed higher accuracy than Keen’s point in both computer simulation and 3D skull model simulation evaluations.
Downloads
References
Eisenring CV, Burn F, Baumann M, et al. sEVD—smartphone-navigated placement of external ventricular drains. Acta Neurochirurgica. 2019;162(3):513– 21.
Li Ching Ng A, Kohan S. Accurate placement of parieto-occipital shunt ventricular catheter: use of craniometrics and technical note. Child’s Nervous System. 2021;37(10):3209–17.
Spitaels J, Riva M, Delpierre I, Dewitte O, Bruneau M. Freehand stereotactic ventricular catheter insertion for ventriculoperitoneal shunts based on individualized radio-anatomical landmarks. Acta Neurochirurgica. 2021;163(4):1103-12.
Konovalov AN, Gadzhiagaev V, Veselkov AA, Okishev D, Eliava S. Analysis of a Novel Entry Point for Freehand Ventriculostomy Using Computerized Tomography Scans. Cureus. 2022 Jan 10;14(1).
Thomale U-W, Schaumann A, Stockhammer F, et al. GAVCA Study: Randomized, Multicenter Trial to Evaluate the Quality of Ventricular Catheter Placement with a Mobile Health Assisted Guidance Technique. Neurosurgery. 2018;83(2)
Elena Virginia Colombo, Bongetta D, Fabio Cofano, Versace A, Garbossa D, Bertuccio A, et al. Ventricular Peritoneal Shunting Using Modified Keen’s Point Approach: Technical Report and Cases Series. Surgeries. 2022;3(4):314–22.
Morone PJ, Dewan MC, Zuckerman SL, Tubbs RS, Singer RJ. Craniometrics and Ventricular Access: A Review of Kocher’s, Kaufman’s, Paine’s, Menovksy’s, Tubbs’, Keen’s, Frazier’s, Dandy’s, and Sanchez’s Points. Oper Neurosurg (Hagerstown). 2020;18(5):461-9.
Yamada SM, Yamada S, Goto Y, Hiroshi Nakaguchi, Murakami M, Hoya K, et al. A simple and consistent technique for ventricular catheter insertion using a tripod. Clinical Neurology and Neurosurgery. 2012;114(6):622–6.
Yamada SM, Kitagawa R, Teramoto A. Relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt. Journal of Clinical Neuroscience. 2013;20(1):99-101.
Junaid M, Ahmed M, Rashid MU. An experience with ventriculoperitoneal shunting at keen’s point for hydrocephalus. Pakistan Journal of Medical Sciences. 2018;34(3).
Peter, Desiree, Yuan Y, Guo X, Michael S, Tam M, et al. A Morphometric Analysis of Commonly Used Craniometric Approaches for Freehand Ventriculoperitoneal Shunting. Oper Neurosurg (Hagerstown). 2022;22(2):51-60.
Chongsrid K, Wirz L, Sukhor S, Mungmee A, Yindeedej V, Aimmanee P. VP Shunt Entry Area Recommender (VPSEAR): A Computer-Assisted System for VP Shunt Operation. Intelligent Systems with Applications. 2023;18:200205.
Dobran M, Nasi D, Mancini F, Maurizio Gladi, Polonara G, Marini A, et al. Relationship between the location of the ventricular catheter tip and the ventriculoperitoneal shunt malfunction. Clinical Neurology and Neurosurgery. 2018;175:50–3.
Simon TD, Schaffzin JK, Stevenson CB, Willebrand K, Parsek M, Hoffman LR. Cerebrospinal Fluid Shunt Infection: Emerging Paradigms in Pathogenesis that Affect Prevention and Treatment. J Pediatr. 2019;206:13-19.
Paff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: A review. Interdisciplinary Neurosurgery. 2018;13:66-70.
Ananthanandorn A. Outcome of Proximal Ventricular Catheter Placement in Ventriculoperitoneal Shunt Operations using the Parietal Approach. J Med Assoc Thai. 2017;100 Suppl 1:S27-32.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles in this journal are copyrighted by the x may be read and used for academic purposes, such as teaching, research, or citation, with proper credit given to the author and the journal.use or modification of the articles is prohibited without permission.
statements expressed in the articles are solely the opinions of the authors.
authors are fully responsible for the content and accuracy of their articles.
other reuse or republication requires permission from the journal."
