Ultrasound-guided versus stereotactically navigated ventriculoperitoneal shunt placement: a randomized clinical trial.

IF 7.2 1区医学 Q1 NEUROSCIENCES

Fluids and Barriers of the CNS Pub Date : 2026-06-26 DOI:10.1186/s12987-026-00833-2

Severina Leu, Tim Hallenberger, Jonathan Rychen, Lea Pacan, Evangelia Christodoulou, Kristine Blackham, Ladina Greuter, Florian Samuel Halbeisen, Ethan Taub, Birgit Westermann, Raphael Guzman, Luigi Mariani, Jehuda Soleman

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引用次数: 0

Abstract

Background: Accurate catheter positioning is essential for optimal outcomes in ventriculoperitoneal shunt (VPS) surgery, while shorter operative times lower infection risk and costs. Navigated VPS placement, using either intraoperative ultrasound-guided (US-G) or stereotactically guided (ST-G) navigation, enhances catheter accuracy and reduces revision rates. However, high-quality studies comparing the two navigation methods are lacking. We aim to compare surgical intervention time, accuracy, and safety of US-G to ST-G VPS placement.

Methods: The Navigated VPS (NAVPS) trial was an investigator-initiated, randomized trial conducted from February 2020 to June 2024 in the Neurosurgical Department of the University Hospital of Basel. Consecutive adults undergoing VPS placement were included. Out of 153 screened participants, 134 participants were included. Participants were randomized 1:1 to receive either US-G or ST-G insertion of the ventricular catheter. The primary outcome was surgical intervention time. An intention to treat analysis was performed calculating surgical intervention time differences. Secondary outcomes were accuracy of catheter positioning, number of ventricular puncture attempts, and VPS dysfunction and complication rates. The study follow-up lasted 6 months.

Results: Of 134 participants, 66 were assigned to US-G and 68 to ST-G. The mean (SD) age was 73 (55.3 to 78) and 66 (54.5 to 73) years for the US-G and ST-G, respectively, and 58 participants (45.7%) were female. The US-G group had significantly shorter surgical intervention times compared to the ST-G group (-11.5 min; 95% CI -18.5 to -4.5; P = 0.002). The number of ventricular puncture attempts was significantly higher in the US-G group, while accuracy of catheter placement, and VPS dysfunction and complications rates were comparable in both groups.

Conclusions: The NAVPS trial shows US-G VPS placement to be more time-efficient, while accuracy of catheter placement and complication rates seem to be comparable to ST-G placement. US-G can be efficiently and safely used in clinical practice.

Trial registration: clinicalTrials.gov Identifier: NCT04450797, date of registration: 22.06.2020.

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超声引导与立体定向导航脑室腹腔分流放置：一项随机临床试验。

背景：准确的导管定位对于脑室腹腔分流术（VPS）的最佳预后至关重要，而更短的手术时间可以降低感染风险和成本。导航VPS放置，使用术中超声引导（US-G）或立体定向引导（ST-G）导航，可提高导管准确性并降低翻修率。然而，比较这两种导航方法的高质量研究是缺乏的。我们的目的是比较US-G与ST-G VPS放置的手术介入时间、准确性和安全性。方法：导航VPS （NAVPS）试验是一项由研究者发起的随机试验，于2020年2月至2024年6月在巴塞尔大学医院神经外科进行。连续接受VPS安置的成年人被纳入研究。在153名被筛选的参与者中，包括134名参与者。参与者按1:1随机分组，接受US-G或ST-G心室导管插入。主要观察指标为手术时间。进行意向治疗分析，计算手术干预时间差异。次要结果是导管定位的准确性、心室穿刺次数、VPS功能障碍和并发症发生率。研究随访6个月。结果：134名参与者中，66名被分配到US-G组，68名被分配到ST-G组。US-G和ST-G的平均（SD）年龄分别为73岁（55.3 - 78岁）和66岁（54.5 - 73岁），58名参与者（45.7%）为女性。与ST-G组相比，US-G组的手术干预时间明显缩短（-11.5 min; 95% CI -18.5 ~ -4.5; P = 0.002）。US-G组的心室穿刺次数明显高于US-G组，而两组的导管放置准确性、VPS功能障碍和并发症发生率相当。结论：NAVPS试验显示US-G VPS放置更省时，而导管放置的准确性和并发症发生率似乎与ST-G放置相当。US-G可有效、安全地用于临床。试验注册：clinicalTrials.gov标识符：NCT04450797，注册日期：22.06.2020。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Fluids and Barriers of the CNS Neuroscience-Developmental Neuroscience

CiteScore

10.70

自引率

8.20%

发文量

审稿时长

14 weeks

期刊介绍： "Fluids and Barriers of the CNS" is a scholarly open access journal that specializes in the intricate world of the central nervous system's fluids and barriers, which are pivotal for the health and well-being of the human body. This journal is a peer-reviewed platform that welcomes research manuscripts exploring the full spectrum of CNS fluids and barriers, with a particular focus on their roles in both health and disease. At the heart of this journal's interest is the cerebrospinal fluid (CSF), a vital fluid that circulates within the brain and spinal cord, playing a multifaceted role in the normal functioning of the brain and in various neurological conditions. The journal delves into the composition, circulation, and absorption of CSF, as well as its relationship with the parenchymal interstitial fluid and the neurovascular unit at the blood-brain barrier (BBB).