Stereotactic guidance for ventricular catheter placement in ventriculoperitoneal shunt surgery: a state-of-the-art review on technical rationale, clinical outcomes, and future directions.
- 1Instituto Parkinson Hoje, São Paulo, Brazil.
- 2Department of Neurology, Discipline of Neurosurgery, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil.
- 3Department of Health Sciences, Federal University of Paraná, Curitiba, Brazil.
Abstract
Ventriculoperitoneal (VP) shunting remains the most frequently performed surgical treatment for hydrocephalus; however, shunt failure rates remain substantial despite technical refinements. Proximal catheter malfunction, often associated with malposition, ventricular wall contact, or choroid plexus obstruction, represents a common cause of shunt revision. Conventional freehand ventricular cannulation is based on surface anatomical landmarks and surgical experience, which may be unreliable in patients with small or distorted ventricles. Stereotactic guidance-including frame-based systems, frameless neuronavigation, and electromagnetic navigation-has been introduced to improve placement accuracy and reproducibility. Randomized and cohort studies consistently demonstrate improved radiographic accuracy and higher first-pass success rates with guided techniques. However, systematic reviews have not uniformly shown reductions in overall shunt revision rates, likely reflecting the multifactorial etiology of shunt failure. Hemorrhagic complications after VP shunt placement are uncommon but clinically important; evidence from VP shunt cohorts and from the broader stereotactic neurosurgery experience (notably deep brain stimulation) suggests that trajectory planning and vascular/sulcal avoidance may reduce bleeding risk. This review synthesizes epidemiological context, technical rationale, comparative outcomes, hemorrhage considerations, health economic implications, and future research priorities regarding stereotactic ventricular catheter placement.
Related
- Technical nuances of the endoscopic resection of a growing third ventricular colloid cyst without hydrocephalus: Two-dimensional operative video.
- Optical coherence tomography in neurovascular intervention: Technical aspects and emerging directions
- Feasibility of a Patient-Specific Digital Twin for Ventriculoperitoneal Shunt Trajectory Planning
- Clinical utility of SPECT/CT radionuclide shuntgraphy in suspected ventriculoperitoneal shunt dysfunction.
- Motor network neurophysiological (TMS-EEG) markers as predictors of outcomes of ventriculoperitoneal shunt sustained for over a year in normal pressure hydrocephalus.
BibTeX
@article{fonoff2026stereotactic,
title = {{Stereotactic guidance for ventricular catheter placement in ventriculoperitoneal shunt surgery: a state-of-the-art review on technical rationale, clinical outcomes, and future directions.}},
author = {Erich Talamoni Fonoff and Igor Baroni Cardoso and Alexandre Maria Santos},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1931318},
url = {https://europepmc.org/article/MED/42909394},
note = {CC BY},
}
RIS
TY - JOUR
TI - Stereotactic guidance for ventricular catheter placement in ventriculoperitoneal shunt surgery: a state-of-the-art review on technical rationale, clinical outcomes, and future directions.
AU - Erich Talamoni Fonoff
AU - Igor Baroni Cardoso
AU - Alexandre Maria Santos
PY - 2026
DA - 2026/10/07
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1931318
UR - https://europepmc.org/article/MED/42909394
AB - Ventriculoperitoneal (VP) shunting remains the most frequently performed surgical treatment for hydrocephalus; however, shunt failure rates remain substantial despite technical refinements. Proximal catheter malfunction, often associated with malposition, ventricular wall contact, or choroid plexus obstruction, represents a common cause of shunt revision. Conventional freehand ventricular cannulation is based on surface anatomical landmarks and surgical experience, which may be unreliable in patients with small or distorted ventricles. Stereotactic guidance-including frame-based systems, frameless neuronavigation, and electromagnetic navigation-has been introduced to improve placement accuracy and reproducibility. Randomized and cohort studies consistently demonstrate improved radiographic accuracy and higher first-pass success rates with guided techniques. However, systematic reviews have not uniformly shown reductions in overall shunt revision rates, likely reflecting the multifactorial etiology of shunt failure. Hemorrhagic complications after VP shunt placement are uncommon but clinically important; evidence from VP shunt cohorts and from the broader stereotactic neurosurgery experience (notably deep brain stimulation) suggests that trajectory planning and vascular/sulcal avoidance may reduce bleeding risk. This review synthesizes epidemiological context, technical rationale, comparative outcomes, hemorrhage considerations, health economic implications, and future research priorities regarding stereotactic ventricular catheter placement.
SN - 1664-2295
ER -