ArticleNeurosciences (Riyadh, Saudi Arabia)2026
Comparison of Free-Hand Technique and Neuronavigation in Intraventricular Shunt Catheter Placement.
Article in Neurosciences (Riyadh, Saudi Arabia), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To compare the accuracy and clinical outcomes of proximal catheter placement using neuronavigation guidance versus the traditional free-hand technique in patients undergoing ventriculoperitoneal shunt (VPS) surgery. Methods: We performed a single-surgeon, before-after cohort study: free-hand cases (2013-2019) and neuronavigation cases (2020-2024). Ethics approval was obtained (İzmir Bakİrçay University; Approval No. 2407; 20 Aug 2025). The primary endpoint was a composite of first-attempt ventricular entry and absence of postoperative day-1 (POD1) Grade-3 malposition. Secondary endpoints included grades, 12-month proximal tip dysfunction, and operative duration. Results: Fifty-two patients were included (neuronavigation N = 24; free-hand N = 28). Composite success was 100% (24/24) with neuronavigation versus 64.3% (18/28) free-hand (RR 1.54, 95% CI 1.16-2.03; p = 0.00095), risk difference +35.7% (NNT≈3). Grade-3 malposition occurred in 0% (0/24) versus 32.1% (9/28) (p = 0.002); Grades 1-2 (no Grade-3) were 100% versus 67.9% (RR 1.46, 95% CI 1.12-1.89). Optimal (Grade-1) placement was 70.8% versus 32.1% (RR 2.20, 95% CI 1.21-4.00; p = 0.0115). Twelve-month proximal tip dysfunction occurred in 8.3% versus 25.0% (RR 0.33, 95% CI 0.08-1.46). Operative time was longer with neuronavigation by +10.49 minutes (95% CI +7.40 to +13.58). Conclusion: In this before-after, single-surgeon series, neuronavigation improved first-pass success and eliminated malposition, with an approximate 10-minute time penalty; multicenter confirmation is warranted. Given the retrospective, historically controlled design, residual confounding and time-related practice changes may persist; nonetheless, the magnitude of effect supports considering neuronavigation when resources and workflow allow in routine practice.
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