{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:14:01Z","timestamp":1789992841551,"version":"4.0.1"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Cerebrospinal fluid shunt ventricular catheters inserted into the frontal horn or trigone are associated with prolonged shunt survival. Developing surgical techniques for accurate catheter insertion could, therefore, be beneficial to patients. This study was conducted to determine if the rate of accurate catheter location with intraoperative ultrasound guidance could exceed 80%.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors conducted a prospective, multicenter study of children (&lt; 18 years) requiring first-time treatment for hydrocephalus with a ventriculoperitoneal shunt. Using intraoperative ultrasound, surgeons were required to target the frontal horn or trigone for catheter tip placement. An intraoperative ultrasound image was obtained at the time of catheter insertion. Ventricular catheter location, the primary outcome measure, was determined from the first postoperative image. A control group of patients treated by nonultrasound surgeons (conventional surgeons) were enrolled using the same study criteria. Conventional shunt surgeons also agreed to target the frontal horn or trigone for all catheter insertions. Patients were triaged to participating surgeons based on call schedules at each center. A pediatric neuroradiologist blinded to method of insertion, center, and surgeon determined ventricular catheter tip location.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Eleven surgeons enrolled as ultrasound surgeons and 6 as conventional surgeons. Between February 2009 and February 2010, 121 patients were enrolled at 4 Hydrocephalus Clinical Research Network centers. Experienced ultrasound surgeons (&gt; 15 cases prior to study) operated on 67 patients; conventional surgeons operated on 52 patients. Experienced ultrasound surgeons achieved accurate catheter location in 39 (59%) of 66 patients, 95% CI (46%\u201371%). Intraoperative ultrasound images were compared with postoperative scans. In 32.7% of cases, the catheter tip moved from an accurate location on the intraoperative ultrasound image to an inaccurate location on the postoperative study. This was the most significant factor affecting accuracy. In comparison, conventional surgeons achieved accurate location in 24 (49.0%) of 49 cases (95% CI [34%\u201364%]). The shunt survival rate at 1 year was 70.8% in the experienced ultrasound group and 66.9% in the conventional group (p = 0.66). Ultrasound surgeons had more catheters surrounded by CSF (30.8% vs 6.1%, p = 0.0012) and away from the choroid plexus (72.3% vs 58.3%, p = 0.12), and fewer catheters in the brain (3% vs 22.4%, p = 0.0011) and crossing the midline (4.5% vs 34.7%, p &lt; 0.001), but they had a higher proportion of postoperative pseudomeningocele (10.1% vs 3.8%, p = 0.30), wound dehiscence (5.8% vs 0%, p = 0.13), CSF leak (10.1% vs 1.9%, p = 0.14), and shunt infection (11.6% vs 5.8%, p = 0.35).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Ultrasound-guided shunt insertion as performed in this study was unable to consistently place catheters into the frontal horn or trigone. The technique is safe and achieves outcomes similar to other conventional shunt insertion techniques. Further efforts to improve accurate catheter location should focus on prevention of catheter migration that occurs between intraoperative placement and postoperative imaging. Clinical trial registration no.: NCT01007786 (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"ClinicalTrials.gov\" xlink:type=\"simple\">ClinicalTrials.gov<\/jats:ext-link>).<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.9.peds1346","type":"journal-article","created":{"date-parts":[[2013,10,11]],"date-time":"2013-10-11T14:58:31Z","timestamp":1381503511000},"page":"565-574","source":"Crossref","is-referenced-by-count":48,"title":["No significant improvement in the rate of accurate ventricular catheter location using ultrasound-guided CSF shunt insertion: a prospective, controlled study by the Hydrocephalus Clinical Research Network"],"prefix":"10.3171","volume":"12","author":[{"given":"William E.","family":"Whitehead","sequence":"first","affiliation":[{"name":"Texas Children's Hospital, Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Riva-Cambrin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Wellons","sequence":"additional","affiliation":[{"name":"Monroe Carell Jr. Children's Hospital, Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhaya V.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, Department of Neurosurgery, University of Toronto, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Holubkov","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Illner","sequence":"additional","affiliation":[{"name":"Diagnostic Imaging, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Jerry","family":"Oakes","sequence":"additional","affiliation":[{"name":"Children's of Alabama, Section of Pediatric Neurosurgery, Division of Neurosurgery, University of Alabama, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas G.","family":"Luerssen","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion L.","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Drake","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, Department of Neurosurgery, University of Toronto, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R. W.","family":"Kestle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds1346","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"883","DOI":"10.3171\/jns.1988.69.6.0883","article-title":"Function of parietal and frontal shunts in childhood hydrocephalus","volume":"69","author":"Albright","year":"1988"},{"key":"b2-peds1346","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"215","DOI":"10.3171\/jns.1968.28.3.0215","article-title":"Control of hydrocephalus by valve-regulated venous shunt: avoidance of complications in prolonged shunt maintenance","volume":"28","author":"Becker","year":"1968"},{"key":"b3-peds1346","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1016\/j.jocn.2004.12.005","article-title":"Failure rate of frontal versus parietal approaches for proximal catheter placement in ventriculoperitoneal shunts: revisited","volume":"12","author":"Dickerman","year":"2005"},{"key":"b4-peds1346","series-title":"Childs Nerv Syst","first-page":"434","article-title":"Rationale and methodology of the multicenter pediatric cerebrospinal fluid shunt design trial","volume":"12","author":"Drake","year":"1996"},{"key":"b5-peds1346","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"284","DOI":"10.3171\/jns.2003.98.2.0284","article-title":"Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a randomized controlled trial","volume":"98","author":"Kestle","year":"2003"},{"key":"b6-peds1346","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.jocn.2004.12.010","article-title":"Image-guided placement of ventricular shunt catheter","volume":"13","author":"Kim","year":"2006"},{"key":"b7-peds1346","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1016\/j.jocn.2008.09.015","article-title":"Ventricular catheter placement accuracy in non-stereotactic shunt surgery for hydrocephalus","volume":"16","author":"Lind","year":"2009"},{"key":"b8-peds1346","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1080\/02688690042906","article-title":"Immediate postoperative CT to assess the correct positioning of a ventricular catheter","volume":"14","author":"Missori","year":"2000"},{"key":"b9-peds1346","series-title":"Peditr Neurosurg","first-page":"245","article-title":"Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus","volume":"29","author":"O'Hayon","year":"2000"},{"key":"b10-peds1346","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"750","DOI":"10.3171\/jns.1994.80.4.0750","article-title":"Accurate placement of coronal ventricular catheter using stereotactic coordinate-guided free-hand passage. 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