{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:25:38Z","timestamp":1788186338848,"version":"build-2803163510"},"reference-count":25,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Objective: This study aimed to compare the clinical outcomes of navigation-assisted and conventional (freehand) ventriculoperitoneal (VP) shunt placement in pediatric hydrocephalus patients. Methods: A retrospective review was conducted of 164 patients under the age of 18 who underwent VP shunt placement for hydrocephalus between 2015 and 2023 and had a minimum postoperative follow-up of 12 months. The conventional technique was used in 116 patients. The navigation-assisted technique (intraoperative ultrasonography or frameless neuronavigation) was used in 48 patients. Demographic data, hydrocephalus etiology, catheter tip position (Yim classification), revision rates, infection, complications, and length of hospital stay were recorded. Catheter tip position was assessed on postoperative imaging by two independent investigators. Results: No significant differences were found between the groups in terms of age, sex, and hydrocephalus etiology. The optimal catheter placement rate was significantly higher in the navigation-assisted group compared to the conventional technique (81.25% vs. 60.34%, p = 0.017). The revision rate was significantly lower in the navigation-assisted group (16.67% vs. 38.79%, p = 0.010). The mean hospital stay was shorter in the navigation-assisted group (7.85 \u00b1 3.97 days vs. 10.20 \u00b1 3.70 days, p &lt; 0.001). The groups were similar in terms of infection (2.08% vs. 9.48%, p = 0.183) and overall complication rates (14.58% vs. 16.38%, p = 0.959). Conclusions: Navigation-assisted VP shunt placement in pediatric hydrocephalus patients is associated with a high rate of optimal catheter position, a low revision rate, and a short hospital stay. These findings support the use of navigation technology in pediatric hydrocephalus surgery, but also reveal that infection and complications are unassociated with the surgical technique.<\/jats:p>","DOI":"10.3390\/medicina62030424","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:14:44Z","timestamp":1771928084000},"page":"424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Navigation-Assisted Ventriculoperitoneal Shunt Placement in Pediatric Hydrocephalus: Improved Catheter Positioning and Reduced Revision Rates"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3905-2206","authenticated-orcid":false,"given":"Emrullah Cem","family":"Kesilmez","sequence":"first","affiliation":[{"name":"Neurosurgery Clinic, Kahramanmara\u015f S\u00fct\u00e7\u00fc \u0130mam University, Kahramanmara\u015f 46050, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muharrem Furkan","family":"Y\u00fczba\u015f\u0131","sequence":"additional","affiliation":[{"name":"Neurosurgery Clinic, Kahramanmara\u015f S\u00fct\u00e7\u00fc \u0130mam University, Kahramanmara\u015f 46050, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed","family":"K\u0131rkge\u00e7it","sequence":"additional","affiliation":[{"name":"Neurosurgery Clinic, MegaPoint Hospital, Kahramanmara\u015f 46100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6813-2064","authenticated-orcid":false,"given":"Hasan","family":"T\u00fcrko\u011flu","sequence":"additional","affiliation":[{"name":"Neurosurgery Clinic, Gaziantep City Hospital, Gaziantep 27470, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kas\u0131m Zafer","family":"Y\u00fcksel","sequence":"additional","affiliation":[{"name":"Neurosurgery Clinic, Kahramanmara\u015f S\u00fct\u00e7\u00fc \u0130mam University, Kahramanmara\u015f 46050, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1007\/s00381-025-06992-1","article-title":"Rate and risk factors for shunt revision in pediatric patients with hydrocephalus during a 17-year study period: A retrospective, population-based study","volume":"41","author":"Huuskonen","year":"2025","journal-title":"Child\u2019s Nerv. Syst. ChNS Off. J. Int. Soc. Pediatr. Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"633","DOI":"10.3171\/2015.5.PEDS14532","article-title":"Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life","volume":"16","author":"Paulsen","year":"2015","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"382","DOI":"10.3171\/2015.6.PEDS14670","article-title":"Risk factors for shunt malfunction in pediatric hydrocephalus: A multicenter prospective cohort study","volume":"17","author":"Kestle","year":"2016","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"553","DOI":"10.3171\/2021.3.PEDS20794","article-title":"Readmissions after ventricular shunting in pediatric patients with hydrocephalus: A Nationwide Readmissions Database analysis","volume":"28","author":"Donoho","year":"2021","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3171\/2012.11.JNS111384","article-title":"Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation","volume":"119","author":"Wilson","year":"2013","journal-title":"J. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.3171\/2015.12.FOCUS15583","article-title":"Optimizing ventriculoperitoneal shunt placement in the treatment of idiopathic intracranial hypertension: An analysis of neuroendoscopy, frameless stereotaxy, and intraoperative CT","volume":"40","author":"Yim","year":"2016","journal-title":"Neurosurg. Focus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"111018","DOI":"10.1016\/j.jocn.2024.111018","article-title":"Improvement in outcomes with ultrasound-guided ventriculoperitoneal shunt insertion","volume":"133","author":"Ong","year":"2025","journal-title":"J. Clin. Neurosci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1007\/s00381-022-05547-y","article-title":"The effect of image-guided ventricular catheter placement on shunt failure: A systematic review and meta-analysis","volume":"38","author":"Spennato","year":"2022","journal-title":"Child\u2019s Nerv. Syst. ChNS Off. J. Int. Soc. Pediatr. Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1093\/neuros\/nyy074","article-title":"Image guidance for ventricular shunt surgery: An analysis of ventricular size and proximal revision rates","volume":"84","author":"Khan","year":"2019","journal-title":"Neurosurgery"},{"key":"ref_10","first-page":"e00088","article-title":"Trends in the Treatment of Pediatric Hydrocephalus Since 2014: Understanding the Role of the 2014 Hydrocephalus Guidelines","volume":"5","author":"Larrew","year":"2024","journal-title":"Neurosurg. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"ons131","DOI":"10.1227\/01.NEU.0000382964.72262.9A","article-title":"A new tool for frameless stereotactic placement of ventricular catheters","volume":"67","author":"Stieglitz","year":"2010","journal-title":"Oper. Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"206","DOI":"10.3171\/2014.9.JNS141001","article-title":"Augmented reality\u2013guided neurosurgery: Accuracy and intraoperative application of an image projection technique","volume":"123","author":"Tabrizi","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"28982","DOI":"10.1038\/s41598-025-14555-2","article-title":"Neuronavigation accuracy of the VOSTARS wearable AR platform vs traditional infrared navigation in a comparative study","volume":"15","author":"Carbone","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1227\/NEU.0000000000000849","article-title":"Image Guidance in Ventricular Cerebrospinal Fluid Shunt Catheter Placement: A Systematic Review and Meta-Analysis","volume":"77","author":"Nesvick","year":"2015","journal-title":"Neurosurgery"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"112","DOI":"10.3171\/2012.3.PEDS122","article-title":"Image-guided cerebrospinal fluid shunting in children: Catheter accuracy and shunt survival","volume":"10","author":"Levitt","year":"2012","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"257","DOI":"10.3171\/2021.9.PEDS21391","article-title":"Anterior versus posterior entry site for ventriculoperitoneal shunt insertion: A randomized controlled trial by the Hydrocephalus Clinical Research Network","volume":"29","author":"Whitehead","year":"2022","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e671","DOI":"10.1016\/j.wneu.2020.01.138","article-title":"Evaluating Shunt Survival Following Ventriculoperitoneal Shunting with and without Stereotactic Navigation in Previously Shunt-Na\u00efve Patients","volume":"136","author":"Jin","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.3171\/2010.3.JNS091237","article-title":"Effect of electromagnetic-navigated shunt placement on failure rates: A prospective multicenter study","volume":"113","author":"Hayhurst","year":"2010","journal-title":"J. Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"150","DOI":"10.3340\/jkns.2013.53.3.150","article-title":"Effect of electromagnetic navigated ventriculoperitoneal shunt placement on failure rates","volume":"53","author":"Jung","year":"2013","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"711","DOI":"10.3171\/2022.2.PEDS2214","article-title":"The Hydrocephalus Clinical Research Network quality improvement initiative: The role of antibiotic-impregnated catheters and vancomycin wound irrigation","volume":"29","author":"Chu","year":"2022","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"123676","DOI":"10.1016\/j.wneu.2025.123676","article-title":"Risk Factors for 30-Day Postoperative Infection in Pediatric Ventricular Shunts for Hydrocephalus","volume":"195","author":"Chan","year":"2025","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1086\/368191","article-title":"Risk Factors for Pediatric Ventriculoperitoneal Shunt Infection and Predictors of Infectious Pathogens","volume":"36","author":"McGirt","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3171\/2011.4.PEDS10551","article-title":"A standardized protocol to reduce cerebrospinal fluid shunt infection: The Hydrocephalus Clinical Research Network Quality Improvement Initiative","volume":"8","author":"Kestle","year":"2011","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1227\/neu.0000000000003009","article-title":"Antibiotic-Impregnated Ventriculoperitoneal Shunts Decrease Bacterial Shunt Infection: A Systematic Review and Meta-Analysis","volume":"95","author":"Obeidat","year":"2024","journal-title":"Neurosurgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/INF.0b013e31824da5bd","article-title":"Revision surgeries are associated with significant increased risk of subsequent cerebrospinal fluid shunt infection","volume":"31","author":"Simon","year":"2012","journal-title":"Pediatr. Infect. Dis. J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/424\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:10:18Z","timestamp":1771931418000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/424"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030424"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030424","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]}}}