The Use of Electromagnetic Navigation in Surgeries for Hydrocephalus and Arachnoid Cysts in Children under One Year of Age

Czech version

Authors: P. Vacek; D. Štěpánek; V. Přibáň
Authors‘ workplace: Neurochirurgické oddělení, LF UK a FN Plzeň
Published in: Cesk Slov Neurol N 2014; 77/110(6): 741-746
Category: Short Communication

Podpořeno MZ ČR- RVO (Fakultní nemocnice Plzeň – PNPI, 00669806).

Overview

Aim:
Surgery for hydrocephalus and arachnoid cysts in small children is still burdened with a high complication rate. Our five-years of experience with the electromagnetic navigation used in surgeries on children under one year of age, is to be presented in the form of a retrospective study.

Material and method:
We were using the electromagnetic navigation in surgeries for hydrocephalus and arachnoid cysts in 30 consecutive children with an average age of 15.3 weeks (one week– 11 months) in our department from January 2009 till December 2013. We performed 19 ventriculoperitoneal shunts, one ventriculoatrial, four endoscopic third ventriculostomies, two cavum septi pellucidi stomies, two arachnoid cyst endoscopic fenestrations and two combined procedures – endoscopic fenestrations and a shunt surgery in one session.

Results:
We always inserted the ventricular catheter into the desired place on the first attempt in our group of patients. We didn’t detect any technical problem which would have led to an inappropriate navigational deviation and, therefore made the next navigation impossible. All patients had a checkup after surgery (by ultrasound through an anterior fontanel or magnetic resonance imaging). A ventricular catheter malfunction (always blocked by choroid plexus) was detected in four patients (18.2%), a shunt infection appeared in one patient (4.5%). A one year “shunt survival rate” appears in 58.8% of our patients. We had to re-operate on two patients after the endoscopic surgery (20%) due to stoma failure and on one patient for liquorrhea.

Conclusions:
Electromagnetic navigation has enabled us to perform shunt and endoscopic surgeries for hydrocephalus and arachnoid cyst in very young children with the same accuracy as in adult patients, without the necessity of head clamping.

Key words:
hydrocephalus – arachnoid cyst – surgical treatment – electromagnetic navigation –endoscope

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Greenfield JP, Souweidane MM. Endoscopic management of intracranial cysts. Neurosurg Focus 2005; 19(6): E7.

2. Kang JK, Lee IW. Long-term follow-up of shunting therapy. Childs Nerv Syst 1999; 15(11– 12): 711– 717.

3. Kestle J, Drake J, Milner R, Sainte- Rose C, Cinalli G, Boop F et al. Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg 2000; 33(5): 230– 236.

4. Cochrane D, Kestle J, Steinbok P, Evans D, Heron N. Model for the cost analysis of shunted hydrocephalic children. Pediatr Neurosurg 1995; 23(1): 14– 19.

5. Roth J, Beni- Adani L, Biyani N, Constantini S. Classical and real- time neuronavigation in pediatric neurosurgery. Childs Nerv Syst 2006; 22(9): 1065– 1071.

6. Kim YB, Lee JW, Lee KS, Lee KC. Image- guided placement of ventricular shunt catheter. J Clin Neurosci 2006; 13(1): 50– 54.

7. Kato A, Yoshimine T, Hayakawa T, Tomita Y, Ikeda T,Mitomo M et al. A frameless, armless navigational system for computer- assisted neurosurgery. Technical note. J Neurosurg 1991; 74(5): 845– 849.

8. Mascott CR. The Cygnus PFS image- guided system. Neurosurgery 2000; 46(1): 235– 238.

9. Rousu JS, Kohls PE, Kall B, Kelly PJ. Computer- assisted image- guided surgery using the Regulus Navigator. Stud Health Technol Inform 1998; 50: 103– 109.

10. Benardete EA, Leonard MA, Weiner HL. Comparison of frameless stereotactic systems: Accuracy, precision and applications. Neurosurgery 2001; 49(6): 1409– 1416.

11. Mangano FT, Limbrick DD jr, Leonard JR, Park TS, Smyth MD. Simultaneous image- guided and endoscopic navigation without rigid cranial fixation: application in infants: technical case report. Neurosurgery 2006; 58 (4 Suppl 2): ONS- E377.

12. Hayhurst C, Byrne P, Eldridge PR, Mallucci CL. Application of electromagnetic technology to neuronavigation: a revolution in image- guided neurosurgery. Technical note. J Neurosurg 2009; 111(6): 1179– 1184. doi: 10.3171/ 2008.12.JNS08628.

13. Gumprecht H, Trost HA, Lumenta CB. Neuroendoscopy combined with frameless neuronavigation. Br J Neurosurg 2000; 14(2): 129– 131.

14. Rohde V, Reinges MH, Krombach GA, Gilsbach JM. The combined use of image- guided frameless stereotaxy and neuroendoscopy for the surgical management of occlusive hydrocephalus and intracranial cysts. Br J Neurosurg 1998; 12(6): 531– 538.

15. Dorward N, Alberti O, Velani B, Gerritsen FA, Harkness WF, Kitchen ND et al. Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation. J Neurosurg 1998; 88(4): 656– 662.

16. Sainte- Rose C, Piatt JH, Renier D, Pierre-Kahn A, Hirsch JF, Hoffman HJ et al. Mechanical complications in shunts. Pediatr Neurosurg 1991; 17(1): 2– 9.

17. Azeem SS, Origitano TC. Ventricular catheter placement with a frameless neuronavigational system: a 1-year experience. Neurosurgery 2007; 60 (Suppl 2): 243– 248.

18. Schicho K, Figl M, Donat M, Birkfellner W, Seemann R, Wagner A et al. Stability of miniature electromagnetic tracking systems. Phys Med Biol 2005; 50(9): 2089– 2098.

19. Whitehead WE, Jea A, Vachhrajani S, Kulkarni AV, Drake JM. Accurate placement of cerebrospinal fluid shunt ventricular catheters with real- time ultrasound guidance in older children without patent fontanelles. J Neurosurg 2007; 107 (Suppl 5): 406– 410. doi: 10.3171/ PED- 07/ 11/ 406.

20. Hayhurst C, Beems T, Jenkinson MD, Byrne P,Clark S, Kandasamy J et al. Effect of electromagnetic- navigated shunt placement on failure rates: a prospective multicenter study. Clinical article. J Neurosurg 2010; 113(6): 1273– 1278. doi: 10.3171/ 2010.3. JNS091237.

21. Cochrane DD, Kestle JR. The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg 2003; 38(6): 295– 301.

22. Kestle JR, Drake JM, Cochrane DD, Milner R, Walker ML, Abbott R 3rd et al. Endoscopic Shunt Insertion Trial participants: Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: A multicenter randomized trial. J Neurosurg 2003; 98(2): 284– 290.

23. Albright AL. Hydrocephalus shunt practice of experienced pediatric neurosurgeons. Childs Nerv Syst 2010; 26(7): 925– 929. doi: 10.1007/ s00381- 010- 1082- 5.