Resident Physician University of California, Irvine Orange, California, United States
Introduction: A ventriculoperitoneal shunt (VPS) is a common neurosurgical procedure to treat normal pressure hydrocephalus (NPH). NPH can be idiopathic or a sequela of remote insult causing poor arachnoid granulation reabsorption of CSF. Commonly, VPS are placed with neuro-navigation. This involves expensive, disposable equipment and increased radiation to the patient from thin-slice CT scans for anatomic registration. An alternative guidance system, such as intraoperative ultrasound (US), can be more cost-effective, efficient, and minimize radiation.
Methods: We present a case series of seven consecutive individuals that underwent US-guided VPS placement at UC Irvine Medical Center. A 2.5cm, elliptical craniotomy was created using a matchstick drill bit. The ultrasound machine with a burr hole transducer was used for real-time, intraoperative placement of the proximal VP shunt. A postoperative CT was performed to rule out hemorrhage and confirm catheter placement.
Results: Excluding the cost of the respective machines, institution specific costs for neuro-navigation are $1353.00, including the stylet, patient tracker, and navigated shunt stylet that are non-reusable, and $531.00 for pre-operative CT. Alternatively, the reusable US probe costs $42.30 per procedure. US use also eliminates the time required for registration, approximately 20 minutes. At this time, no patients have had adverse events from US VPS placement, including no revisions or hemorrhages. This method does, however, require extra training for proper ultrasound views, a larger burr hole and cover.
Conclusion : The use of US instead of neuro-navigation can save $1841.70 per procedure. Patients have an equal length of stay for either placement modality. Some of the advantages of US over neuro-navigation include cost, time, reduction in preoperative radiation, and intraoperative confirmation of placement. US is a safe and effective alternative to neuro-navigation.
