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P102 Shunting slit ventricles: a comparison of the parieto-occipital vs frontal approach
  1. CL Craven,
  2. L D’Antona,
  3. S Thompson,
  4. J Ramos,
  5. S Sennik,
  6. LD Watkins,
  7. AK Toma
  1. National Hospital for Neurology and Neurosurgery, London, UK


Objectives Slit ventricles can be a challenging target during shunt catheter insertion. Traditionally, the frontal approach has been considered optimal. At this centre, routine use of electromagnetic (EM) stereotatic guidance (StealthTM, Medtronic) has enabled a parieto-occipital burr hole approach to the frontal horns. We compare shunt placement and revisions required for patients with slit ventricles who had shunts inserted via a parieto-occipital (P-O) approach vs. frontal shunt.

Design Retrospective cohort.

Subjects Patients with slit ventricles and a ventricular shunt inserted using EM guidance between 2012–2018.

Methods Slit ventricles were defined as <3 mm (widest). Outcome measures included placement accuary and survival using Kaplan-Meier curve.

Results 82 patients (77F:5M) aged 34.9±10.8 years (mean ±SD) had shunts inserted for IIH (n=63), chiari/syrinx (n=8), congenital hydrocephalus (n=10), pseudomeningocoele (n=1). 35 had primary P-O shunts and 46 had frontal shunts. Overall, 94% of cases had the catheter tip sitting in the frontal horn. The P-O approach was just as accurate as the frontal approach. Eight P-O shunts and 9 frontal shunts required revision over a 60 month periods. There was no significant different in shunt survival between the two approaches (p=0.99).

Conclusions EM guided placement has enabled the P-O approach to be as safe and with equivalent survival to frontal approach. The accuracy of shunt placement between the two approaches was equivocal.

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