ELEKTROMANYETİK VE OPTİK NAVİGASYON KULLANILARAK YAPILAN VENTRİKÜLOPERİTONEAL ŞANT CERRAHİSİNİN SONUÇLARI: 31 HASTADAKİ DENEYİMLER

Öz

Amaç: Ventriküloperitoneal (VP) şant prosedürü, nöroşirürji alanında sıkça yapılan bir işlemdir ve normal basınçlı hidrosefali, enfeksiyon, travma veya subaraknoid kanama sonrası VP şant bağımlılığı gibi patolojileri tedavi etmek için kullanılır. Ventrikülü bypass eden bir şant kateterinin yerleştirilmesi kısa bir süre sonra şant disfonksiyonuna yol açacağı kesin olarak bilinmektedir. Bu nedenle, navigasyon destekli şant cerrahisi, serbest el kateter yerleştirmeye kıyasla kanülasyon denemelerinin sayısını azaltmada ve ventrikül kateterini uygun konumda yerleştirmede önem kazanır. Gereç ve Yöntem: Bu retrospektif çalışmaya, 2016 ile 2023 yılları arasında elektromanyetik (EM) navigasyon ve optik navigasyon kullanılarak iki farklı cerrah tarafından iki farklı klinikte VP şant yerleştirilen 31 hasta dahil edildi.Çalışma toplumu iki gruba ayrınları iki gruba ayırıldı. İlk grupta, 16 hastada Liv Hastanesi, İstanbul merkezinde stereotaktik optik navigasyon ve ayrıca Strata (Medtronic, Minneapolis, ABD) programlanabilir valv kullanımı yapıldı. İkinci grupta, 15 hasta Florence Nightingale Hastanesi, Istanbul merkezinde EM ve Codman Certas (Integra Lifesciences, New Jersey, ABD) programlanabilir valv kullanılarak ameliyat edildi. Bulgular: Hastaların yaş aralığı 36 ila 87 yıl arasındaydı, ortalama yaşları (73.74±9.06) idi. Çalışmaya katılan hastaların 12'si erkek, 19'u kadındı. Tüm hastalar normal basınçlı hidrosefali nedeniyle ameliyat edildi. EM grubunda, ameliyat sonrası bilgisayarlı tomografi (BT) bulgularına ve Hayhurst tarafından tanımlanan radyolojik ölçeğe göre 7 grad I ve 8 grad II hasta bulunmaktaydı; optik navigasyon grubunda ise, 13 grad I ve 3 grad II hasta bulunmaktaydı. EM navigasyon grubundaki üç hastada, farklı şant ayarlarında aşırı drene olmaya bağlı subdural effüzyon gelişti. Bu üç hastanın hiçbirinde ek cerrahiye gerek duyulmadı. Çalışmamızda intraparankimal kanama ya da şant disfonksiyonu komplikasyonları izlenmedi. Sonuç: Şant cerrahisinde navigasyonun kullanımı, proksimal başarısızlığı önler ve intraparenkimal kanama ve şant disfonksiyonu komplikasyonlarını azaltır. Optik navigasyonun kullanımı, çivili başlık ve uzatılmış preoperatif hazırlık süresi gerektirse de, ventriküler kateter yerleştirme doğruluğu, bu dezavantajlara rağmen optik navigasyon ve EM navigasyon kullanıldığında benzerdir. Maliyet etkinliği ve yüksek doğruluk açısından, özellikle EM sisteminin ek maliyeti düşünüldüğünde, şant cerrahisinde optik navigasyon sistemi kullanılabilir.

Anahtar Kelimeler

• Elektromanyetik navigasyon
• optik navigasyon
• şant disfonksiyonu

RESULTS OF VENTRICULOPERITONEAL SHUNT SURGERY USING ELECTROMAGNETIC AND OPTICAL NAVIGATION: EXPERIENCES IN 31 PATIENTS

Öz

Objective: The ventriculoperitoneal (VP) shunt procedure is frequently performed in the field of neurosurgery to treat pathologies such as normal-pressure hydrocephalus, infection, trauma, or VP shunt dependency after subarachnoid haemorrhage. Although the precise impact of ventricular catheter placement on shunt dysfunction remains not fully elucidated, it is well established that a shunt catheter bypassing the ventricle will lead to shunt dysfunction shortly after placement. Therefore, navigation- assisted shunt surgery gains significance in order to reduce the number of cannulation attempts and for inserting the ventricle catheter in the proper position compared to free hand catheter placement. Material and Method: This retrospective study enrolled 31 patients who underwent VP shunt placement in two different clinics by two different surgeons using electromagnetic and optical navigation between 2016 and 2023. The study population was grouped into two. In the first group, 16 patients underwent VP shunt surgery using stereotactic optical navigation and also Strata (Medtronic, Minneapolis, USA) programmable valve in Liv Hospital, İstanbul. In the second group, 15 patients were operated using EM navigation and Codman Certas (Integra Lifesciences, New Jersey, USA) programmable valve in Florence Nightingale Hospital, İstanbul. Result: The age range of patients was 36 to 87 years, with a mean age of (73.74±9.06). Twelve of the patients participating in the study were male, and 19 were female. All patients were operated because of normal-pressure hydrocephalus. In the EM navigation group, there were 7 grade I and 8 grade II patients, and in the optical navigation group, there were 13 grade I and 3 grade II patients according to the postoperative CT findings and the radiological scale defined by Hayhurst. In three patients from the EM Navigation group, subdural effusion developed due to overdrainage in different shunt settings. In none of these three patients an additional surgical intervention was needed. There were no intraparenchymal haemorrhage or shunt dysfunction complications in our study. Conclusion: The use of navigation in shunt surgery prevents proximal failure and reduces the complications of intraparenchymal haemorrhage and shunt dysfunction. Although the use of optical navigation requires the use of a pinned headrest and an extended preoperative preparation time, the accuracy of ventricular catheter placement is similar when using optical navigation and EM navigation, despite these disadvantages. Due to its cost-effectiveness and high accuracy, the optically guided navigation system can be used in shunt surgery, especially considering the extra cost of the electromagnetic neuronavigation system.

Anahtar Kelimeler

• Electromagnetic navigation
• optical navigation
• shunt dysfunction

Kaynakça

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