Ventriculoperitoneal shunt for brain displacement due to chronic subdural hematoma, using real-time navigated ventriculostomy by three-dimensional robotic C-arm: Technical note

Ventriculoperitoneal (VP) shunts are widely used in the treatment of hydrocephalus. Optimal ventricular catheter (OVC) placement is required to reduce mechanical dysfunction, particularly when the lateral ventricle is deformed by other factors. We present a novel technique of VP shunt placement through Keen’s point by three dimensional (3D) robotic C-arm navigation in cases of brain displacement due to chronic subdural hematoma (SDH) and post-traumatic hydrocephalus (PTH). A 74-year-old male with PTH presented with deformed lateral ventricles due to right chronic SDH. A workflow chart of a real-time right ventriculostomy navigation system using a 3D robotic C-arm is introduced. OVC placement was achieved using virtual surgical planning in a shifted brain case. Correct OVC placement is crucial to the reduction of mechanical dysfunction. Real-time ventriculostomy using 3D robotic C-arm navigation can both reduce the rate of mechanical dysfunction and offer safe and feasible access to the lateral ventricles without causing parenchymal injury, particularly when the ventricles are deformed.