VP shunt entry area recommender (VPSEAR): A computer-assisted system for VP shunt operation

Abstract

Hydrocephalus is a condition with an abnormal cerebrospinal fluid (CSF) accumulation in the brain's ventricles resulting in ventricular enlargement. One of the most common surgical treatments for hydrocephalus is the ventriculoperitoneal (VP) Shunt operation. A freehand technique using surface anatomy ventricular catheter placement has been widely used in VP Shunt operations because of its simplicity and low cost. However, this technique trades off with moderate accuracy. To improve accuracy, most existing freehand techniques involved using tools or software to manually measure distances and/or drilling angles from CT or MRI slides. In this work, we developed the first fully automated system VP shunt entry area recommender (VPSEAR) for a pre-planned freehand placement. The program with a user- interface took the patient's CT slides, calculated a circular entry site on a skull, and reported a unique circular entry region. The program integrated several mathematical knowledge and 3-D data processing techniques to ensure high accuracy and acceptable running time. We tested the invented programs on a collection of CT slices of 15 patients with 30 head sides and evaluated the system's accuracy against the traditional Keen's method using 3D Slicer software. We achieved an average accuracy of 95.33% using five internal points evaluation, with accuracy improvement over Keen's method up to 40.33%. The program running time was less than 15 min per head side.

Keywords

• Ventriculoperitoneal shunt (VP shunt)
• Hydrocephalus
• Cerebral ventricle
• Preoperative surgical planning
• Computer-assisted system
• Brain CT-guided software