Journal of neurosurgery. Pediatrics · 2026
Heterogeneity of catheter insertion rates: an initial benchtop assessment of shunt catheter insertion for hydrocephalus.
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Menkara Adam, Horbatiuk Jeffrey, Johnston James M, Arynchyna-Smith Anastasia, Brinkley Taylor, Hale Andrew T, Feldman Michael Joseph, Najera Ricardo A, Gonzalez Gomez Martina, Blount Jeffrey P, Harris Carolyn A
Аннотация
OBJECTIVE: The aim of this study was to investigate hydrocephalus shunt insertion dynamics and variability across a group of clinicians using a polyvinyl alcohol (PVA)-Phytagel-based brain-mimicking model for ventricular catheter placement.
METHODS: The rate of catheter insertion through a simplified PVA-Phytagel-based brain mimic was assessed in a group of clinicians at an academic pediatric neurosurgery division. Lateral and longitudinal catheter position and motion throughout insertion depth were assessed and analyzed. Additionally, survey data were collected to better understand the intentionality and thought process underlying each surgeon's insertion approach.
RESULTS: A total of 57 insertions were collected across 19 participants, of whom 16 were neurosurgeons and included in the final analysis. Based on survey results, the authors found that there was a positive correlation between the surgeons' attempt to speed up at earlier anatomical landmarks (ependyma) and slow down at deeper anatomical landmarks (deeper ventricular levels) throughout the depth of insertion. However, in practice, there was no correlation between the intended insertion rate and the actual insertion rate of the surgeons. Additionally, the authors found a high degree of variability in both the longitudinal and lateral directions for both position and velocity, independent of trial number, individual surgeon, or insertion depth.
CONCLUSIONS: In the brain mimic of compliant uniform hydrogel, the surgeon's insertion rate throughout insertion and across samples was found to not be uniform, with catheter insertion rates being highly heterogeneous and nonrepeatable. Analogous fields within the neural implant space have regulated output for both insertion rates and dynamics in order to optimize implant outcome and minimize neuroinflammatory response. The authors believe this study sets a precedent to begin exploration of hydrocephalic tissue response in vivo to differential longitudinal and lateral catheter velocities.
METHODS: The rate of catheter insertion through a simplified PVA-Phytagel-based brain mimic was assessed in a group of clinicians at an academic pediatric neurosurgery division. Lateral and longitudinal catheter position and motion throughout insertion depth were assessed and analyzed. Additionally, survey data were collected to better understand the intentionality and thought process underlying each surgeon's insertion approach.
RESULTS: A total of 57 insertions were collected across 19 participants, of whom 16 were neurosurgeons and included in the final analysis. Based on survey results, the authors found that there was a positive correlation between the surgeons' attempt to speed up at earlier anatomical landmarks (ependyma) and slow down at deeper anatomical landmarks (deeper ventricular levels) throughout the depth of insertion. However, in practice, there was no correlation between the intended insertion rate and the actual insertion rate of the surgeons. Additionally, the authors found a high degree of variability in both the longitudinal and lateral directions for both position and velocity, independent of trial number, individual surgeon, or insertion depth.
CONCLUSIONS: In the brain mimic of compliant uniform hydrogel, the surgeon's insertion rate throughout insertion and across samples was found to not be uniform, with catheter insertion rates being highly heterogeneous and nonrepeatable. Analogous fields within the neural implant space have regulated output for both insertion rates and dynamics in order to optimize implant outcome and minimize neuroinflammatory response. The authors believe this study sets a precedent to begin exploration of hydrocephalic tissue response in vivo to differential longitudinal and lateral catheter velocities.