Stereotactic guidance for ventricular catheter placement in ventriculoperitoneal shunt surgery: a state-of-the-art review on technical rationale, clinical outcomes, and future directions.

Ventriculoperitoneal (VP) shunting remains the most frequently performed surgical treatment for hydrocephalus; however, shunt failure rates remain substantial despite technical refinements. Proximal catheter malfunction, often associated with malposition, ventricular wall contact, or choroid plexus obstruction, represents a common cause of shunt revision. Conventional freehand ventricular cannulation is based on surface anatomical landmarks and surgical experience, which may be unreliable in patients with small or distorted ventricles. Stereotactic guidance-including frame-based systems, frameless neuronavigation, and electromagnetic navigation-has been introduced to improve placement accuracy and reproducibility. Randomized and cohort studies consistently demonstrate improved radiographic accuracy and higher first-pass success rates with guided techniques. However, systematic reviews have not uniformly shown reductions in overall shunt revision rates, likely reflecting the multifactorial etiology of shunt failure. Hemorrhagic complications after VP shunt placement are uncommon but clinically important; evidence from VP shunt cohorts and from the broader stereotactic neurosurgery experience (notably deep brain stimulation) suggests that trajectory planning and vascular/sulcal avoidance may reduce bleeding risk. This review synthesizes epidemiological context, technical rationale, comparative outcomes, hemorrhage considerations, health economic implications, and future research priorities regarding stereotactic ventricular catheter placement.