The Shunt Design Trial demonstrated the importance of ventricular catheter position as a determinant of risk of shunt failure. [Tuli S. Change in ventricular size and effect of ventricular catheter placement in pediatric patients with shunted hydrocephalus. Neurosurgery 1999;45:1329-33.] Several technologies assist the surgeon in optimizing ventricular catheter position. Illustrated is a 1.2mm endoscope that actually fits inside the shunt catheter and peeks out through the tip of the ventricular end. The surgeon can use real-time images of ventricular anatomy to confirm proper placement. The efficacy of this technology is being tested in a multicenter, randomized, controlled trial, the Endoscopic Shunt Insertion Trial.
