Neuromate (R) Robot-Assisted Ventricular Catheter Insertion

Background and importance: Insertion of ventricular catheters into small ventricles may require image guidance. Several options exist, including ultrasound guidance, frameless, and frame-based stereotactic approaches. There is no literature on management options when conventional image guidance fails to cannulate the ventricle. The accuracy of the robotic arm is well established in functional and epilepsy surgery. We report the first case using the Neuromate (R) robot for the placement of a shunt ventricular catheter into the lateral ventricle after a failed attempt with a more commonly used frameless electromagnetic navigation system.Clinical presentation: A 30-year-old man had twice previously undergone foramen magnum decompression for a Chiari 1 malformation. He subsequently developed a significant cervical syrinx with clinical deterioration and a decision was made to place a ventriculoperitoneal shunt. As the ventricles were small, frameless electromagnetic navigation was used but the ventricle could not be cannulated. The Neuromate (R) robot was subsequently used to place the ventricular catheter successfully.Conclusion: Neuromate (R) robot-assisted ventricular catheter placement may be considered when difficulty is experienced with more commonly used image guidance techniques.