Paul Roblot1,2, Etienne Lefevre3, Romain David4, Pier-Luka Pardo5, Lorenzo Mongardi6,5, Laurent Denat7, Thomas Tourdias7,8, Dominique Liguoro6,9, Vincent Jecko6, Jean-Rodolphe Vignes6,5. 1. Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France. paul.roblot@chu-bordeaux.fr. 2. Laboratory for Experimental Surgery, DETERCA Pr Vignes, University of Bordeaux, Bordeaux, France. paul.roblot@chu-bordeaux.fr. 3. Department of Neurosurgery, APHP, Hôpital de La Pitié-Salpêtrière, 75013, Paris, France. 4. Physical and Rehabilitation Medicine Unit, PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, University of Poitiers, 86000, Poitiers, France. 5. Laboratory for Experimental Surgery, DETERCA Pr Vignes, University of Bordeaux, Bordeaux, France. 6. Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France. 7. Institute of Bioimaging, University of Bordeaux, 33000, Bordeaux, France. 8. Department of Diagnostic and Therapeutic Neuroimaging, Pellegrin Hospital, Place Amélie-Raba-Léon, 33000, Bordeaux, France. 9. Laboratory of Anatomy, University of Bordeaux, 33000, Bordeaux, France.
Abstract
PURPOSE: Ventricular drainage remains a usual but challenging procedure for neurosurgical trainees. The objective of the study was to describe reliable skin landmarks for ideal entry points (IEPs) to catheterize brain ventricles via frontal and parieto-occipital approaches. METHODS: We included 30 subjects who underwent brain MRI and simulated the ideal catheterization trajectories of lateral ventricles using anterior and posterior approaches and localized skin surface IEPs. The optimal frontal target was the interventricular foramen and that for the parieto-occipital approach was the atrium. We measured the distances between these IEPs and easily identifiable skin landmarks. RESULTS: The frontal IEP was localized to 116.8 ± 9.3 mm behind the nasion on the sagittal plane and to 39.7 ± 4.9 mm lateral to the midline on the coronal plane. The ideal catheter length was estimated to be 68.4 ± 6.4 mm from the skin surface to the interventricular foramen. The parieto-occipital point was localized to 62.9 ± 7.4 mm above the ipsilateral tragus on the coronal plane and to 53.1 ± 9.1 mm behind the tragus on the axial plane. The ideal catheter length was estimated to be 48.3 ± 9.6 mm. CONCLUSION: The IEP for the frontal approach was localized to 11 cm above the nasion and 4 cm lateral to the midline. The IEP for the parieto-occipital approach was 5.5 cm behind and 6 cm above the tragus. These measurements lightly differ from the classical descriptions of Kocher's point and Keen's point and seem relevant to neurosurgical practice while using an orthogonal insertion.
PURPOSE: Ventricular drainage remains a usual but challenging procedure for neurosurgical trainees. The objective of the study was to describe reliable skin landmarks for ideal entry points (IEPs) to catheterize brain ventricles via frontal and parieto-occipital approaches. METHODS: We included 30 subjects who underwent brain MRI and simulated the ideal catheterization trajectories of lateral ventricles using anterior and posterior approaches and localized skin surface IEPs. The optimal frontal target was the interventricular foramen and that for the parieto-occipital approach was the atrium. We measured the distances between these IEPs and easily identifiable skin landmarks. RESULTS: The frontal IEP was localized to 116.8 ± 9.3 mm behind the nasion on the sagittal plane and to 39.7 ± 4.9 mm lateral to the midline on the coronal plane. The ideal catheter length was estimated to be 68.4 ± 6.4 mm from the skin surface to the interventricular foramen. The parieto-occipital point was localized to 62.9 ± 7.4 mm above the ipsilateral tragus on the coronal plane and to 53.1 ± 9.1 mm behind the tragus on the axial plane. The ideal catheter length was estimated to be 48.3 ± 9.6 mm. CONCLUSION: The IEP for the frontal approach was localized to 11 cm above the nasion and 4 cm lateral to the midline. The IEP for the parieto-occipital approach was 5.5 cm behind and 6 cm above the tragus. These measurements lightly differ from the classical descriptions of Kocher's point and Keen's point and seem relevant to neurosurgical practice while using an orthogonal insertion.
Authors: Claudia L Craven; Laura Pradini-Santos; Aimee Goel; Lewis Thorne; Laurence D Watkins; Ahmed K Toma Journal: World Neurosurg Date: 2019-12-13 Impact factor: 2.104