Skin landmarks as ideal entry points for ventricular drainage, a radiological study.
Surg Radiol Anat. 2022-09-23; 44(10): 1385-1390
DOI: 10.1007/s00276-022-03019-1
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Roblot P(1)(2), Lefevre E(3), David R(4), Pardo PL(5), Mongardi L(6)(5), Denat L(7), Tourdias T(7)(8), Liguoro D(6)(9), Jecko V(6), Vignes JR(6)(5).
Author information:
(1)Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie
Raba-Léon, 33076, Bordeaux Cedex, France. .
(2)Laboratory for Experimental Surgery, DETERCA Pr Vignes, University of
Bordeaux, Bordeaux, France. .
(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.
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.
© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS,
part of Springer Nature.