PURPOSE: Ventricular drainage remains a challenging procedure for neurosurgical trainees, particularly in healthy subjects. 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 healthy 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 114.00 ± 6.75 mm behind the nasion on the sagittal plane and to 40.04 ± 3.07 mm lateral to the midline on the coronal plane. The ideal catheter length was estimated to be 73.08 ± 4.03 mm from the skin surface to the interventricular foramen. The parieto-occipital IEP point was localized to 61.40 ± 4.44 mm above the ipsilateral tragus on the coronal plane and to 56.53 ± 6.86 mm behind the tragus on the axial plane. The ideal catheter length was estimated to be 51.65 ± 2.86 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 differ from the classical descriptions of Kocher’s point and Keen’s point and seem relevant to neurosurgical practice.