Skin landmarks as ideal entry points for ventricular drainage, a radiological study.

Abstract

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. 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. The frontal IEP was localized to 116.8 ± 9.3mm behind the nasion on the sagittal plane and to 39.7 ± 4.9mm lateral to the midline on the coronal plane. The ideal catheter length was estimated to be 68.4 ± 6.4mm from the skin surface to the interventricular foramen. The parieto-occipital point was localized to 62.9 ± 7.4mm above the ipsilateral tragus on the coronal plane and to 53.1 ± 9.1mm behind the tragus on the axial plane. The ideal catheter length was estimated to be 48.3 ± 9.6mm. The IEP for the frontal approach was localized to 11cm above the nasion and 4cm lateral to the midline. The IEP for the parieto-occipital approach was 5.5cm behind and 6cm 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.