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

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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.

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Availability of data and materials

PR had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Data are available on request to the corresponding author.

Code availability

Not applicable

Abbreviations

MRI:

Magnetic resonance imaging

IEP:

Ideal entry points

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Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France

    Paul Roblot, Lorenzo Mongardi, Dominique Liguoro, Vincent Jecko & Jean-Rodolphe Vignes

  2. Laboratory for Experimental Surgery, DETERCA Pr Vignes, University of Bordeaux, Bordeaux, France

    Paul Roblot, Pier-Luka Pardo, Lorenzo Mongardi & Jean-Rodolphe Vignes

  3. Department of Neurosurgery, APHP, Hôpital de La Pitié-Salpêtrière, 75013, Paris, France

    Etienne Lefevre

  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

    Romain David

  5. Institute of Bioimaging, University of Bordeaux, 33000, Bordeaux, France

    Laurent Denat & Thomas Tourdias

  6. Department of Diagnostic and Therapeutic Neuroimaging, Pellegrin Hospital, Place Amélie-Raba-Léon, 33000, Bordeaux, France

    Thomas Tourdias

  7. Laboratory of Anatomy, University of Bordeaux, 33000, Bordeaux, France

    Dominique Liguoro

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  1. Paul Roblot
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  2. Etienne Lefevre
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  10. Jean-Rodolphe Vignes
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Contributions

Contributors PR and JRV had the idea for the paper. PR, PLP and VJ prepared the first draft. EL and LD prepared the draft figures. TT and JRV assisted with imaging interpretation and critically reviewed the manuscript for intellectual content. PR, VJ and JRV were involved in the clinical care of the patients and critically reviewed the manuscript for intellectual content.

Corresponding author

Correspondence to Paul Roblot.

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Conflict of interest

All the authors declare: no support from any organization for this study; no financial relationships with any organizations that might have an interest in the submitted work.

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Approval was obtained from the institutional ethics board (2016-A00434-47).

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All the participants provided a written informed consent.

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Roblot, P., Lefevre, E., David, R. et al. Skin landmarks as ideal entry points for ventricular drainage, a radiological study. Surg Radiol Anat 44, 1385–1390 (2022). https://doi.org/10.1007/s00276-022-03019-1

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