Accuracy and Safety of Bedside External Ventricular Drain Placement at Two Different Cranial Sites : Kocher's Point versus Forehead.

Park, Young Gil; Woo, Hyun Jin; Kim, Ealmaan; Park, Jaechan

doi:2011.50.4.317

Original Article

Journal of Korean Neurosurgical Society 2011;50(4): 317-321.
doi: https://doi.org/10.3340/jkns.2011.50.4.317

Accuracy and Safety of Bedside External Ventricular Drain Placement at Two Different Cranial Sites : Kocher's Point versus Forehead.

Young Gil Park, Hyun Jin Woo, Ealmaan Kim, Jaechan Park

¹Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea. jparkmd@hotmail.com
²Department of Neurosurgery, Keimyung University College of Medicine, Daegu, Korea.

ABSTRACT

OBJECTIVE
External ventricular drain (EVD) is commonly performed with a freehand technique using surface anatomical landmarks at two different cranial sites, Kocher's point and the forehead. The aim of this study was to evaluate and compare the accuracy and safety of these percutaneous ventriculostomies.
METHODS
A retrospectively review of medical records and head computed tomography scans were examined in 227 patients who underwent 250 freehand pass ventriculostomy catheter placements using two different methods at two institutions, between 2003 and 2009. Eighty-one patients underwent 101 ventriculostomies using Kocher's point (group 1), whereas 146 patients underwent 149 forehead ventriculostomies (group 2).
RESULTS
In group 1, the catheter tip was optimally placed in either the ipsilateral frontal horn or the third ventricle, through the foramen of Monro (grade 1) in 82 (81.1%) procedures, in the contralateral lateral ventricle (grade 2) in 4 (3.9%), and into eloquent structures or non-target cerebrospinal space (grade 3) in 15 (14.8%). Intracerebral hemorrhage (ICH) >1 mL developed in 5 (5.0%) procedures. Significantly higher incidences of optimal catheter placements were observed in group 2. ICH>1 mL developed in 11 (7.4%) procedures in group 2, showing no significant difference between groups. In addition, the mean interval from the EVD to ventriculoperitoneal shunt was shorter in group 2 than in group 1, and the incidence of EVD-related infection was decreased in group 2.
CONCLUSION
Accurate and safe ventriculostomies were achieved using both cranial sites, Kocher's point and the forehead. However, the forehead ventriculostomies provided more accurate ventricular punctures.

Key Words: Computed tomography; Freehand; Hydrocephalus; Ventriculostomy