Re-evaluation of classic posterior ventricular puncture sites employing a three dimensional brain simulation model.

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Re-evaluation of classic posterior ventricular puncture sites employing a three dimensional brain simulation model.

World Neurosurg. 2017 Jul 29;:

Authors: Tayebi Meybodi K, Hoseinzadeh E, Ahmadi M, Taghvaei M, Saberi H

Abstract
OBJECTIVE: To revalidate the craniometric dimensions of classic posterior burr holes for ventricular catheter insertion in hydrocephalic patients, based on ideal catheter position on 3D simulated computed tomographic (CT) reconstruction model of the ventricles.
METHODS: Fifteen hydrocephalic patients underwent multislice, thin-cut CT, in order to determine the Cartesian coordinates of a new point for optimal posterior ventricular catheterization, geomatrically. Then, success rate for ventricular puncture and the thickness of brain traversed by the catheter with 3 approaches (Frazier, Keen, and the suggested point) were compared.
RESULTS: The suggested burr hole point for posterior ventricular catheterization is 51 and 57 millimeters posterior and 58 and 60 millimeters above the external auditory meatus parallel to orbitomeatal plane in the right and left sides respectively, which was significantly different with classical Frazier and Keen points. The success rate for the approaches with suggested point and Frazier point were 100% in comparison to Keen approach (83%). This 17% difference was marginally significant (p value = 0.052). The parenchymal mantle for Frazier point was thicker than that of suggested point in both sides, although the difference was statistically significant only in the right side (p value = 0.006). While the parenchymal mantle in Keen approach was thinner than that of suggested approach, the difference was not significant.
CONCLUSIONS: The use of suggested burr hole point for posterior ventricular catheterization may decrease the parenchymal mantle of the brain transgressed by the catheter, and may also marginally improve the chance of successful posterior ventricular catheterization.

PMID: 28765021 [PubMed - as supplied by publisher]

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