Craniometrics and ventricular access

Craniometrics and Ventricular Access:
A Review of Kocher’s, Kaufman’s, Paine’s, Menovksy’s, Tubbs’, Keen’s, Frazier’s, Dandy’s, and Sanchez’s Points

1. Craniometrics and Ventricular Access: A Review of Kocher’s, Kaufman’s, Paine’s, Menovksy’s , Tubbs’, Keen’s, Frazier’s, Dandy’s, and Sanchez’s Points By Dr. Shahnawaz Alam Mch -Neurosurgery

2. The ventricular system is routinely accessed for a variety of emergency and elective neurosurgical procedures. Depending upon the indications, different locations within the ventricles may need to be accessed. Thus, a multitude of ventricular access points have been described over the past century. Each entry point requires an operative technique with different surface landmarks for burr hole placement, trajectories for catheter passage, and ending locations within the ventricles. Although ventricular access is one of the most common procedures performed, there is a paucity of literature illustrating the operative techniques for the most common ventricular access points. Additionally, the operative techniques depicted within the current literature are poor quality and difficult to interpret.

3. Because it is important that all neurosurgeons be versed in the craniometrics associated with these techniques, there is a need for high-quality images with clear measurements depicting the details of each access point, which remains unmet. In this historical review, they describe the indications and operative techniques for 9 ventricular access points. They separate them into anterior and posterior categories based upon their starting location relative to the external auditory canal. Anterior access sites include Kocher’s, Kaufman’s, Paine’s, Menovksy’s, and Tubbs’ points; posterior access sites include Keen’s, Frazier’s, Dandy’s, and Sanchez’s points. Additionally, they include detailed, Multiview illustrations that provide the reader with a novel understanding of the craniometrics associated with each point.

4. Ventricular access via Kocher's point MC Location for EVD May be used for ETV, endoscopic removal colloid cyst or VP-shunting Failure rate 4-40% ( Abdoh MG et al)

5. Ventricular access via Paine’s, Hyun’s, and Park's points In pt. undergoing FT-craniotomy when there is concern for severe brain edema; lessens the need of brain retraction Theoretical risk of damaging Brocas’s area, head of caudate nucleus, thalamus; But no clinical series to demonstrate its efficacy & safety In series, Hyun’s point more accurate trajectory with 100% success rate Park’s point- 94% success rate with 2.5% chance of injury compared with 90% with paine’s point

6. Ventricular access via Kaufman’spoint Rapid access to ventricular system for emergent drainage of CSF Rarely used d/t cosmetic appearance 90% success rate

7. Ventricular access via Menovsky’s point Used while performing supraorbital craniotomy through eyebrow incision 87% success rate

8. Ventricular access via Tubbs’ point. Emergent ventricular decompression via transorbital route; spinal needle No burr; time efficient; Risk of globe injury; No clinical series

9. Ventricular access via Keen’s point Used for elective placement of proximal VP-shunt catheter Emergent CSF diversion during posterior fossa sx No clinical series

10. Ventricular access via Dandy’s point Initially used for ventriculography In a case series 100% success rate ( Lee,s et al)

11. Ventricular access via Frazier’s point In a case series 100% success rate ( Lee,s et al)

12. Ventricular access via Sanchez’s point For catherization of temporal horn in setting of trapped ventricle or to endoscopically access mesial temporal structures 100% success rate ( sanchez et al)

13. CONCLUSION The ventricles are accessed for numerous emergent and elective neurosurgical procedures, and all neurosurgeons should feel comfortable using craniometrics to help cannulate the ventricles when neuronavigation is unavailable. This review provides detailed descriptions and illustrations of the most common anterior and posterior ventricular access points and should serve as an important reference for both neurosurgical trainees and experienced neurosurgeons.

14. REFERENCES Lind CR, Tsai AM, Law AJ, Lau H, Muthiah K. Ventricular catheter trajectories from traditional shunt approaches: a morphometric study in adults with hydrocephalus. J Neurosurg . 2008;108(5):930-933. Park YG, Woo HJ, Kim E, Park J. Accuracy and safety of bedside external ventricular drain placement at two different cranial sites: Kocher’s point versus forehead. J Korean Neurosurg Soc. 2011;50(4):317-321. Schodel P, Proescholdt M, Brawanski A, Bele S, Schebesch KM. Ventriculostomy for acute hydrocephalus in critically ill patients on the ICU–outcome analysis of two different procedures. Br J Neurosurg . 2012;26(2):227-230. Sanchez JJ, Rincon- Torroella J, Prats- Galino A, et al. New endoscopic route to the temporal horn of the lateral ventricle: surgical simulation and morphometric assessment. J Neurosurg . 2014;121(3):751-759. Keen WW. Surgery of the lateral ventricles of the brain. Lancet North Am Ed. 1890;136(3498):553-555. Tillmanns H. Something about puncture of the brain. Br Med J. 1908;2:983-984. Dandy WE. Ventriculography following the injection of air into the cerebral ventricles. Ann Surg. 1918;68(1):5-11. Kaufmann GE, Clark K. Emergency frontal twist drill ventriculostomy. J Neurosurg . 1970;33(2):226-227. Paine JT, Batjer HH, Samson D. Intraoperative ventricular puncture. Neurosurgery. 1988;22(6):1107-1109. Menovsky T, De Vries J, Wurzer JA, Grotenhuis JA. Intraoperative ventricular puncture during supraorbital craniotomy via an eyebrow incision. J Neurosurg . 2006;105(3):485-486. Hyun SJ, Suk JS, Kwon JT, Kim YB. Novel entry point for intraoperative ventricular puncture during the transsylvian approach. Acta Neurochir (Wien). 2007;149(10):1049-1051; discussion 1051. Park J, Hamm IS. Revision of Paine’s technique for intraoperative ventricular puncture. Surg Neurol. 2008;70(5):503-508; discussion 508. Tubbs RS, Loukas M, Shoja MM, Cohen- Gadol AA. Emergency transorbital ventricular puncture: refinement of external landmarks. J Neurosurg . 2009;111(6):1191-1192. Frazier CH. Operation for the radical cure of trigeminal neuralgia: analysis of five hundred cases. Ann Surg. 1928;88(3):534-547. Hildebrandt G, Surbeck W, Stienen MN. Emil Theodor Kocher: the first Swiss neurosurgeon. Acta Neurochir . 2012;154(6):1105-1115; discussion 1115. Cushing H. Surgery of the head. In: Keen WW, ed. Surgery: Its Principles and Practice. Vol 3. Philidelphia : WB Saunders; 1908:17-276. Woo H, Kang DH, Park J. Preoperative determination of ventriculostomy trajectory in ventriculoperitoneal shunt surgery using a simple modification of the standard coronal MRI. J Clin Neurosci . 2013;20(12):1754-1758. Jones RF, Stening WA, Brydon M. Endoscopic third ventriculostomy. Neurosurgery. 1990;26(1):86-92; discussion 91-82. Zohdi A, El Kheshin S. Endoscopic approach to colloid cysts. Minim Invasive Neurosurg . 2006;49(5):263-268. Wang WH, Hung YC, Hsu SP, et al. Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage . J Chin Med Assoc. 2015;78(2):101-107. Abdoh MG, Bekaert O, Hodel J, et al. Accuracy of external ventricular drainage catheter placement. Acta Neurochir . 2012;154(1):153-159. Rehman T, Rehman A, Ali R, et al. A radiographic analysis of ventricular trajectories. World Neurosurg . 2013;80(1-2):173-178. Toma AK, Camp S, Watkins LD, Grieve J, Kitchen ND. External ventricular drain insertion accuracy: is there a need for change in practice? Neurosurgery. 2009;65(6):1197-1201; discussion 1200-1191. Madrazo Navarro I, Garcia Renteria JA, Rosas Peralta VH, Dei Castilli MA. Transorbital ventricular puncture for emergency ventricular decompression. J Neurosurg . 1981;54(2):273-274. Wilson SR, Schauer B, Price DD. Transorbital ventricular decompression in an acutely decompensated hydrocephalic ED patient. Am J Emerg Med. 2007;25(2):208-210. WW K. Surgery of the lateral ventricles of the brain. Med News. 1890;58:275- 278. Aitken AR. A ventricular catheter guide for rapid and accurate ventricular access. J Clin Neurosci . 1996;3(3):257-260. Mortazavi MM, Adeeb N, Griessenauer CJ, et al. The ventricular system of the brain: a comprehensive review of its history, anatomy, histology, embryology, and surgical considerations. Childs Nerv Syst. 2014;30(1):19-35. Chen CC, Lin HL, Cho DY. Endoscopic surgery for thalamic hemorrhage : a technical note. Surg Neurol. 2007;68(4):438-442; discussion 442. Lee CK, Tay LL, Ng WH, Ng I, Ang BT. Optimization of ventricular catheter placement via posterior approaches: a virtual reality simulation study. Surg Neurol. 2008;70(3):274-277; discussion 277-278.

15. Thank You !