Craniometrics and ventricular access
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The document reviews various ventricular access points used in neurosurgery, detailing nine specific techniques categorized into anterior and posterior sites. It highlights the need for clearer literature and quality images regarding operative techniques for these access points, emphasizing their significance in both emergency and elective procedures. The review aims to serve as a reference for neurosurgeons to understand craniometrics and improve their skills in ventricular cannulation.
Craniometrics and ventricular access
- 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.
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- 15. ThankYou!