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Free-hand stereotactic ventricular catheter insertion technique based on radio-anatomical landmarks. How I do it

  • How I Do it - CSF Circulation
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Abstract

Background

Accurate ventricular catheter (VC) placement plays an important role in reducing the risk of ventriculoperitoneal shunt failure. Free-hand VC insertion is associated with a significant misplacement rate. Consequently, several expensive alternative methods that are unfortunately not available worldwide have been used. To overcome these limitations, we developed a simple surgical technique based on radio-anatomical landmarks aimed at reducing VC’s misplacements.

Method

We reproduce the preoperative imaging on the patient’s head using common anatomical landmarks. This allows defining stereotactic VC coordinates to be followed during the surgical procedure.

Conclusion

This simple and cost-effective method improves VC insertion accuracy.

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Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

CP:

Catheter plane

CSF:

Cerebrospinal fluid

CT:

Computed tomography

EAC:

External auditory canal

Ep:

Entry point

FOM:

Foramen of Monro

Fp:

Frontal point

IBO:

Inferior border of the orbit

MPR:

Multi-planar reconstruction

MRI:

Magnetic resonance imaging

OP:

Oblique plane

RP:

Reference plane

Tp:

Target point

VC:

Ventricular catheter

VPS:

Ventriculoperitoneal shunt

Ep-x:

x coordinate for the entry point

Ep-x’:

x’ coordinate for the entry point

Ep-y:

y coordinate for the entry point

Fp-x:

x coordinate for the frontal point

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Brussels, Belgium

    Michaël Bruneau, Julien Spitaels & Matteo Riva

  2. Department of Neurosurgery, Mont-Godinne Hospital, UCL Namur, Yvoir, Belgium

    Matteo Riva

Authors
  1. Michaël Bruneau
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  2. Julien Spitaels
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  3. Matteo Riva
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Corresponding author

Correspondence to Michaël Bruneau.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Key points

1. Determine all reference landmarks on the preoperative exam.

2. Reproduce these landmarks on the patient’s head.

3. Keep the OP parallel to the floor.

4. Maintain CP, OP, and Ep visible after draping.

5. Insert the drain following a trajectory corresponding to the intersection between the OB and the CP.

6. Check CSF outflow until reaching the Tp.

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This article is part of the Topical Collection on CSF Circulation

Electronic supplementary material

This video illustrates the stereotactic ventricular catheter insertion technique based on radio-anatomical landmarks. (MP4 43,959 kb)

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Bruneau, M., Spitaels, J. & Riva, M. Free-hand stereotactic ventricular catheter insertion technique based on radio-anatomical landmarks. How I do it. Acta Neurochir 163, 1097–1102 (2021). https://doi.org/10.1007/s00701-020-04549-6

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  • DOI: https://doi.org/10.1007/s00701-020-04549-6

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