Abstract
Background and objectives
The narrow surgical passage provided by the supraorbital keyhole craniotomy restricts the instrument’s maneuverability and presents a number of technical challenges. Inadequate brain relaxation may eventually result in unavoidable brain retraction and neurological impairments. The article aims to provide a novel intraoperative ventriculostomy to assist in overcoming the barrier of a narrow surgical corridor and assess its feasibility and safety compared to other techniques.
Methods
The craniometric point was planned on one normal computed tomography (CT) brain. The coordinates were verified on 43 magnetic resonance imaging (MRI) brain images uploaded on the neuronavigation system (StealthStation S8 version 1.0; Medtronic, Louisville, USA). The ventriculostomy point was 3 cm superior to glabella, 2 cm lateral to midline, 6 cm deep to the brain surface in the perpendicular direction, and parallel to the floor of the anterior cranial fossa. Subsequently, the abovementioned radiologically calculated ventriculostomy trajectory was confirmed on 32 consecutive patients (without neuronavigation) of suprasellar mass undergoing supraorbital craniotomy between February 2022 and April 2023. The technical issues, feasibility, and outcomes were assessed.
Results
Out of 32 patients, in 29 patients, ventricular hit was attained in a single attempt, and the rest 3 patients needed two attempts. The intraoperative ventricular hit rate was 100% with 90.6% success in a single attempt. No ventriculostomy-related complications occurred. Compared to ELD (external lumbar drainage), performing an intraoperative ventriculostomy had no discernible difference in the perception of the brain retraction force. Intraoperative ventriculostomy fully eliminated the low back pain or radiculopathy that patients with ELD rarely have even after drain removal.
Conclusion
The novel intraoperative frontal ventriculostomy is a safe trajectory and is a valid alternative to Menovsky’s ventriculostomy or external lumbar drainage. The authors recommend this technique be generally utilized in supraorbital keyhole approaches to optimize brain relaxation and minimize secondary adverse events.
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Data availability
The data associated with the paper are not publicly available but are available from the corresponding author on reasonable request.
Abbreviations
- CT:
-
Computed tomography
- MRI:
-
Magnetic resonance imaging
- CSF:
-
Cerebrospinal fluid
- ELD:
-
External lumbar drainage
- EVD:
-
External ventricular drainage
- FM:
-
Foramen of Monro
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Acknowledgements
Authors acknowledge all professors and consultants in the Department of Neurosurgery for the guidance and assistance.
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Saraj Kumar Singh and Anand Kumar Das contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Anand Kumar Das, Saraj Kumar Singh, and Suraj Kant Mani. The first draft of the manuscript was written by Anand Kumar Das, and all authors commented on previous versions of the manuscript. Anand Kumar Das and Saraj Kumar Singh contributed equally to the work. All authors read and approved the final manuscript.
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Supplementary Information
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Supplementary file1 Video 1 Neuronavigation video of non-contrast CT brain demonstrating the planning of novel anterior frontal ventriculostomy (MP4 1051 KB)
Supplementary file2 Video 2 Intraoperative demonstration of the novel anterior frontal ventriculostomy after supraorbital craniotomy (MP4 114354 KB)
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Das, A.K., Singh, S.K. & Mani, S.K. Novel freehand frontal ventriculostomy in the supraorbital keyhole approach: technical note. Acta Neurochir 165, 3249–3254 (2023). https://doi.org/10.1007/s00701-023-05798-x
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DOI: https://doi.org/10.1007/s00701-023-05798-x