Revisiting the rules for freehand ventriculostomy: a virtual reality analysis

Journal of Neurosurgery
Clemens RaabeAndreas Raabe

Abstract

OBJECTIVE Frontal ventriculostomy is one of the most frequent and standardized procedures in neurosurgery. However, many first and subsequent punctures miss the target, and suboptimal placement or misplacement of the catheter is common. The authors therefore reexamined the landmarks and rules to determine the entry point and trajectory with the best hit rate (HtR). METHODS The authors randomly selected CT scans from their institution's DICOM pool that had been obtained in 50 patients with normal ventricular and skull anatomy and without ventricular puncture. Using a 5 × 5-cm frontal grid with 25 entry points referenced to the bregma, the authors examined trajectories 1) perpendicular to the skull, 2) toward classic facial landmarks in the coronal and sagittal planes, and 3) toward an idealized target in the middle of the ipsilateral anterior horn (ILAH). Three-dimensional virtual reality ventriculostomies were simulated for these entry points; trajectories and the HtRs were recorded, resulting in an investigation of 8000 different virtual procedures. RESULTS The best HtR for the ILAH was 86% for an ideal trajectory, 84% for a landmark trajectory, and 83% for a 90° trajectory, but only at specific entry points. The highest HtRs ...Continue Reading

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Citations

Nov 26, 2019·Acta neurochirurgica·Christian V EisenringMarkus F Oertel
Sep 13, 2019·Journal of Clinical Medicine·Charlene Y C ChauAngelos G Kolias
Dec 18, 2020·International Journal of Computer Assisted Radiology and Surgery·Zongchao YiWenyao Hong

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