Ventricular catheter trajectories from traditional shunt approaches: a morphometric study in adults with hydrocephalus

Object The purpose of this study was to compare the margins of error of different shunt catheter approaches to the lateral ventricle and assess surface anatomical aiming landmarks for free-hand ventricular catheter insertion in adult patients with hydrocephalus. Methods Four adults who had undergone stereotactic brain magnetic resonance (MR) imaging and had normal ventricles, and 7 prospectively recruited adult patients with acute hydrocephalus were selected for inclusion in this study. Reconstructed MR images obtained prior to surgical intervention were geometrically analyzed with regard to frontal, parietal, and parietooccipital (occipital) approaches in both hemispheres. Results The ventricular target zones were as follows: the frontal horn for frontal and occipital approaches, and the atrium/ posterior horn for parietal approaches. The range of possible angles for successful catheter insertion was smallest for the occipital approach (8° in the sagittal plane and 11° in the coronal plane), greater for ...