Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China.
Department of Electrical Engineering, City University of Hong Kong, Hong Kong, China.
Oper Neurosurg (Hagerstown). 2022 Feb 1;22(2):51-60. doi: 10.1227/ONS.0000000000000047.
Ventricular catheter tip position is a predictor for ventriculoperitoneal shunt survival. Cannulation is often performed freehand, but there is limited consensus on the best craniometric approach.
To determine the accuracy of localizing craniometric entry sites and to identify which is associated with optimal catheter placement.
This is a retrospective analysis of adult patients who underwent ventriculoperitoneal shunting. The approaches were categorized as Kocher's, Keen's, Frazier's and Dandy's points as well as the parieto-occipital point. An accurately sited burr hole was within 10 mm from standard descriptions. Optimal catheter tip position was defined as within the ipsilateral frontal horn.
A total of 110 patients were reviewed, and 58% (65/110) of burr holes were accurately sited. Keen's point was the most correctly identified (65%, 11/17), followed by Kocher's point (65%, 37/57) and Frazier's point (60%, 3/5). Predictors for accurate localization were Keen's point (odds ratio 0.3; 95% CI: 01-0.9) and right-sided access (odds ratio 0.4; 95% CI: 0.1-0.9). Sixty-three percent (69/110) of catheters were optimally placed with Keen's point (adjusted odds ratio 0.04; 95% CI: 0.01-0.67), being the only independent factor. Thirteen patients (12%) required shunt revision at a mean duration of 10 ± 25 mo. Suboptimal catheter tip position was the only independent determinant for revision (adjusted odds ratio 0.11; 95% CI: 0.01-0.98).
This is the first study to compare the accuracy of freehand ventricular cannulation of standard craniometric entry sites for adult patients. Keen's point was the most accurately sited and was a predictor for optimal catheter position. Catheter tip location, not the entry site, predicted shunt survival.
脑室导管尖端位置是脑室-腹腔分流术存活的预测因子。置管通常是徒手进行的，但对于最佳颅测量入路方法尚未达成共识。
确定颅测量入路定位的准确性，并确定哪些入路与最佳导管放置相关。
这是一项对成人脑室-腹腔分流术患者进行的回顾性分析。该入路分为 Kocher 点、Keen 点、Frazier 点和 Dandy 点以及顶枕点。准确的钻颅孔位置距离标准描述的距离在 10mm 以内。最佳导管尖端位置定义为同侧额角内。
共回顾了 110 例患者，其中 58%（65/110）的钻颅孔位置准确。Keen 点是最准确识别的（65%，11/17），其次是 Kocher 点（65%，37/57）和 Frazier 点（60%，3/5）。准确定位的预测因素是 Keen 点（优势比 0.3；95%CI：0.1-0.9）和右侧入路（优势比 0.4；95%CI：0.1-0.9）。63%（69/110）的导管位置最佳，采用 Keen 点（调整后的优势比 0.04；95%CI：0.01-0.67），是唯一的独立因素。13 例患者（12%）需要在平均 10±25 个月时进行分流术修订。导管尖端位置不理想是修订的唯一独立决定因素（调整后的优势比 0.11；95%CI：0.01-0.98）。
这是第一项比较成人患者标准颅测量入路徒手脑室置管准确性的研究。Keen 点是最准确的定位点，是最佳导管位置的预测因素。导管尖端位置而不是入路预测分流术的存活。
