Chen Xiaohai, Chen Tengda, Xie Zhangkun, Xu Lunshan, Qi Zhen, Guo Xieli
Department of Neurosurgery, Jinjiang Municipal Hospital (Shanghai Sixth People's Hospital Fujian), Jinjiang , Fujian , China.
Department of Neurosurgery, Daping Hospital, Army Medical University, Chongqing , China.
Oper Neurosurg. 2024 Dec 2;29(3):351-360. doi: 10.1227/ons.0000000000001467.
In conventional freehand frontal ventriculostomy, the Kocher point is the entry point, the external auditory canal is the sagittal target, and the coronal targets include the ipsilateral medial canthus (IMC), the midpoint between the bilateral external auditory meatus (MAM), the contralateral medial canthus (CMC), and the region perpendicular to the skull (P). The aim of this study was to calculate puncture accuracy of the 4 conventional methods to guide clinical selection.
Patient data from thin-slice computed tomography scans were imported, and a 3-dimensional model was reconstructed using software to simulate puncture. The accuracy and puncture depth of the 4 freehand frontal ventriculostomy methods were analyzed.
From January 1, 2022, to December 30, 2023, 520 patients were screened and 206 were enrolled; 137 (66.5%) participants were males, and 69 (33.5%) were females. The median age of the patients was 64 years (IQR 53-73). The maximal frontal horn width was 21.7-53.7 mm (IQR 34.4-40.0), and the intercanthal distance was 26.0-43.2 mm (IQR 30.7-34.9). Simulating bilateral ventricular puncture, for the IMC trajectory, the puncture accuracy was 13.3% (55/412) [95% CI 10.4-17.0] and the puncture depth was 41.8 ± 4.6 mm. For the MAM trajectory, the puncture accuracy was 74.5% (307/412) [95% CI 70.1-78.5] and the puncture depth was 43.6 ± 4.3 mm. For the P trajectory, the puncture accuracy was 90.5% (373/412) [95% CI 87.3-93.0] and the puncture depth was 49.4 ± 5.9 mm. For the CMC trajectory, the puncture accuracy was 100.0% (412/412) [95% CI 99.1-100.0] and the puncture depth was 47.2 ± 5.2 mm.
Compared with the MAM trajectory, the CMC and P trajectories were more reliable in frontal ventriculostomy, but the P trajectory may enter the contralateral ventricle. The IMC trajectory is not recommended unless the frontal horn is wider than 45 mm or the Kocher point is moved inward.
在传统徒手额部脑室造瘘术中， Kocher点为穿刺点，外耳道为矢状面靶点，冠状面靶点包括同侧内眦（IMC）、双侧外耳道中点（MAM）、对侧内眦（CMC）以及与颅骨垂直的区域（P）。本研究旨在计算这4种传统方法的穿刺准确性，以指导临床选择。
导入薄层计算机断层扫描的患者数据，使用软件重建三维模型以模拟穿刺。分析4种徒手额部脑室造瘘术方法的准确性和穿刺深度。
2022年1月1日至2023年12月30日，共筛查520例患者，纳入206例；137例（66.5%）为男性，69例（33.5%）为女性。患者的中位年龄为64岁（四分位间距53 - 73岁）。额角最大宽度为21.7 - 53.7 mm（四分位间距34.4 - 40.0 mm），内眦间距为26.0 - 43.2 mm（四分位间距30.7 - 34.9 mm）。模拟双侧脑室穿刺，对于IMC路径，穿刺准确率为13.3%（55/412）[95%置信区间10.4 - 17.0]，穿刺深度为41.8±4.6 mm。对于MAM路径，穿刺准确率为74.5%（307/412）[95%置信区间70.1 - 78.5]，穿刺深度为43.6±4.3 mm。对于P路径，穿刺准确率为90.5%（373/412）[95%置信区间87.3 - 93.0]，穿刺深度为49.4±5.9 mm。对于CMC路径，穿刺准确率为100.0%（412/412）[95%置信区间99.1 - 100.0]，穿刺深度为47.2±5.2 mm。
与MAM路径相比，CMC和P路径在额部脑室造瘘术中更可靠，但P路径可能进入对侧脑室。除非额角宽度大于45 mm或Kocher点向内移动，否则不建议采用IMC路径。
