The "optimal" burr hole position for endoscopic third ventriculostomy: results from 31 stereotactically guided...

ETV is a well established and successful method in contemporary neurosurgery. With growing experience there is a more efficient patient selection and further advances in technical know how. We evaluated retrospectively a consecutive group of 27 patients who were treated in our institution by stereotactic guided ETV between 1992 and 1996. When reviewing their postoperative imaging studies (MRI/CT) we could measure the position of the burr hole as port of entry for the rigid endoscope in 17 out of 23 finally selected patients. The median lateral position was 28 mm (mean 26.5 mm) from the midline and 8 mm (mean 6.5 mm) anterior of the coronal suture. We conclude that the optimal burr hole position should be 3 cm lateral to the midline and 1 cm anterior of the coronal suture, in the patients with normal anatomical findings.