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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Emergency transorbital ventricular puncture: refinement of external landmarks
R Shane Tubbs1, Marios Loukas, Mohammadali M Shoja
1Section of Pediatric Neurosurgery, Children's Hospital, 1600 7th Avenue South ACC 400, Birmingham, Alabama 35233, USA. rstubbs@uab.edu
Journal of Neurosurgery
|April 21, 2009
Summary
This study refines the transorbital ventriculostomy technique for emergency intracranial pressure management. Precise anatomical landmarks were identified for safe and effective ventricular access in cadavers.
Area of Science:
- Neurosurgery
- Anatomy
- Emergency Medicine
Background:
- Elevated intracranial pressure (ICP) with herniation necessitates emergency ventricular access.
- The transorbital approach using a spinal needle is a documented, albeit minimally defined, procedure.
- Previous reports lacked detailed external landmarks for transorbital ventriculostomy.
Purpose of the Study:
- To define precise external landmarks for the transorbital approach to the lateral ventricles.
- To improve the safety and efficacy of transorbital ventriculostomy in emergency situations.
Main Methods:
- The transorbital puncture of lateral ventricles was performed on five adult cadavers (10 sides).
- An axial cranial section exposed the lateral ventricular system for procedural guidance.
- Evaluation focused on identifying optimal landmarks for catheter placement.
Main Results:
- Consistent entry into the lateral ventricular system was achieved.
- Puncture occurred superior to the foramen of Monro, through the orbital roof.
- Optimal trajectory involved puncturing medial to the midpupillary line at specific angles.
Conclusions:
- Transorbital ventriculostomy is a viable, though uncommon, emergency procedure for elevated ICP.
- The refined anatomical landmarks presented enhance neurosurgical utility for this approach.
