The Technique for Transorbital Ventricular Puncture: An Anatomic Approach

Area of Science:

• Neurosurgery
• Emergency Medicine
• Anatomy

Background:

• Transorbital ventricular puncture is a minimally invasive procedure with limited anatomical guidance.
• It offers a potential life-saving intervention for acute decompensated hydrocephalus and intracranial hypertension.

Purpose of the Study:

• To define reliable anatomical structures and landmarks for executing transorbital puncture.
• To facilitate the safe and effective use of this technique in emergency settings.

Main Methods:

• Analysis of 120 head CT scans to identify optimal orbital roof entry points.
• Cadaveric dissection and puncture (4 sides) to register angles, distances, and anatomical references.
• Determination of specific needle trajectory for ventricular access.

Main Results:

• Perforation point identified 2.5 cm (female) or 3.0 cm (male) lateral to the midline, inferior to the superciliary arch.
• Optimal needle trajectory: 45° inferiorly, 20° medially, advancing 2.0 cm to bone, then 4.5 cm to the anterior horn of the lateral ventricle.
• Established specific measurements and angles for safe ventricular entry.

Conclusions:

• Reliable anatomical reference points for transorbital puncture have been established.
• This technique provides a viable bedside approach to the anterior horn of the lateral ventricle for emergency intracranial pressure management.