Epistemology of Kocher's Point

Although ventricular puncture remains one of the oldest and most frequent procedures in neurosurgery and most neurosurgeons perform ventriculostomy via Kocher's point, Swiss surgeon Theodor Emil Kocher is almost never cited. In fact, a plethora of measurements is ascribed to "Kocher's point." This article tracks the original technique described by Theodor E. Kocher. His thorough investigation of craniocerebral topography enabled him to devise a cranioencephalometer with which he was able to localize cerebral areas on the surface of the cranium in living patients for surgical planning. The measurements of Kocher's point depend on individual craniometry. Kocher originally described ventricular puncture via a trephination 2.5 to 3.0-cm paramedian to a point between the anterior and middle third on the nasion-inion-line. This reliably helps to stay on or before the coronal suture when puncturing the frontal horn of the lateral ventricle-the most common neurosurgical procedure-and represents a safe entry point with minimal risk of injury to eloquent primary, secondary, or supplementary motor cortex as well as bridging veins or venous lacunae.