Ventricular Catheter Insertion on the Occipital and Parietooccipital Bone: A Nonmetric Complementary Technique

Abstract Background and Study Aim  Hydrocephalus is a common disease of the pediatric population, with cerebrospinal fluid diversion as the management of choice. All current insertion techniques require craniometrics calculation that may not be applicable for pediatric patients, due to significant variation in head circumference. We describe a complementary method of inserting ventricular catheters, devoid of craniometrics. Materials and Methods  The insertion site is based on two imaginary lines on the sagittal plane (superior and inferior limits) and four imaginary lines on the axial plane of a computed tomography/magnetic resonance imaging. The insertion point is chosen based on the shortest location from the outer table of the bone to the ventricle. The length of catheter insertion is calculated based on the distance between the calvarial outer table and the foramen of Monro. Results  Two case examples of ventricular catheter insertions, in pediatric patients with noncommunicating hydrocephalus, are described. External ventricular drain and ventriculoperitoneal shunt were inserted using this technique, with no required craniometrics measurements. Conclusion  This complementary method of inserting ventricular catheters can be easily tailored and implemented by junior neurosurgical residents to senior neurosurgeons as it precludes the measurement of the catheter insertion points.