CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2023; 12(01): 071-075
DOI: 10.1055/s-0042-1756507
Original Article

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

Turki Elarjani
1   Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
Othman Bin Alamer
2   Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
Othman Alhammad
3   Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
› Author Affiliations
Funding No funding was received to conduct this study.


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.

Authors' Contributions

TE was responsible for the conceptualization, methodology, writing, and editing. OB contributed to the methodology, editing, and data curation. OA was involved in the conceptualization, editing, supervision, and data curation. Patient families are aware and agree of the publication of this manuscript, and all patient figures are anonymized.

Publication History

Article published online:
03 October 2022

© 2022. Neurological Surgeons' Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Duong J, Elia CJ, Miulli D, Dong F, Sumida A. An approach using the occipital parietal point for placement of ventriculoperitoneal catheters in adults. Surg Neurol Int 2019; 10: 21
  • 2 Morone PJ, Dewan MC, Zuckerman SL, Tubbs RS, Singer RJ. Craniometrics and ventricular access: a review of Kocher's, Kaufman's, Paine's, Menovksy's, Tubbs', Keen's, Frazier's, Dandy's, and Sanchez's Points. Oper Neurosurg (Hagerstown) 2020; 18 (05) 461-469
  • 3 Stagno V, Navarrete EA, Mirone G, Esposito F. Management of hydrocephalus around the world. World Neurosurg 2013; 79 (2, Suppl): 23.e17-23.e20
  • 4 Aschoff A, Kremer P, Hashemi B, Kunze S. The scientific history of hydrocephalus and its treatment. Neurosurg Rev 1999; 22 (2-3): discussion 94–95 67-93
  • 5 Hirsch JF. Surgery of hydrocephalus: past, present and future. Acta Neurochir (Wien) 1992; 116 (2-4): 155-160
  • 6 Lifshutz JI, Johnson WD. History of hydrocephalus and its treatments. Neurosurg Focus 2001; 11 (02) E1
  • 7 Garg A, Suri A, Chandra PS, Kumar R, Sharma BS, Mahapatra AK. Endoscopic third ventriculostomy: 5 years' experience at the All India Institute of Medical Sciences. Pediatr Neurosurg 2009; 45 (01) 1-5
  • 8 Li V. Methods and complications in surgical cerebrospinal fluid shunting. Neurosurg Clin N Am 2001; 12 (04) 685-693 , viii
  • 9 Dandy WE. Ventriculography following the injection of air into the cerebral ventricles. Ann Surg 1918; 68 (01) 5-11
  • 10 Frazier CH. Operation for the radical cure of trigeminal neuralgia: analysis of five hundred cases. Ann Surg 1928; 88 (03) 534-547
  • 11 Hildebrandt G, Surbeck W, Stienen MN. Emil Theodor Kocher: the first Swiss neurosurgeon. Acta Neurochir (Wien) 2012; 154 (06) 1105-1115 , discussion 1115
  • 12 Kaufmann GE, Clark K. Emergency frontal twist drill ventriculostomy. Technical note. J Neurosurg 1970; 33 (02) 226-227
  • 13 Menovsky T, De Vries J, Wurzer JA, Grotenhuis JA. Intraoperative ventricular puncture during supraorbital craniotomy via an eyebrow incision. Technical note. J Neurosurg 2006; 105 (03) 485-486
  • 14 Paine JT, Batjer HH, Samson D. Intraoperative ventricular puncture. Neurosurgery 1988; 22 (6 Pt 1): 1107-1109
  • 15 Sánchez JJ, Rincon-Torroella J, Prats-Galino A. et al. New endoscopic route to the temporal horn of the lateral ventricle: surgical simulation and morphometric assessment. J Neurosurg 2014; 121 (03) 751-759
  • 16 Tubbs RS, Loukas M, Shoja MM, Cohen-Gadol AA. Emergency transorbital ventricular puncture: refinement of external landmarks. J Neurosurg 2009; 111 (06) 1191-1192
  • 17 Keen WW. Surgery of the lateral ventricles of the brain. Lancet 1890; 136: 553-555
  • 18 Lind CR, Tsai AM, Law AJ, Lau H, Muthiah K. Ventricular catheter trajectories from traditional shunt approaches: a morphometric study in adults with hydrocephalus. J Neurosurg 2008; 108 (05) 930-933