Sagitta frame – A universal system for ventricular puncture. Clinical correlation – Initial experience

Ventricular puncture is one of the most common neurosurgical procedures. Most frequently it is conducted in emergency situations and in practice the freehand technique is applied. This allows fast and easy drainage of the ventricular system. The main problem of this technique is accuracy. Suboptimal or incorrect placement of the catheter occurs in 23–60 % of cases. We present the first clinical application of the “Sagitta Frame” developed by the Department of Neurosurgery, University hospital “N. I. Pirogov”, Sofia, Bulgaria together with Technical university – Sofia. The “Sagitta Frame” was applied intraoperatively in 20 patients. All patients were fixed with the Mayfield head clamp and the preoperative images /CT or MRI/ were uploaded on a Brainlab navigation system, the navigation system was solely used to verify the accurate trajectory. The universal system for ventricular puncture was applied to each patient and the entry point was marked and after that verified on the Brainlab navigation system. The application of the universal system for ventricular puncture takes less than 5 min. The neuronavigational verification confirmed successful ventricular puncture in every patient. Ventricular puncture is a life-saving procedure. In an emergency situation it could be performed in an intensive care unit or even in an emergency department. In many hospitals in small living areas, it is impossible to have 24/7 a neurosurgeon on call. With the universal system for ventricular puncture the placement of a catheter in the lateral ventricle could be performed in an emergency situation with great accuracy by a general surgeon or an ICU doctor.