Anatomical and radiological analysis of ventricular catheter trajectories: neuronavigation-guided dissection and tractography-based 3D visualization

Ventricular catheter placement (VCP) is a life-saving intervention frequently performed in emergency departments and intensive care units. The free hand technique is the most commonly used approach for placing catheters. This study demonstrates the anatomical and radiological relationship between catheters inserted through the most commonly used access points and the anatomical structures in their path. Moreover, we calculate the insertion angles and catheter lengths that should be specified during VCP. Six donated human heads, fixed in 10% formalin and injected with colored silicone dye, were used in this study. Ventricular catheters were inserted through Kocher's, Paine's, Keen's, Frazier's, and Dandy's points under navigation. Dissection was performed from the skin to the inner wall of the ventricle while preserving the inserted catheters. The insertion angle and delivery length for each access point were measured both in the donated human heads and in 50 patients with hydrocephalus. In addition, magnetic resonance tractography was performed, and the relationship of each catheter with anatomical structures was presented as a three-dimensional model. Catheters inserted from Keen's and Paine's points pass through regions containing dense and crucial vascular structures. Catheters inserted from Keen's, Paine's, and Frazier's points enter the cortex through eloquent areas. The catheter inserted from Keen's point passes through the most diverse white matter pathway. Catheters inserted from Kocher's and Dandy's points pass through regions with less dense cortical vascular structures. Moreover, they pass through noneloquent cortical structures and fewer white matter tracts. This is the first anatomical dissection and tractography report describing the relationship between catheters introduced through the most common ventricular access sites and the anatomical structures along their path from the skin to the ventricle. Understanding the anatomical and radiological three-dimensionality of VCP will increase the safety of its applications.