A Surgical Landmark for Frontal Ventriculostomy: A Craniometric Study in Thai Cadavers and Dry Skulls
Nawaporn Techataweewan MD*, Amnat Kitkhuandee MD**, Pichayen Duangthongphon MD**, Yanyong Toomsan MSc*
Affiliation : * Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : The free-hand pass method of ventriculostomy catheter placement using surface anatomical landmarks can
be a lifesaving emergency neurosurgical procedure allowing assessment and management of intracranial pressure for
critically ill patients. The procedure requires a burr hole through the skull and the appropriate location of this point is
essential to success.
Objective : To determine cranial measurements to assist with optimal ventriculostomy burr hole placement in Thai patients.
Material and Method: Measurements of the frontal bone were performed on 65 embalmed cadaveric cranial vaults
(33 males and 32 females) and 729 dry skulls (349 males and 380 females) at the Department of Anatomy, Faculty of
Medicine, Khon Kaen University, Thailand.
Results : In the large sample of dry skulls, measurements from nasion to bregma were 127.9 mm in males and 124.0 mm in
females. The mean distance between the mid-supraorbital rim and the coronal suture on the right is 105.9 mm in males and
99.6 mm in females, and on the left 100.0 mm in males and 94.2 mm in females. The measurements were statistically
significant larger in males than in females, and statistically significant larger on the right side than the left in both sexes.
These measurements on dry skulls were smaller than on cadaveric scalps by approximately 8 mm.
Conclusion : The mean values from nasion to bregma and mid-supraorbital rim to coronal suture were determined. This is
a first step in improving success rates with the procedure in Thai patients.
Keywords : Kocher’s point, Intraventricular catheter, Cranial shape
