Kocher's point

Is a common entry point for an intraventricular catheter to drain cerebral spinal fluid from the cerebral ventricles.

see Emil Theodor Kocher.

It is located 2.5 centimeters from the midline (at approximately the mid-pupillary line) approximately 11 cm posterior to the nasion. It is important to be at least 1 cm anterior to the coronal suture to avoid the motor strip.

Ventriculostomy entry sites are commonly selected by freehand estimation of Kocher's point or approximations from skull landmarks and a trajectory toward the ipsilateral frontal horn of the lateral ventricles.

In 100 virtual lines through Kocher's point toward the ipsilateral ventricle, 19% were predicted to cause cortical vein injury and suspected hemorrhage (radius ≤ 3 mm). Little difference existed between cerebral hemispheres (right 18%, left 20%). The average (± SD) distance from the trajectory line and a cortical vein was 7.23 ± 4.52 mm. In all 19 images that predicted vessel injury, a site of entry for an avascular zone near Kocher's point could be achieved by moving the trajectory less than 1.0 cm laterally and less than 1.0 cm along the anterior/posterior axis, suggesting that empirical measures are suboptimal, and that patient-specific coordinates based on preprocedural CTA/CVA imaging may optimize ventriculostomy in the future.

In this institutional radiographic imaging analysis, traditional methods of ventriculostomy site selection predicted significant rates of cortical vein injury, matching described rates in the literature. CTA/CTV imaging potentiates identification of patient-specific cannulation sites and custom trajectories that avoid cortical vessels, which may lessen the risk of intracranial hemorrhage during ventriculostomy placement. Further development of this software is underway to facilitate stereotactic ventriculostomy and improve outcomes 1).

Robertson FC, Abd-El-Barr MM, Mukundan S Jr, Gormley WB. Ventriculostomy-associated hemorrhage: a risk assessment by radiographic simulation. J Neurosurg. 2017 Sep;127(3):532-536. doi: 10.3171/2016.8.JNS16538. Epub 2016 Dec 2. PubMed PMID: 27911234.
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  • Last modified: 2019/11/08 18:49
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