Insights from using biplanar intersection for freehand frontal ventriculostomy: a retrospective case-control study with virtual simulation.

Background: Frontal ventriculostomy (FV) is essential in neurosurgery; however, traditional freehand puncture methods have low accuracy, and ultrasound guidance is time consuming and expensive. To improve freehand puncture accuracy, this study introduced a biplanar intersection (BI) method, and analyzed the frontal-horn puncture mechanism. No related reports exist to date.

Methods: Three-dimensional (3D) computed tomography (CT) reconstruction was performed using data from random patients, aged ≥18 years, who presented with enlarged lateral ventricles, and an Evans index >0.33, and had no signs of ventricular compression, deformation, displacement, or a history of craniectomy. This study was conducted at Fujian Provincial Hospital between May 2022 and May 2023. Using the principles of BI, we determined the location coordinates, and conducted a variance analysis. We simulated the puncture using the BI method and compared it with traditional methods. Differences between groups were evaluated using chi-squared tests and independent samples t-tests.

Results: A total of 135 patients (110 males, 25 females; aged 18-78 years) were included in the study. The lateral projection was situated 13.3±1.5 mm anteriorly and 45.7±4.1 mm superiorly in relation to the intersection of the anterior margin of the tragus and the superior margin of the zygomatic arch. The anterior projection was located 13.8±2.4 mm above and 5.5±1.1 mm lateral to the glabella. The mean puncture depth was determined to be 56 mm (48-64 mm). In a sub-analysis of 36 patients, the BI method exhibited a significantly higher optimal puncture rate (36/36 versus 31/36, χ=5.373, P=0.021<0.05) and reduced lateral deviation (2.69 versus 13.97 mm, =-20.61, P<0.05).

Conclusions: The BI method, which is founded on rigorous mathematical principles, was shown through simulations to have enhanced precision in puncture efficiency. However, further clinical research needs to be conducted to ascertain its effectiveness.