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We read with interest the article by Fiorella et al,1 which presents their experience in the iGuide guidance system (Siemens, Erlangen, Germany) for on-table external ventricular drain placement. The article describes catheter placement under a trajectory that is planned on cone-beam CT (CBCT).
We have in our practice identified modifications which we feel increase accuracy:
After antiseptic preparation a 23G needle is placed at Kocher's point. CBCT is then performed, allowing delineation of the expected point-of-entry, and adjustment if necessary.
After CBCT, both the A- and B-planes are moved …