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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 …
Contributors AHYC conceived the article and drafted the manuscript. All authors reviewed and approved submission of the final manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.