• Hiroaki Matsuzaki, Tadahiro Otsuka, Ken Uekawa, Takashi Nakagawa, and Nobuyuki Tsubota.
• Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan. Electronic address: lemeridien1520@gmail.com.
• World Neurosurg. 2017 Aug 1; 104: 45-47.

ObjectiveVentriculostomy from Paine's point is an effective technique to ensure that the brain is relaxed for aneurysm surgery. This study aimed to use Paine's point for other neurosurgical procedures (except for those that require a pterional approach) by delineation of surface landmarks for identification of Paine's point on the cranium and scalp.MethodsBased on the anatomical knowledge and examination of 3-dimensional computed tomography images of skull, we determined novel surface landmarks to identify Paine's point on the cranium and scalp. The new method was used in patients with intraventricular hemorrhage and aneurysmal subarachnoid hemorrhage caused by ruptured aneurysm of the anterior communicating artery.ResultsThe puncture point was determined at a point located 2.5 cm superior to the supraorbital margin on linea temporalis on the skull and 2.5 cm superior to the eyebrow along the anterior edge of temporal muscle on the skin. Ventriculostomy was performed from Paine's point in patients with intraventricular hemorrhage or aneurysmal subarachnoid hemorrhage who underwent aneurysm surgery via an interhemispheric approach. No adverse events were observed in any of the patients.ConclusionsBy accurate surface marking on skull and skin, the use of Paine's point for ventriculostomy performed via an interhemispheric approach or for simple burr-hole surgery was found to be safe and reliable.Copyright © 2017 Elsevier Inc. All rights reserved.

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