• Mario Gomar-Alba, José Javier Guil-Ibáñez, José Luis Ruiz-García, José Miguel Plá-Ruiz, Fernando García-Pérez, Antonio José Vargas-López, Leandro Saucedo, María José Castelló-Ruiz, Gaizka Urreta-Juárez, Gema Bravo-Garrido, Gracia María Castro-Luna, Tesifón Parrón-Carreño, and José Masegosa-González.
• Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; University of Almería, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain. Electronic address: mariogomar@hotmail.es.
• World Neurosurg. 2024 Jul 1; 187: 192819-28.

BackgroundVentriculoscopic neuronavigation has been described in several articles. However, there are different ventriculoscopes and navigation systems. Due to these different combinations, it is difficult to find detailed neuronavigation protocols. We describe, step-by-step, a simple method to navigate both the trajectory until reaching the ventricular system, as well as the intraventricular work.MethodsWe use a rigid ventriculoscope (LOTTA, KarlStorz) with an electromagnetic stylet (S8-StealthSystem, Medtronic). The protocol is based on a modified or 3-dimensionally printed trocar for navigating the extraventricular step and on a modified pediatric nasogastric tube for the intraventricular navigation.ResultsThis protocol can be set up in less than 10 minutes. The extraventricular part is navigated by introducing the electromagnetic stylet inside the modified or 3-dimensionally printed trocar. Intraventricular navigation is done by combining a modified pediatric nasogastric tube with the electromagnetic stylet inside the endoscope's working channel. The most critical point is to obtain a blunt-bloodless ventriculostomy while achieving perfect alignment of all targeted structures via pure straight trajectories.ConclusionsThis protocol is easy-to-set-up, avoids head rigid-fixation and bulky optical-based attachments to the ventriculoscope, and allows continuous navigation of both parts of the surgery. Since we have implemented this protocol, we have noticed a significant enhancement in both simple and complex ventriculoscopic procedures because the surgery is dramatically simplified.Copyright © 2024 Elsevier Inc. All rights reserved.

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