Utilization of Paine’s technique: projecting puncture point to the skull and skin

Abstract Objective Ventriculostomy from Paine’s point is an effective technique to obtain a slack brain for aneurysm surgery. This study aimed to use Paine’s point for other neurosurgical procedures (except for those that require pterional approach) by delineation of surface landmarks for identification of Paine’s point on the cranium and scalp. Methods Based on the anatomical knowledge and examination of 3D CT images of skull, we determined novel surface landmarks to identify Paine’s point on cranium and scalp. The new method was used in patients with intraventricular hemorrhage (IVH) and aneurysmal subarachnoid hemorrhage (aSAH) caused by ruptured aneurysm of the anterior communicating artery. Results 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 IVH or aSAH who underwent aneurysm surgery via an interhemispheric approach. No adverse events were observed in any of the patients. Conclusion By accurate surface marking on skull and skin, 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.