Dual-step burr hole with periosteal anchoring technique: a robust method for ventricular catheter fixation – how I do it

Proximal catheter-related complications of ventriculoperitoneal shunt (VPS) and Ommaya reservoir implantation remain an important factor leading to reoperation rates and morbidity. Conventional fixation methods often fail to provide adequate mechanical stability. A shallow outer burr hole is created to accommodate a catheter with right-angle guide. A smaller inner burr hole is then drilled at the centre to expose the dura and allow catheter passage. The connector is anchored to the preserved pericranium using nonabsorbable sutures, followed by reapproximation of the periosteal flap. This technique provides a robust, multiplanar mechanical barrier against catheter migration and kinking.