Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Accurate localization of Keen's point is a critical step in ventriculoperitoneal (VP) shunt surgery, directly influencing ventricular catheter placement and subsequent shunt function. In many low- and middle-income countries, Keen's point is commonly identified using fingerbreadth estimation or surgeon experience rather than standardized cranial measurements. Variability in localization may contribute to catheter malposition, shunt dysfunction, and unfavorable clinical outcomes. This study aimed to compare standardized measurement-based localization of Keen's point with conventional estimation techniques in terms of localization accuracy, surgical complications, and clinical outcomes. <bold>Methods:</bold> This prospective comparative study included 140 patients undergoing VP shunt placement for hydrocephalus. Patients were divided into two groups according to the method used for localization of Keen's point. In the standardized measurement group, Keen's point was identified using predefined anatomical landmarks and measuring tape. In the conventional estimation group, localization was performed using fingerbreadth estimation and surgeon experience. Also demographic characteristics etiology of hydrocephalus, postoperative imaging findings, catheter tip location, complications and clinical outcomes were recorded and analyzed. Neurological status is assessed using the Glasgow Coma Scale (GCS). <bold>Results:</bold> The majority of patients were children, and congenital hydrocephalus was the most common etiology (49.3%). Overall clinical improvement was observed in 75.7% of patients. Satisfactory postoperative imaging was achieved in 74.3% of cases, while hydrocephalus resolved in 67.1%. The standardized measurement group demonstrated superior radiological outcomes, with a higher proportion of satisfactory postoperative CT scans (95.7% vs. 57.1%) and greater hydrocephalus resolution rates (78.6% vs. 55.7%) compared with the conventional estimation group. Postoperative GCS scores were also significantly higher in the standardized measurement group (p = 0.02). <bold>Conclusion:</bold> Standardized measurement-based localization of Keen's point was associated with improved catheter placement accuracy, better radiological outcomes, and superior neurological recovery compared with conventional estimation techniques. Adoption of standardized localization methods may represent a simple, reproducible, and cost-effective strategy to improve VP shunt outcomes, particularly in resource-limited settings. </p>