Routine placement of a ventricular reservoir at endoscopic third ventriculostomy

Objective: Endoscopic third ventriculostomy (ETV) failure may be abrupt in onset, causing a potentially life threatening increase in intracranial pressure. ETV failure may also have a more insidious onset, and in these cases, diagnosis on clinical and radiological grounds can be difficult. this study evaluates the usefulness emergency ventricular access or the diagnosis of ETV failure. Methods: A retrospective review of 84 consecutive patients undergoing ETV with routine insertion of a ventricular resevoir during a 4-year period (1996-2000) was undertaken. The mean follow-up period was 14.8 months. End points for ETV failure were shunt insertion or revision of ETV. The diagnosis and therapeutic use of the resevoir was quantified. Results: The resevoir was used in 32% of patients (n = 27). The resevoir allowed life-saving emergency ventricular access in two cases of acute recurrent hydrocephalus, the resevoir allowed for assessment of intracranial pressure (n = 19) and/or a therapeutic trial of cerebrospinal fluid aspiration (n = 5). Seven of these patients subsequently required revision ETV or shunt insertion. In the 14 patients who had normal intracranial pressure, conservative management was successful. The resevoir also facilitated intracranial drug administration for postoperative ventriculitis (n = 2). No patients requested resevoir removal. Conclusion: Routine insertion of a ventricular resevoir allows life-saving emergency therapeutic cerebrospinal fluid aspiration to be performed for sudden neurological deterioration caused by ventriculostomy failure. It also assists in the diagnosis of ETV failure and allows intrathecal drug administration.