title: Routine placement of a ventricular reservoir at endoscopic third ventriculostomy.
abstract: 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 of routine ventricular reservoir placement at the time of ETV for subsequent 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 reservoir 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 diagnostic and therapeutic use of the reservoir was quantified.
  
  
  RESULTS
  The reservoir was used in 32% of patients (n = 27). The reservoir allowed life-saving emergency ventricular access in two cases of acute recurrent hydrocephalus. In patients with symptoms but equivocal radiological evidence of recurrent hydrocephalus, the reservoir 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 reservoir also facilitated intrathecal drug administration for postoperative ventriculitis (n = 2). No patients requested reservoir removal.
  
  
  CONCLUSIONS
  Routine insertion of a ventricular reservoir 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.
authors.affiliation: Department of Neurosurgery, Frenchay Hospital, Bristol, England.
authors.forename: Kristian
authors.initials: K
authors.lastname: Aquilina
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Edwards
authors.forename: Ian K
authors.initials: IK
authors.lastname: Pople
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D017211:Treatment Failure; D014696:Ventriculostomy / Q000009:adverse effects*