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Jacob S. Young, Andrew J. Gogos, Matheus P. Pereira, Ramin A. Morshed, Jing Li, Matthew J. Barkovich, Shawn L. Hervey-Jumper, and Mitchel S. Berger

role in the development of GBM, and tumor proximity to the SVZ may portend a worse prognosis independent of the surgical risks associated with removing the lesion. 7 Relatively little is known about the importance of ventricular entry (VE) during periventricular tumor resection. Reports vary on the potential role VE plays in facilitating tumor dissemination, and thus whether it negatively impacts patient survival. One report found that entering the ventricle during tumor resection was associated with a significantly higher rate of perioperative complications, with

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Jessin K. John, Adam M. Robin, Aqueel H. Pabaney, Richard A. Rammo, Lonni R. Schultz, Neema S. Sadry, and Ian Y. Lee

surgical limitations that may accompany these lesions. 21 , 29 Such complications may include the development of postoperative hydrocephalus, intraventricular hemorrhage (IVH), CSF leak, or ventriculitis. Periventricular tumor location is associated with smaller resections and poorer survival. 6 , 7 , 29 In such cases, extent of resection (EOR) is sacrificed in order to prevent ventricular entry. 6 This finding may relate to the perception that ventricular entry leads to further complications and thus surgeons may practice avoidance of aggressive resection strategies

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J. Paul Elliott, G. Evren Keles, Michael Waite, Nancy Temkin, and Mitchel S. Berger

of disseminated intracranial disease. 1, 17, 18, 25, 27 Although CSF dissemination has been reported in nonsurgically treated patients with malignant glioma, some authors believe that surgical intervention, especially ventricular entry, increases the risk of CSF tumor dissemination. 15, 27 Several reports suggest that an increased risk of CSF dissemination is associated with tumors located adjacent to the CSF pathways; 3, 14, 26 however, neither of these potential risk factors has been shown to have a significant impact on the incidence of disseminated disease

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Ken R. Winston, Joseph T. Ho, and Susan A. Dolan

reuse a ventricular entry site that has been associated with infection. Many surgeons prefer to insert the new shunt in a different quadrant of the head, often on the contralateral side. Switching to a new site is perceived by its advocates as conservative practice, and the rationale for this is based on 2 closely related beliefs: a contaminated shunt track cannot be reliably sterilized, and the risk of recurrent infection is less if a new ventricular entry is made in a faraway location. 5 Risks associated with making additional ventricular punctures, although well

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Yutaka Hayashi, Mitsutoshi Nakada, Shingo Tanaka, Naoyuki Uchiyama, Yasuhiko Hayashi, Daisuke Kita, and Jun-ichiro Hamada

against longer survival. Among these factors is CSF dissemination of the tumor cells—one of the most important obstacles to overcome. 1 , 2 , 5 , 17 With the intention of performing GTR for the treatment of GBM, the incidence of ventricular entry during resection may increase, especially for tumors located near the ventricle. A ventricular entry during resection may be associated with CSF dissemination of the tumor cells, and CSF dissemination leads to CSF malabsorption followed by postoperative communicating hydrocephalus. 5 , 7 , 17 In 7 recent consecutive cases of

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Ken R. Winston and Vinay Bhardwaj

Object

The safety of reusing ventricular drain sites for shunting CSF in patients with no history of infection involving either the ventricular drain or the CSF was the focus of this investigation.

Methods

Prospectively accrued clinical data on all patients who, in an 8-year span ending in June 2008, underwent external ventricular drain placement and subsequently required CSF shunts were retrospectively evaluated for evidence of shunt infection and other complications.

Results

The infection rate for 50 consecutive operations in 50 patients who met the inclusion criteria was 2.0%.

Conclusions

Data from this study support the position that the reuse of ventriculostomy tracts when implanting first-time CSF shunts is, with regard to the risk of infection, a safe practice and avoids all risks associated with making a new ventricular entry.

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Jacob R. Joseph, Ashwin Viswanathan, and Daniel Yoshor

corpus callosum forms the anterior border of the septum pellucidum, while the splenium forms the posterior border. The general technical aspects of corpus callosotomy have been well described. 8 , 15 Entry into the lateral ventricles is a common occurrence with corpus callosotomy. However, while unavoidable and even necessary for some procedures, ventricular entry is generally recognized in neurosurgery as a potential cause of increased morbidity. For example, violation of the ependyma and intraventricular bleeding can increase the risk of aseptic meningitis or

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Akshitkumar M. Mistry, Nishit Mummareddy, Travis S. CreveCoeur, Jock C. Lillard, Brandy N. Vaughn, Jean-Nicolas Gallant, Andrew T. Hale, Natalie Griffin, John C. Wellons III, David D. Limbrick Jr., Paul Klimo Jr., and Robert P. Naftel

emerging that shed light on the mechanisms responsible for the increased malignancy of HGGs in contact with the SVZ in adults. For example, a recent clinical investigation has suggested that the increased mortality associated with SVZ+ HGGs may in part be attributable to an increased rate of tumor dissemination and hydrocephalus, which are independently associated with SVZ+ HGGs. 15 The prior literature, summarized here, 16 has suggested that ventricular entry, which occurs at a significantly higher rate in SVZ+ HGGs, 15 may lead to increased tumor dissemination

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Yutaka Maki, Yoshihiko Kokubo, Tadao Nose, and Yoshihiko Yoshii

T here are many reports of the use of radioisotope cisternography in conditions with pathological patterns of cerebrospinal fluid flow; however, few pertain to its use in the normal child. 1–4 Ventricular reflux (or ventricular entry) of the radiopharmaceutical agent is the characteristic sign of communicating hydrocephalus. If radioactivity remains in the ventricular area for 24 to 48 hours or more, “ventricular stasis” is said to be present; however, if radioactivity disappears within 24 hours, it is known as “early ventricular reflux.” Early ventricular

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Idiopathic normal-pressure hydrocephalus

Results of shunting in 62 patients

Peter McL. Black

independently at home; Grade II, some supervision required at home; Grade III, significant impairment requiring some custodial care; Grade IV, full custodial care necessary. The results of cisternographic study classified as “typical NPH” included ventricular entry of isotope, delayed clearance, and failure of convexity ascent at 72 hours. 8, 14 Other patterns were: “normal” (no ventricular entry, full convexity ascent), and “mixed” (any other pattern). Cranial computerized tomography (CT) scan reports were reviewed for comments regarding ventricular enlargement and