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Gary D. Vander Ark and Karl Stecher Jr.

T he use of ventricular cannulation for measuring intracranial pressure, removal of ventricular fluid, and ventriculography has increased markedly in recent years. Instrumentation for ventricular puncture ideally should be readily available, simple, sterile, and inexpensive. Because we were unable to interest a manufacturer in providing such a kit, we have developed a ventriculostomy apparatus that meets the above criteria using materials readily available in most general hospitals. The materials necessary are pictured in Fig. 1 . Only the twist drill is

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Percutaneous tunnel ventriculostomy

Summary of 100 procedures

William A. Friedman and John K. Vries

P ercutaneous ventriculostomy is an important therapeutic adjunct for the control of hydrocephalus, for intracranial pressure (ICP) monitoring, and for the management of bacterial infection of the central nervous system. The infection rate for this procedure, however, has remained high, despite meticulous care of the external drainage system and the use of prophylactic antibiotics. 8, 12 One important source for bacterial infection in these cases is contamination of the tract of the ventricular catheter at the site where it penetrates the scalp. The authors

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Theodore H. Schwartz, Brian Ho, Charles J. Prestigiacomo, Jeffrey N. Bruce, Neil A. Feldstein, and Robert R. Goodman

R ecent advances in endoscopic technology have led to a rise in the performance of third ventriculostomy for noncommunicating hydrocephalus. Although this technique avoids the risks of infection, malfunction, and overfunction associated with the placement of a mechanical shunt, its reliance on the reabsorptive capacity of the arachnoid granulations often translates into a minimal or unappreciable change in ventricular size. This may be true even in patients who experience symptomatic relief following successful surgery. Various invasive or costly techniques have

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Max Schneider, Christian Kunz, Andrej Pal’a, Christian Rainer Wirtz, Franziska Mathis-Ullrich, and Michal Hlaváč

T he ventriculostomy is among the most common operations in neurosurgical practice, either as a standalone procedure, such as in placement of an external ventricular drain (EVD), or as part of a more complex operation, such as the implantation of a shunt system. 1 The procedure is usually conducted freehand, using visible or palpable anatomical landmarks for orientation. 2 This remains true even in times of widespread availability of technical aids such as neuronavigation systems, whose setup and application are often considered too time-consuming. 3 The

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John A. Kusske, Paul T. Turner, George A. Ojemann, and A. Basil Harris

T he association between subarachnoid hemorrhage (SAH) and the development of hydrocephalus has been well documented. 1–3, 6, 7, 10, 15 Hydrocephalus may appear acutely after hemorrhage, or emerge within hours or days. Treatment of hydrocephalus with a permanent shunt is reported to have produced noticeable clinical improvement. 12 We suggest that it is more effectively treated with external ventriculostomy. External ventricular drainage accomplishes two objectives: 1) patients with poor clinical grades unfavorable to surgery improve with ventricular

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Philippe Decq, Caroline Le Guerinel, Stéphane Palfi, Michel Djindjian, Yves Kéravel, and Jean-Paul Nguyen

S ince its first description by Dandy 3 in 1922 and its first realization under endoscopic control by Mixter 18 in 1923, third ventriculostomy has been more and more routinely performed for the treatment of non-communicating hydrocephalus 1, 2, 4, 6, 7, 11–13, 20, 21 After the works of Guiot, et al., 10 in 1963, the development of endoscopes made the procedure easier and safer than with radioscopic 5, 9 or stereotactic control alone. 15 The introduction of a rigid endoscope through a precoronal burr hole into the frontal horn of the lateral ventricle, and

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S. Scott Lollis and David W. Roberts

R OBOTIC applications hold great promise for improving clinical outcomes and reducing the complications of surgery. Because of its amenability to stetions of surgery. Because of its amenability to stereotactic techniques, its focus on narrow surgical corridors, and its traditional high-technology emphasis, neurosurgery offers a fertile ground for the application of robotic technology. We hypothesized that image-guided, robotic placement of a ventriculostomy catheter is safe, highly accurate, and highly reproducible. Clinical Material and Methods

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Jon I. McIver, Jonathan A. Friedman, Eelco F. M. Wijdicks, David G. Piepgras, Mark A. Pichelmann, L. Gerard Toussaint III, Robyn L. McClelland, Douglas A. Nichols, and John L. D. Atkinson

R ecurrent hemorrhage is an important source of morbidity after initial rupture of an intracranial aneurysm. 1, 13 Theoretically, CSF drainage in patients with an unsecured, recently ruptured cerebral aneurysm may increase transmural pressure across the aneurysm wall, thereby increasing the likelihood of recurrent hemorrhage. 9 Despite the widespread use of ventriculostomy for the treatment of acute hydrocephalus after aneurysmal SAH, there is no consensus regarding the risk of rebleeding when ventriculostomy is performed before aneurysm repair. This

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Paolo Missori, Sergio Paolini, and Maurizio Domenicucci

Andreas van Wessel to report, for the first time, the true intraventricular collection of CSF in a case of pediatric hydrocephalus. 34 This discovery questioned the value of a surgical procedure that had been in use for more than 2 millennia. Based on his surgical knowledge, Hieronymus Fabricius d'Acquapendente (Fabrizio d'Acquapendente or Fabricius, c. 1533–1619) reported a new surgical technique, which confirmed the intraventricular location of the fluid. The Cannula in Ventriculostomy Fabricius' 11 major surgical text, Opera Chirurgica in Duas Partes Divisa

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Faith C. Robertson, Muhammad M. Abd-El-Barr, Srinivasan Mukundan Jr., and William B. Gormley

V entriculostomy is one of the most common neurosurgical procedures, with more than 40,000 performed annually for both diagnostic and therapeutic purposes. 1 Historically, ventriculostomy placement involved freehand catheterization using skull surface anatomy to estimate an appropriate entry site, first performed by Keen in 1890. 12 Later, Kocher used a craniometer to estimate ventricle location by anatomical skull landmarks, followed by Dandy cannulating the anterior and occipital ventricular horns in 1918, 7 to the device-assisted method described by Ghajar