84 Ventricular Access Device
Daniel Sciubba

♦ Preoperative

• Review imaging (computed tomography, magnetic resonance imaging, or ultrasound in neonate)
  
• Ventricular catheter placement:
  
  
  
  
  • Right frontal placement preferred (see Chapter 83, External Ventricular Drain [Ventriculostomy])
    
  • Target largest ventricle if ventricular asymmetry exists

Equipment

• Basic shunt tray
  
• Ventricular access device (Ommaya, Leroy, etc.)

Operating Room Set-up

• Headlight
  
• Loupes (optional)
  
• Bipolar cautery

Anesthetic Issues

• Room should be warm to ensure normothermia in neonates
  
• Intravenous antibiotics with skin flora coverage (cefazolin 2 g for adults, 30 mg/kg for pediatrics) should be given 30 minutes prior to incision

♦ Intraoperative

Subgaleal Pocket (Fig. 84.1)

• Clamp or blunt digital dissection used to create pocket
  
• Reservoir placed in pocket
  
• Reservoir sutured to galea or fastened with screw to skull as needed

Catheter Placement

• See Chapter 83
  
• Consider stereotactic placement, especially for patients with small or shifted ventricles

Connection

• Once in ventricle, catheter connected to reservoir with 2–0 silk tie
  
• Prior to closure, aspirate from reservoir using a 23-gauge needle or smaller to confirm correct catheter placement in ventricle or cyst

Fig. 84.1 Ventricular access device with catheter in ventricle, with either no distal catheter (Ommaya), distal catheter placed in subgaleal compartment, or distal catheter in peritoneum.

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