Gaudena, a.J., pears, c., parker, a., woon, k., kock, h., hunn, m., symons, w., and wickremesekera, a.Endoscopic neuroendoscopy using a novel ventricular access port.British journal of neurosurgery.2018, vol.32, no.6, 653¿656 https://doi.Org/10.1080/02688697.2017.1418292.Background: hydrocephalus remains an important aspect of neurosurgical care and in select circumstances, the endoscopic third ventriculostomy (etv) continues to remain an important treatment.In our initial experience of etv using the commercially available plastic ventricular ports we found them both restrictive and expensive.Following this experience, we developed a stainless steel ventricular access port (vap).We present our novel method of access involving this non-disposable ventricular port.Method: we have developed a series of custom-made, (b)(4)-grade stainless steel vaps designed specifically for our ventricular endoscopes.Following a standard burr-hole, cannulation of the lateral ventricle is performed inserting this port and removing the trocar allowing free access using a standard ventriculoscope without the requirement for disposable plastic ports.Since 2008 our unit has used a standard method of ventricular access using this device.We present our long-term experience of cases of endoscopic ventriculoscopy and ventriculostomy using this method of ventricular access.Results: from december 2008 to january 2016, 56 patients underwent an endoscopic third ventriculostomy using the stainless steel ventricular port.Two 2 patients (3.6%) had a recorded complication in the form of minor self-limiting intraventricular haemorrhage.No cases of infection or mortality were noted in this patient series.Conclusion: we demonstrate our long-term experience with a non-disposable vap for ventricular access.This method remains safe with results that are comparable to published series.We suggest this met reportable events: 1 patient (1.2%) had an intraventricular haemorrhage related to the procedure which resolved spontaneously and did not affect the outcome of the procedure.1 other patient (1.2%) an etv was not able to be completed and was abandoned in favour of a ventriculo-peritoneal shunt in the same sitting.In this case, the port was placed into the lateral ventricle and the endoscope was passed into the lateral ventricle with no difficulty.Of the series 20 patients (23.3%) who had an etv required further intervention with a ventriculo-peritoneal shunt, secondary to patient selection, unrelated to the use of the vap.Four patients (4.6%) required a repeat etv following initial failure using the same system which ranged from the early postoperative phase up to 3 years following the initial procedure.One patient (1.2%) had a csf leak recorded in the immediate postoperative period.Two patients (2.4%) had a recorded complication in the form of intraoperative self-limiting intraventricular haemorrhage requiring no further surgical intervention.
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