Ventricular access device placement in the fourth ventricle to treat malignant fourth XXXX : technical note.

@entity1 @entity1313 @entity5 @entity51 @entity1499 @entity67
PURPOSE: @entity67 ( @entity67 ) are commonly placed in the lateral ventricle but rarely placed in other ventricular compartments. This manuscript describes technical aspects of VAD placement into the fourth ventricle for the purpose of treating @entity1313 . METHODS: As part of a pilot clinical trial to treat recurrent malignant @entity1313 in @entity1 , seven @entity1 underwent posterior fossa craniotomy and placement of a ventricular catheter under direct vision into the fourth ventricle. The catheter was placed without passing through any brain parenchyma. It was then connected to a VAD placed subcutaneously at the inferior aspect of the incision. Three of the seven @entity1 underwent simultaneous subtotal resection of recurrent @entity5 located in the fourth ventricle or cerebellum, and one @entity1 underwent simultaneous @entity5 biopsy. The VAD was used to administer chemotherapy ( @entity1499 ) in five of the seven @entity1 . RESULTS: Six @entity1 had no new @entity51 after surgery, and one @entity1 had partial left-sided facial weakness that was attributed to resection of @entity5 close to the floor of the fourth ventricle. No new @entity51 were caused by VAD placement or by @entity1499 infusions into the fourth ventricle. CONCLUSIONS: A VAD for chemotherapy infusion can be placed safely into the fourth ventricle without damaging the brainstem or cerebellum. Attention to anatomical details specific to the fourth ventricle are important when placing a fourth ventricle VAD and when using it to administer chemotherapy.
