====== Ventricular access device ======

===== General information =====

An indwelling [[ventricular catheter]] connected to a [[reservoir]] that is positioned under the [[scalp]] for the purpose of chronic access to the [[intrathecal]] space (usually the [[ventricular system]]), or sometimes other intracranial compartments such as [[tumor cyst]]s. Sometimes referred to generically as an [[Ommaya reservoir]]; however, this is actually a trade name.

===== Indications =====

1. administration of intrathecal (IT) [[antineoplastic]] [[chemotherapy]]:

Patients with [[leptomeningeal carcinomatosis]] face a particularly grim prognosis. Current treatment consists of [[intrathecal]] delivery of [[methotrexate]] (MTX) or [[cytosine arabinoside]] (Ara-C) via [[ventricular access device]] ([[Ommaya reservoir]]) or [[lumbar puncture]]. Yet despite these interventions, the median survival after diagnosis is only 4-7 months
((Chen TC, Napolitano GR, Adell F, Schönthal AH, Shachar Y. Development of the
Metronomic Biofeedback Pump for leptomeningeal carcinomatosis: technical note. J 
Neurosurg. 2015 Aug;123(2):362-72. doi: 10.3171/2014.10.JNS14343. Epub 2015 May
8. PubMed PMID: 25955873.
)).

a) For CNS [[lymphoma]] or [[leukemia]] 

b) IT chemotherapy is often used for the following even in the absence of CNS involvement
because of the high relapse rate in the CNS: acute lymphoblastic leukemia, lymphoblastic
lymphoma, Burkitt’s lymphoma

2. administration of intrathecal antibiotic for chronic [[meningitis]]

3. chronic removal of CSF from infants with [[intraventricular hemorrhage]]

4. for fluid aspiration from a chronic [[tumor cyst]] that is resistant to therapy (radiation or surgery)