The subcutaneous ventricular access device or ventricular reservoir (Fig. 57.1) is used to drain cerebrospinal fluid (CSF) from the ventricular system in preterm infants with posthemorrhagic ventricular dilatation (PHVD) and occasionally in term infants with obstructive hydrocephalus following intracranial hemorrhage or aqueduct stenosis (1, 2, 3, 4, 5, 6, 7). The ventricular reservoir is inserted in preterm infants who are too small and/or unstable to have a ventriculoperitoneal (VP) shunt inserted and it may abrogate or delay the need for a VP shunt in some infants. It also allows drainage and clearing of CSF which may be bloody and have a high protein content, particularly in the early posthemorrhagic phase, thereby decreasing the risk of blockage when a VP shunt is inserted (2, 3, 6, 7, 8). A ventricular reservoir is preferably not placed within the first postnatal week because of the risk of rebleeding.

Insertion of a ventricular reservoir under ultrasound guidance is recommended. The reservoir is usually tapped immediately following insertion, by the neurosurgeon, to ensure proper placement. Subsequently, initially daily taps are performed in the neonatal intensive care unit (NICU), aiming to remove enough CSF to prevent further ventriculomegaly and preferably reduce ventricular size, maintain normal head growth, and reduce pressure on the surrounding periventricular white matter (2, 6, 7, 9).