AbstractWe report the effectiveness of a new strategy for ventricular cannulation that allows for easy insertion into the firm ventricular wall.The new ventricular needle consisting of an outer needle, a dull inner needle, and a sharp inner needle was used for a firm ventricular wall tap in five patients. The dull inner needle was used for the brain mantle tap, whereas the sharp needle was used for penetrating the ventricular wall. The outer needle with the insertion of the dull inner needle was set for initial puncture. If the operator felt that the ventricular wall was firm or confirmed that the tip of the cannula indented the wall of the ventricle using real-time ultrasound monitoring before penetrating the ventricle wall, then the inner needle was changed to the sharp one to penetrate the ventricular wall. After confirming that the trajectory was now passing into the ventricle, the ventricular catheter was placed using the trajectory.There was no perioperative complication associated with insertion of the device. All catheters were inserted with a single pass through the brain mantle.The new ventricular tap strategy is safe and effective for firm ventricular wall tap and ventricular catheter insertions.