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Hydrocephalus: ventriculostomy

Procedure description

A ventriculostomy is a procedure performed to drain cerebrospinal fluid from the brain.  At the same time, the pressure in the brain can be accurately monitored.  There are a number of reasons why cerebrospinal fluid may build up in the brain (tumor, meningitis, hemorrhage, and others).

A ventriculostomy may be placed at the patient's bedside or in the operating room.  The patient may be sedated if required, and a local anesthetic is used.  A "twist drill" hole is made in the skull, and a catheter (tube) is placed through it, into the frontal horn of the lateral ventricle (placed through the lobe in the front of the brain, into a fluid filled cavity known as the ventricle).  Through this tube, fluid can be withdrawn if the pressure in the brain becomes too high, and the intracranial pressure can be continually monitored. 

Procedure Risks

Risks for ventriculostomy can be broken down into two categories, 1) those related to the operative site, and 2) those related to the risks of anesthesia. 

Risks related to the operative site

Surgical Exposure:  The patient is placed on their back.   The incision in the scalp is small.  There is risk of non healing of the scalp or bone post operatively. 

Brain injury:  The surgery involves placing a tube through the surface of the brain into the ventricle (fluid filled cavity within the brain).   The ventricle is sometimes difficult to "hit" or target, and several "passes" of the tube through the brain may be necessary.  Each pass carries risk of brain damage and bleeding.  There could be bleeding if an artery or vein is hit, and this could require emergent surgery to open the skull and remove the clot.  If there is  injury to the brain, it could result in weakness, seizures, stroke, paralysis, coma or death.  There may be residual fluid or blood, requiring additional surgery in the future.  Damage to the frontal lobes of the brain may result in personality changes.

General Risks
These include such  general difficulties as bleeding, infection, stroke, paralysis, coma and death.  Incisions on the scalp generally heal well, but could become  tender, numb,  or may heal in an unpleasant manner.  There is also the possibility that the surgery may not relieve the symptoms for which the procedure was performed.    The catheter in the brain is connected to a drainage bag, which is external to the body.  This means that there is a slightly higher risk of infection, than if the tube were completely internal.

Risks of Anesthesia: Blood clots in the legs, heart attacks, reaction to the anesthetic, reaction to blood transfusion, if  given.

Post-operative care:

Since a patient is not discharged home with a ventriculostomy in place, but is cared for by the nurses in the hospital, the postoperative care will be performed by the nurses in the hospital.

 

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