Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection
CPT4 code
Name of the Procedure:
Ventricular Puncture through Previous Burr Hole, Fontanelle, Suture, or Implanted Ventricular Catheter/Reservoir; Without Injection. Commonly referred to as Ventricular Tap or Ventriculostomy.
Summary
A ventricular puncture is a medical procedure where a small amount of cerebrospinal fluid (CSF) is removed from the brain's ventricles. This is done through a pre-existing opening in the skull (such as a burr hole, fontanelle, suture) or an implanted device (such as a ventricular catheter/reservoir).
Purpose
This procedure addresses situations where the cerebrospinal fluid needs to be sampled for diagnostic testing or when excess fluid needs to be drained to reduce intracranial pressure. The goal is to obtain cerebrospinal fluid for analysis or to relieve pressure caused by fluid buildup in the brain.
Indications
- Increased intracranial pressure
- Diagnostic testing for infections, bleeding, or metabolic disorders
- Hydrocephalus (excess fluid in the brain)
- Monitoring of cerebral conditions in critically ill patients
Preparation
- Fasting may be required for a few hours before the procedure.
- Medication adjustments, including withholding blood thinners.
- Pre-procedure imaging studies (CT, MRI) to evaluate the ventricles' condition.
Procedure Description
- Preparation: The patient is positioned appropriately, and the site is cleaned and sterilized.
- Anesthesia: Local anesthesia may be administered to numb the area.
- Access: Using a needle, the healthcare provider accesses the brain ventricle through the pre-existing opening or implanted device.
- Fluid Removal: A small amount of cerebrospinal fluid is drawn out.
- Closure: The access site is cleaned and bandaged.
Tools used include sterilized needles, syringes, antiseptic solutions, and drapes. Local anesthesia is typically used, although sedation may be provided for patient comfort.
Duration
The procedure typically takes between 15 and 30 minutes.
Setting
The ventricular puncture is performed in a hospital, either in an operating room, intensive care unit, or specialized procedural suite.
Personnel
- Neurosurgeon or neurologist
- Nurses
- Anesthesiologist (if sedation is used)
Risks and Complications
- Infection at the puncture site
- Bleeding
- Damage to brain structures
- Headache
- Altered brain function if too much CSF is removed
Management of complications includes antibiotics for infection, surgical intervention for bleeding, and supportive care for any neurological changes.
Benefits
- Relief from increased intracranial pressure
- Accurate diagnosis of conditions from CSF analysis
- Improved patient monitoring and management
Benefits are often realized immediately, especially in cases of severe fluid buildup.
Recovery
- Monitoring of vital signs and neurological status for several hours post-procedure.
- The patient may need to lie flat for a while to prevent headaches.
- Follow-up appointments to assess the outcome and decide on further care.
- Most patients can resume normal activities within a day or two unless otherwise advised.
Alternatives
- External ventricular drain (EVD)
- Lumbar puncture (spinal tap)
- Imaging studies (CT, MRI)
Each alternative has its pros and cons, such as varying degrees of invasiveness, effectiveness, and suitability depending on the patient's specific condition.
Patient Experience
During the procedure, the patient might feel pressure or mild discomfort. Post-procedure, headaches and soreness at the puncture site are common but manageable with pain medications and rest. Comfort measures such as lying down and adequate analgesia are provided to enhance recovery.