62162 Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage

Name of the Procedure:

Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage

Summary

Neuroendoscopy is a minimally invasive surgical technique used to remove a colloid cyst from the brain. The procedure involves using an endoscope to access and excise or fenestrate the cyst via a small incision. An external ventricular catheter is also placed to help drain cerebrospinal fluid and manage intracranial pressure.

Purpose

Medical Condition

• Colloid cysts in the brain's ventricles

Goals

• Remove the cyst to alleviate symptoms
• Prevent potential complications like hydrocephalus or sudden neurological decline

Indications

Symptoms

• Headaches
• Nausea/Vomiting
• Memory problems
• Hydrocephalus (fluid buildup in the brain)

Patient Criteria

• Presence of a symptomatic colloid cyst
• Imaging findings suggesting a risk of obstructive hydrocephalus

Preparation

• Fasting for 6-8 hours prior to the procedure
• Adjustments to current medications as directed by the physician
• Pre-procedure diagnostic tests: MRI or CT scans, blood tests, and neurological assessment

Procedure Description

1. Patient is administered general anesthesia.
2. A small incision is made in the scalp, and a burr hole is drilled into the skull.
3. An endoscope is carefully inserted into the brain to locate the colloid cyst.
4. Using specialized instruments, the surgeon excises or fenestrates the cyst.
5. An external ventricular catheter is placed to drain cerebrospinal fluid and reduce intracranial pressure.
6. The catheter is connected to an external drainage system.
7. The incision is closed, and the patient is moved to recovery.

Tools and Technology

• Neuroendoscope
• Surgical instruments for excision or fenestration
• External ventricular catheter and drainage system

Anesthesia

• General anesthesia

Duration

Typically, 2-4 hours.

Setting

Hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Neuroendoscope technician

Risks and Complications

Common Risks

• Infection
• Bleeding
• CSF leakage

Rare Risks

• Damage to surrounding brain tissue
• Seizures
• Stroke

Management

• Postoperative antibiotics for infection
• Close monitoring and immediate intervention for complications

Benefits

• Relief from symptoms like headaches and nausea
• Reduced risk of hydrocephalus and sudden neurological events
• Improvement in overall quality of life, often noticeable within a few days to weeks

Recovery

• Initial recovery in the intensive care unit for close monitoring
• Instructions for catheter care if it remains temporarily
• Gradual resumption of normal activities
• Follow-up appointments for monitoring progress and removing the catheter if necessary

Alternatives

Other Treatment Options

• Stereotactic aspiration
• Open neurosurgery

Pros and Cons

• Stereotactic aspiration: Less invasive but may require multiple interventions
• Open neurosurgery: More invasive, longer recovery, but allows for better access if the cyst is complex

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-operation, mild to moderate pain or discomfort around the incision site may occur, manageable with prescribed pain medication. Some patients may experience headaches, nausea, or fatigue during the initial recovery phase.