Name of the Procedure:

Twist Drill Hole for Subdural, Intracerebral, or Ventricular Puncture; Implantation of Ventricular Catheter/Monitoring Device

Summary

This procedure involves making a small hole in the skull to allow access to subdural, intracerebral, or ventricular spaces for various medical purposes. It is commonly used to implant a ventricular catheter, install a pressure recording device, or place another type of intracerebral monitoring device.

Purpose

This procedure is designed to relieve pressure from brain hemorrhages, monitor intracranial pressure, or drain cerebrospinal fluid in cases of hydrocephalus. The goals include reducing symptoms like headaches or confusion, preventing brain damage, and closely monitoring brain function.

Indications

• Severe head trauma
• Brain hemorrhage or stroke
• Hydrocephalus (excess fluid accumulation in the brain)
• Monitoring for intracranial pressure in critically ill patients
• Symptoms like severe headache, confusion, or unconsciousness due to increased intracranial pressure

Preparation

• Fasting for 6-8 hours prior to the procedure
• Stopping certain medications (e.g., blood thinners) as recommended by the doctor
• Pre-procedure imaging tests like CT or MRI scans to guide the procedure
• Blood tests to check clotting function

Procedure Description

1. The patient is usually given local anesthesia to numb the scalp and sometimes conscious sedation.
2. The surgical area is shaved and sterilized.
3. The surgeon drills a small hole into the skull using a specialized twist drill.
4. Once the hole is made, the surgeon carefully inserts the catheter or monitoring device into the designated area (subdural, intracerebral, or ventricular).
5. The device is secured and the scalp is sutured or stapled closed.
6. The device is connected to external monitoring equipment, if applicable.

Duration

The procedure typically takes around 1 to 2 hours, depending on complexity.

Setting

The procedure is generally performed in a hospital operating room or a specialized interventional radiology suite.

Personnel

• Neurosurgeon or neurosurgical specialist
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technologists
• Radiologist (if imaging guidance is used)

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Damage to brain tissue
• Device malfunction or displacement
• Seizures
• Reactions to anesthesia

Benefits

• Immediate relief from elevated intracranial pressure
• Accurate monitoring of brain conditions
• Prevention of further brain injury
• Timely and precise intervention for brain-related emergencies

Recovery

• Hospital stay ranging from a few days to a week, depending on the patient’s condition
• Regular monitoring of neurological status and device function
• Instructions for care of the surgical site
• Restrictions on physical activity to avoid dislodging the device
• Follow-up appointments for device adjustment or removal

Alternatives

• Non-invasive monitoring techniques (e.g., transcranial Doppler)
• Medical management of intracranial pressure with drugs or hyperventilation
• Surgical options like craniotomy for more severe cases Pros and cons of alternatives include less invasiveness but potentially less precision and effectiveness for severe conditions.

Patient Experience

• Mild discomfort or pressure during local anesthesia administration
• Patients may feel drowsy but should not feel pain during the procedure
• Post-procedure soreness at the surgical site
• Pain management with prescribed medications
• Initial swelling and bruising may occur but will subside within a few days