Name of the Procedure:

Burr Hole(s); for implanting ventricular catheter, reservoir, EEG electrode(s), pressure recording device, or other cerebral monitoring device (separate procedure)

Summary

A burr hole procedure involves drilling a small hole in the skull to enable the implantation of various cerebral monitoring devices or treatments. This allows for direct access to the brain for diagnostic or therapeutic purposes.

Purpose

The procedure addresses conditions that require monitoring or direct intervention in the brain, such as hydrocephalus, increased intracranial pressure, or epilepsy. The goal is to accurately diagnose and manage these conditions by monitoring brain activity or pressure and providing necessary treatments.

Indications

• Symptoms of increased intracranial pressure (headaches, nausea, vision problems)
• Hydrocephalus (excess cerebrospinal fluid in the brain)
• Epilepsy (requiring EEG monitoring)
• Severe brain trauma or hemorrhage
• Neurological conditions needing direct monitoring of brain pressure or activity

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments might be necessary, especially blood thinners.
• Pre-procedure imaging tests (CT scan or MRI) to guide the precise location of the burr hole.
• Blood tests to assess overall health and clotting status.

Procedure Description

1. The patient is positioned, and the surgical area is sterilized.
2. Local or general anesthesia is administered.
3. A small incision is made in the scalp.
4. A specialized surgical drill is used to create a burr hole in the skull.
5. The necessary device (ventricular catheter, reservoir, EEG electrode, etc.) is carefully implanted through the burr hole.
6. The device is secured in place, and the incision is closed with sutures or staples.
7. Post-placement imaging may be done to ensure correct positioning.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and the specific device being implanted.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center equipped for neurosurgeries.

Personnel

• Neurosurgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologist

Risks and Complications

• Common risks: Infection, bleeding at the surgical site, mild pain at the incision site.
• Rare risks: Damage to brain tissue, seizures, cerebrospinal fluid leakage, stroke.
• Management: Regular monitoring, antibiotics for infection, immediate intervention for severe complications.

Benefits

• Accurate diagnosis and monitoring of brain conditions.
• Relief from symptoms associated with hydrocephalus or high intracranial pressure.
• Improved management of epilepsy or other neurological disorders.
• Benefits are typically realized soon after the procedure, with diagnostic data or symptom relief evident within days.

Recovery

• Short hospital stay for monitoring and recovery.
• Pain management with prescribed medications.
• Incision care instructions provided.
• Avoid strenuous activities for several weeks.
• Follow-up appointments to monitor healing and device function.

Alternatives

• Non-invasive imaging techniques (MRI, CT scans) for diagnosis.
• Medical management with medications (in cases where appropriate).
• Endoscopic third ventriculostomy (for hydrocephalus).
• Pros and cons depend on the specific condition being treated and can be discussed with the healthcare provider.

Patient Experience

• During the procedure: Usually none if under general anesthesia; mild discomfort if under local anesthesia.
• After the procedure: Mild to moderate pain at the incision site, managed with medications.
• Gradual resumption of normal activities, with specific guidelines from the healthcare provider.
• Emotional and psychological support may be beneficial, especially for patients undergoing treatment for chronic conditions.