Name of the Procedure:

Insertion of Subcutaneous Reservoir, Pump, or Continuous Infusion System for Connection to Ventricular Catheter

Summary

This procedure involves placing a small device under the skin, such as a reservoir, pump, or continuous infusion system, which is connected to a ventricular catheter to manage fluid flow within the brain. It's commonly used in conditions that require consistent medication delivery or cerebrospinal fluid (CSF) drainage.

Purpose

The procedure addresses problems like hydrocephalus, where excess cerebrospinal fluid (CSF) builds up in the brain, causing pressure and potential damage. The goal is to effectively control fluid levels in the brain and maintain normal intracranial pressure, improving symptoms and reducing risks of complications.

Indications

• Hydrocephalus (buildup of CSF in the brain)
• Chronic intracranial hypertension
• Need for regular administration of medications directly into the CSF
• Non-responsive to other forms of treatment
• Candidates include patients diagnosed with the above conditions and those who are experiencing symptoms such as headaches, balance problems, or cognitive difficulties.

Preparation

• Patients may be required to fast for a certain period before the procedure.
• Adjustments in current medications might be necessary.
• Pre-procedure assessments typically include imaging tests like MRI or CT scans to map the ventricular system.
• Blood tests may be conducted to check overall health and readiness for surgery.

Procedure Description

1. The patient is given anesthesia to ensure they are asleep and pain-free.
2. A small incision is made in the scalp where the catheter will be inserted into the ventricle (a fluid-filled cavity) of the brain.
3. The other end of the catheter is connected to a subcutaneous reservoir, pump, or infusion system, which is placed under the skin, often near the belly or chest.
4. The surgeon ensures the device is securely positioned and properly connected.
5. The incision is closed with stitches, and a dressing is applied.

Tools: Surgical scalpel, catheter, reservoir/pump/infusion device, sutures. Anesthesia: General anesthesia is typically used.

Duration

The procedure usually takes between 1 to 2 hours.

Setting

This procedure is performed in a hospital operating room.

Personnel

The team typically includes:

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Technicians

Risks and Complications

Common risks:

• Infection at the incision site.
• Bleeding.
• Blockage or malfunction of the catheter or infusion system. Rare risks:
• Damage to brain tissue.
• Neurological complications such as seizures. Management:
• Antibiotics for infections.
• Additional surgery might be required to address blockages or malfunctions.

Benefits

• Relief from symptoms of fluid buildup like headaches, nausea, and cognitive issues.
• Better regulation of intracranial pressure.
• Improved quality of life and reduction in complications associated with unmanaged hydrocephalus.

Recovery

• Patients may need to stay in the hospital for a few days for monitoring.
• Post-procedure instructions include wound care and activity restrictions.
• Follow-up appointments to check the device and overall condition.
• Full recovery may take a few weeks, during which physical activities might be limited.

Alternatives

• Medications to manage symptoms (less effective for severe cases).
• Endoscopic third ventriculostomy (another surgical option).
• Pros and cons: Medications often have limited efficacy in severe cases, while surgical alternatives may have different risk profiles or success rates depending on the individual patient’s condition.

Patient Experience

During:

• Patients won't feel anything due to general anesthesia. After:
• Some pain and swelling at the incision sites managed with pain medications.
• Possible headaches as the body adjusts.
• Comfort measures include pain management strategies and careful monitoring for complications.