Name of the Procedure:

Neuroendoscopy, Intracranial, for Placement or Replacement of Ventricular Catheter and Attachment to Shunt System or External Drainage

Summary

In layman's terms, neuroendoscopy is a minimally invasive surgical procedure performed to place or replace a tube (ventricular catheter) in the brain, which helps drain excess cerebrospinal fluid either to an external drainage system or into another part of the body through a shunt system. The procedure involves using a small camera (endoscope) to navigate within the brain.

Purpose

The procedure addresses conditions where there is excess cerebrospinal fluid (CSF) in the brain, a condition known as hydrocephalus. The goals are to relieve pressure on the brain, prevent fluid buildup, alleviate symptoms such as headaches and nausea, and prevent potential brain damage.

Indications

• Symptoms of hydrocephalus such as persistent headaches, nausea, vomiting, and balance problems.
• Diagnosed with conditions like congenital hydrocephalus, normal pressure hydrocephalus, or brain hemorrhage that leads to fluid buildup.
• Previous shunt failure or infection requiring replacement or adjustment.

Preparation

• Patients are typically instructed to fast for several hours before the procedure.
• Medication adjustments may be necessary, particularly blood thinners.
• Pre-procedure imaging, such as MRI or CT scans, may be required to plan the surgical approach.

Procedure Description

1. The patient is positioned and administered general anesthesia.
2. A small incision is made in the scalp and a hole is drilled into the skull.
3. An endoscope is inserted through the hole to provide a visual of the brain's ventricles.
4. The surgeon places or replaces the ventricular catheter in the appropriate ventricle.
5. The catheter is then connected either to an external drainage system or to a shunt system for internal drainage.
6. The endoscope is removed, and the incision is closed.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

This procedure is performed in a hospital surgical suite or a specialized neurosurgical center.

Personnel

• Neurosurgeon
• Surgical nurses
• Anesthesiologist
• Operating room technician

Risks and Complications

• Common risks: Infection, bleeding, and wound healing problems.
• Rare risks: Stroke, brain damage, or reactions to anesthesia.
• Possible complications include catheter blockage, shunt failure, or need for a repeat procedure.

Benefits

• Alleviation of symptoms related to hydrocephalus.
• Prevention of further neurological damage.
• Improvement in quality of life often noticeable within a few days to weeks after the procedure.

Recovery

• Post-procedure monitoring in the hospital for a few days.
• Instructions may include activity restrictions, wound care, and medication regimens.
• Follow-up appointments for imaging and shunt function assessment.
• Full recovery may take several weeks.

Alternatives

• Endoscopic third ventriculostomy (ETV), where a bypass is created to drain CSF.
• Serial lumbar punctures, though this is often temporary and less effective.
• Each alternative has its own pros and cons, and suitability depends on the patient's specific condition.

Patient Experience

During the procedure, the patient will be under general anesthesia and won't feel any pain. Post-procedure, some discomfort and mild pain at the incision site may be managed with pain medications. Patients might experience relief from hydrocephalus symptoms fairly quickly, and will be monitored closely to ensure there are no complications.