Name of the Procedure:

Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter).

Summary

Neuroendoscopy is a minimally invasive surgical procedure performed inside the skull (intracranial) to treat issues within the brain's ventricles. This specific procedure involves removing adhesions (scar tissue), creating openings in the septum pellucidum, or addressing intraventricular cysts and may include managing a ventricular catheter.

Purpose

This procedure addresses neurological conditions involving blockages or fluid buildup within the brain's ventricles, which can lead to symptoms like headaches, nausea, and changes in mental status. The goal is to improve cerebrospinal fluid (CSF) flow or remove obstructions, ultimately relieving symptoms and preventing further neurological damage.

Indications

• Hydrocephalus (accumulation of cerebrospinal fluid within the brain).
• Obstructive lesions or cysts within the ventricular system.
• Adhesions or scar tissue causing CSF flow obstruction.
• Patients experiencing symptoms such as persistent headaches, balance issues, or cognitive changes related to fluid buildup in the brain.

Preparation

• Patients are usually required to fast for 8 hours before the procedure.
• Medication adjustments may be needed, particularly for blood thinners.
• Pre-operative imaging studies such as MRI or CT scans are required to plan the surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made in the scalp, and a burr hole is drilled into the skull.
3. A neuroendoscope (a small, flexible tube with a camera) is inserted through the burr hole into the brain's ventricular system.
4. The surgeon uses specialized instruments to dissect adhesions, fenestrate the septum pellucidum, or remove/relocate cysts within the ventricles.
5. If needed, a ventricular catheter is placed, replaced, or removed to manage CSF flow.
6. The incision is closed, and the patient is moved to a recovery area.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity.

Setting

This procedure is performed in a hospital operating room equipped with specialized endoscopic equipment.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Damage to brain tissue
• Risks associated with anesthesia
• Complications related to catheter placement, such as malfunction or migration
• CSF leak

Benefits

• Alleviates symptoms caused by CSF blockages or cysts in the brain.
• Minimally invasive, which often results in shorter recovery times and less postoperative pain.
• Improves overall quality of life and neurological function.

Recovery

• Patients typically stay in the hospital for a few days for monitoring.
• Instructions for post-procedure care include wound care and activity restrictions.
• Follow-up appointments are necessary to ensure proper recovery and monitor for complications.
• Full recovery can vary but generally occurs within a few weeks to a couple of months.

Alternatives

• Traditional open brain surgery may be an option, though it is more invasive.
• Medical management with medications to reduce symptoms.
• Ventriculoperitoneal (VP) shunting, another surgical option to divert CSF.

Patient Experience

• During the procedure, patients will be under general anesthesia and will not feel pain.
• Postoperatively, some discomfort or headache may be expected, which can be managed with pain medications.
• Patients may experience mild swelling or nausea, but most symptoms subside within a few days.
• Continuous support from nursing staff ensures comfort and addresses any immediate postoperative concerns.