Name of the Procedure:

Ventriculocisternostomy (Torkildsen type operation)

Summary

The Torkildsen type operation, also known as ventriculocisternostomy, is a surgical procedure that creates a new pathway for cerebrospinal fluid (CSF) to flow from the lateral ventricles of the brain to the cisterna magna, thereby alleviating hydrocephalus. This helps to bypass obstructions and reduce pressure build-up in the brain.

Purpose

Medical Condition Addressed:

• Hydrocephalus or cerebrospinal fluid buildup and obstruction in the ventricular system of the brain.

Goals/Outcomes:

• To relieve elevated intracranial pressure
• To prevent or mitigate neurological damage by restoring normal CSF flow.

Indications

Symptoms/Conditions:

• Persistent headaches
• Nausea and vomiting
• Vision disturbances from increased intracranial pressure.
• Enlarged ventricles visible on imaging studies due to CSF flow obstruction.

Patient Criteria:

• Patients diagnosed with obstructive hydrocephalus not amenable to other forms of treatment.
• Patients for whom shunt procedures are not suitable due to various factors.

Preparation

Pre-Procedure Instructions:

• Fasting for 8 hours before surgery.
• Ceasing certain medications as advised by the healthcare provider.
• Undergoing preoperative imaging studies like MRI or CT scans.

Diagnostic Tests or Assessments:

• Neurological examination
• Imaging studies to confirm the site of obstruction and CSF pathway.
• Blood tests to ensure general health prior to surgery.

Procedure Description

Steps:

1. Administration of general anesthesia.
2. Positioning the patient appropriately on the operating table.
3. Making a small incision in the scalp and drilling a small burr hole in the skull.
4. Inserting a catheter through the lateral ventricle.
5. Threading the catheter under the skin to reach the cisterna magna near the base of the brain.
6. Securing the catheter in place and closing the incision.

Tools and Technology:

• Surgical scalpel and drills.
• Catheters.
• Imaging guidance tools like intraoperative ultrasound.

Anesthesia:

• General anesthesia to ensure the patient is unconscious and pain-free during the procedure.

Duration

• Approximately 2 to 3 hours.

Setting

• Performed in a hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses

Risks and Complications

Common Risks:

• Infection
• Bleeding at the surgical site
• Misplacement or blockage of the catheter

Possible Complications:

• Seizures
• Neurological deficits if nearby brain structures are damaged.
• CSF leakage

Management of Complications:

• Antibiotic treatment for infections.
• Revising the catheter placement surgically if necessary.

Benefits

• Relief from symptoms associated with increased intracranial pressure.
• Prevention of potential brain damage due to prolonged pressure.
• Improvements in quality of life, with benefits often noticeable within a few days post-surgery.

Recovery

Post-Procedure Care:

• Monitoring in an intensive care unit for the first 24 hours.
• Gradual return to normal activities as symptoms improve.
• Regular follow-up visits with imaging studies to monitor success.

Expected Recovery Time:

• Initial recovery in 1 to 2 weeks, full recovery within 4 to 6 weeks.

Alternatives

Other Treatment Options:

• Ventriculoperitoneal (VP) shunt surgery.
• Endoscopic third ventriculostomy (ETV).

Pros and Cons:

• VP shunt: Effective but requires lifelong management and monitoring for shunt failure.
• ETV: Less invasive but not suitable for all types of hydrocephalus.

Patient Experience

During the Procedure:

• Under general anesthesia, so the patient will be asleep and feel no pain.

Post-Procedure:

• Pain management with prescribed medications.
• Possible discomfort at incision sites.
• Gradual improvement in symptoms of hydrocephalus.
• Temporary restrictions on physical activities to promote healing.