Name of the Procedure:

Ventriculocisternostomy, Third Ventricle
Common name(s): Third Ventriculostomy, Endoscopic Third Ventriculostomy (ETV)

Summary

Ventriculocisternostomy, specifically targeting the third ventricle, is a surgical procedure used to create an opening in the floor of the third ventricle to allow cerebrospinal fluid (CSF) to bypass an obstruction and improve fluid drainage within the brain.

Purpose

Condition Addressed: Hydrocephalus (excessive accumulation of CSF in the brain leading to increased pressure)
Goals: The primary aim is to alleviate the symptoms of hydrocephalus, such as headaches, nausea, and balance problems, by improving CSF flow and reducing intracranial pressure.

Indications

• Obstructive hydrocephalus, such as aqueductal stenosis.
• Symptoms including headaches, nausea, vomiting, balance difficulties, and visual disturbances.
• Ineffectiveness or shortcomings of other treatments like shunt systems.
• Patients who are suitable candidates based on imaging studies and neurological evaluation.

Preparation

• Fasting: Typically, patients are instructed to fast for at least 6-8 hours before the procedure.
• Medications: Adjustments may be needed; anticoagulants may be temporarily halted.
• Pre-Op Tests: Imaging studies like MRI or CT scans to assess the brain's ventricular system.
• Assessment: Neurological examination and possibly blood tests to ensure patient stability.

Procedure Description

1. Anesthesia: The patient will be administered general anesthesia.
2. Positioning: The patient is positioned to allow optimal access to the brain.
3. Incision: A small incision is made in the scalp, usually at the front of the head.
4. Craniotomy: A burr hole is created in the skull to insert an endoscope.
5. Navigation: The endoscope is guided to the third ventricle.
6. Creating the Opening: A small hole is made in the floor of the third ventricle using specialized tools, allowing CSF to flow directly to the basal cisterns (subarachnoid space).
7. Closure: The instruments are removed, and the incision is closed with sutures or staples.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital operating room equipped with specialized neurosurgical instruments and imaging technology.

Personnel

• Surgeon: A neurosurgeon specializing in brain and spinal surgeries.
• Anesthesiologist: Manages anesthesia and monitors vital signs.
• Nursing Staff: Assists with the procedure and patient care.

Risks and Complications

• Common Risks: Infection, bleeding, CSF leak.
• Rare Risks: Damage to surrounding brain structures, neurological deficits, failure to alleviate symptoms (requiring additional surgery), seizures.

Benefits

The primary benefit is the relief of hydrocephalus symptoms. Successful procedure can improve neurological function and quality of life, often noticeable within days to weeks after surgery.

Recovery

• Post-Procedure Care: Monitoring in the recovery room or ICU. Pain management, antibiotics, and steroids may be administered.
• Instructions: Patients should avoid strenuous activities for several weeks. Follow-up imaging to ensure the new CSF pathway remains open.
• Recovery Time: Most patients require 1-2 days of hospital stay and a few weeks of home rest before returning to normal activities.

Alternatives

• Shunt Systems: Placement of a ventriculoperitoneal shunt to drain excess CSF.
  • Pros: Effective for various types of hydrocephalus.
  • Cons: Require lifelong maintenance, higher risk of infection and blockage.

Patient Experience

During the procedure (under anesthesia): No sensation or awareness.
After the procedure: Possible headache, nausea, and mild discomfort around the incision site. Pain management includes medications and rest. Post-operative imaging and follow-up visits are crucial to monitor recovery.

By addressing the need for CSF drainage, third ventriculocisternostomy helps alleviate symptoms of hydrocephalus, providing significant benefits to patients with suitable indications.