Name of the Procedure:

Ventriculocisternostomy, third ventricle; stereotactic, neuroendoscopic method

Summary

Ventriculocisternostomy using a neuroendoscopic, stereotactic method is a minimally invasive surgical procedure that creates a pathway to allow cerebrospinal fluid (CSF) to flow directly from the third ventricle to the basal cisterns, bypassing obstructed pathways. This procedure is guided by precise imaging techniques to ensure accuracy.

Purpose

This procedure is performed to treat hydrocephalus, a condition characterized by an excessive accumulation of cerebrospinal fluid in the brain, which can cause increased intracranial pressure. The goal is to alleviate symptoms such as headaches, nausea, and cognitive impairments by normalizing the flow of CSF and relieving pressure on the brain.

Indications

• Patients with obstructive hydrocephalus.
• Symptoms of increased intracranial pressure such as severe headaches, nausea, vomiting, and blurred vision.
• Cases where previous shunt procedures have failed or shunt dependence is to be reduced.

Preparation

• Patients may be required to fast for a certain period before the procedure.
• Medications that thin the blood may need to be adjusted or stopped.
• Preoperative imaging studies like MRI or CT scans are necessary to plan the surgery.
• A general health assessment, including blood tests, is often required.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small burr hole is created in the skull, typically in the frontal region.
3. A neuroendoscope equipped with a camera and light source is inserted through the burr hole to visualize the brain structures.
4. Using stereotactic guidance, the surgeon navigates the endoscope to the floor of the third ventricle.
5. A small opening is made in the floor of the third ventricle to create a pathway to the basal cisterns, allowing CSF to flow freely.
6. The neuroendoscope is removed, and the incision is closed.

Duration

The procedure typically takes 1 to 2 hours.

Setting

This surgery is performed in a hospital operating room with specialized neurosurgical equipment.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Neuroendoscopy specialists

Risks and Complications

• Infection
• Bleeding or hemorrhage
• Injury to surrounding brain structures
• Formation of scar tissue or blockage of the new CSF pathway
• Complications related to anesthesia

Benefits

• Relief from symptoms of hydrocephalus
• Reduced need for shunt placement or maintenance
• Improved quality of life
• Benefits are often realized within days to weeks after the procedure.

Recovery

• Initial recovery involves a brief stay in the hospital (1-3 days).
• Pain and discomfort are usually managed with medication.
• Patients need to avoid strenuous activities for several weeks.
• Follow-up appointments are necessary to monitor healing and CSF flow.
• Imaging studies may be conducted to ensure the procedure’s success.

Alternatives

• Ventriculoperitoneal (VP) shunt placement, which diverts fluid from the ventricles to the abdomen.
• Endoscopic third ventriculostomy (ETV) without stereotactic guidance.
• Pros and cons: VP shunt can be more versatile but comes with a higher risk of infection and mechanical failure. ETV without stereotactic guidance may be less precise.

Patient Experience

• Patients will be asleep during the procedure due to general anesthesia.
• Post-operative discomfort in the head area, managed with pain medications.
• Feelings of fatigue and need for rest during the initial recovery period.
• Gradual improvement in hydrocephalus symptoms as CSF flow normalizes.