Ventriculostomy: Causes, Symptoms, Treatment and Cost

Ventriculostomy is a surgical procedure to create an opening in the ventricles of the brain. This opening allows cerebrospinal fluid (CSF) to be drained from the ventricles, reducing pressure on the brain and improving neurological symptoms.

There are two main types of ventriculostomy: external and internal.

• External Ventriculostomy

  External ventriculostomy is a procedure in which a small hole is made in the skull to drain excess cerebrospinal fluid (CSF) from the lateral ventricles of the brain. This procedure is used to treat hydrocephalus, a condition that occurs when there is an abnormal accumulation of CSF within the brain.

  During this procedure, a neurosurgeon will make a small incision at the top or side of the skull and then insert a small tube into one of the lateral ventricles. The tube will be connected to a drainage system that will allow for CSF to be removed from the brain.

• Internal Ventriculostomy

  Internal ventriculostomy is similar to external ventriculostomy, but instead of making an incision in the skull, a neurosurgeon will make an incision in one of the lateral ventricles and insert a catheter directly into it.

  This catheter is connected to another catheter that runs outside of the body and drains CSF from inside the brain into another drainage system. Internal ventriculostomies are often used when external ones are not possible due to anatomical reasons or other medical conditions.

The main benefits of ventriculostomy include:

• Reduced intracranial pressure: Ventriculostomy helps reduce the intracranial pressure by allowing CSF to drain out of the ventricles and into other areas of the body. This can help reduce symptoms associated with hydrocephalus such as headaches, nausea, vomiting, confusion and difficulty walking.
• Improved quality of life: By reducing symptoms associated with hydrocephalus, patients can experience improved quality of life due to increased mobility and lessened fatigue.
• Reduced risk of complications: Ventriculostomy also reduces the risk of complications related to hydrocephalus such as seizures and infections.
• Improved neurological functioning: Ventriculostomy can help improve neurological functioning by helping reduce swelling in the brain and allowing for better blood flow throughout it which helps improve overall cognitive functioning.

Ventriculostomy is typically done to reduce pressure within the ventricles, which can be caused by a variety of conditions such as hydrocephalus, intracranial hemorrhage, or other brain injuries.

It can also be used for diagnostic purposes and to provide access for medications and other treatments.

The risks of ventriculostomy include infection, bleeding, hydrocephalus (excess fluid in the brain), and damage to surrounding structures.

Additionally, there is a risk of over-draining or under-draining the ventricles, which can lead to further complications.

In rare cases, aneurysms or other structural problems may occur due to the procedure.

• Before undergoing ventriculostomy surgery, it is critical to get yourself and your body ready for the procedure by taking the necessary precautions.
• Have a conversation with your primary care physician about any medical issues you have, any drugs you are currently taking, and any allergies you may have.
• It is also important to get a full physical exam and laboratory tests done prior to the procedure.
• In addition to this, it is essential that you do not consume anything by mouth after the stroke of midnight the night before the surgery.
• Due to the fact that the surgery will include the use of anaesthetic, you will need to make arrangements for someone to drive you home when it is over.
• Finally, make sure you understand all of the risks involved with having a ventriculostomy so that you can make an informed decision about whether or not it is right for you.

Ventriculostomy is usually done with an endoscope, which is a thin tube with a camera on the end that is inserted through an opening made in the skull. Once the endoscope reaches the ventricle, it is used to create an opening for CSF drainage. After that, the fluid can be collected and examined for any abnormalities or infections that may have been present.

• Obtain consent from the patient or their legal representative that they have been informed.
• Prepare the patient's skin by cleaning it with an antiseptic solution and sterilizing the area around the incision site.
• Position the patient in a comfortable position, typically lying on their side with their head slightly elevated to ensure better access to the ventricles.
• Administer any necessary preoperative medications and sedation, as well as antibiotics to reduce risk of infection.
• Have all necessary equipment ready for use during the procedure, including a ventricular catheter, a ventricular drainage system, sterile gloves and drapes, and other supplies as needed.

Make an incision in the scalp overlying the desired ventricle and create a small burr hole for insertion of the catheter into that ventricle.

Insert a flexible catheter into one of the lateral ventricles through this burr hole and connect it to a drainage system that will allow cerebrospinal fluid (CSF) to be drained out of that particular ventricle while monitoring pressure levels in real time via an external transducer device or manometer connected to tubing from within or outside of that particular ventricle’s cavity wall during drainage process (ventriculostomy).

Monitor pressure levels throughout the procedure using a manometer or transducer device; adjust flow rate accordingly if pressure levels become too high or low during the drainage process (ventriculostomy).

Close incision site with sutures or staples as appropriate.

Apply sterile dressing over wound area after closure is complete if desired/needed by the surgeon/physician team performing ventriculostomy.

The cost of a Ventriculostomy procedure in India can vary depending on the hospital and type of procedure. Generally, the cost can range from around Rs. 20,000 to Rs. 2 lakhs.

• Closely monitor the patient's vital signs as well as the patient's neurological condition.
• Keep an eye out for any indications of infection or obstruction in the drainage coming from the ventriculostomy catheter.
• Administer antibiotics as prescribed to prevent infection in the area around the catheter insertion site.
• Maintain aseptic technique when caring for the catheter and drainage system to avoid introducing bacteria into the system.
• Check for signs of increased intracranial pressure (ICP) such as headache, nausea, vomiting, confusion, and changes in vital signs or mental status.
• Evaluate for any complications such as fluid leakage from puncture sites, brain herniation, or hydrocephalus due to obstruction of CSF flow at any time during treatment or after removal of ventriculostomy catheters.
• Provide patient education on potential side effects and complications associated with ventriculostomies such as infection, bleeding, seizures, and headaches due to increased ICP levels.

Food to eat after ventriculostomy include:

• Fruits and vegetables: Apples, oranges, bananas, carrots, spinach, kale, broccoli.
• Protein-rich foods: Chicken, fish, eggs, beans and legumes.
• Whole grains: Brown rice, quinoa, oats and whole wheat breads.
• Dairy products: Low-fat milk and yogurt.
• Healthy fats: Olive oil and avocados.
• Nuts and seeds: Almonds, walnuts and flaxseeds.
• Herbs and spices: Garlic powder, oregano and basil leaves for added flavor to meals without adding extra calories or fat content.

The safety of ventriculostomy depends on many factors, including the skill and experience of the surgeon performing it, as well as any pre-existing medical conditions or problems that could increase risk.

Generally speaking, however, ventriculostomy is considered safe when performed by an experienced surgeon with appropriate precautions.

No, ventriculostomy is not painful. The procedure is performed under general anaesthesia, so the patient will not feel any pain during the surgery. However, some discomfort may be experienced afterwards due to the insertion of a catheter into the brain and/or swelling at the site of incision.

The recovery time for a ventriculostomy procedure can vary depending on the individual, the severity of their condition, and the type of procedure performed.

Generally, it is expected that a person will take several days to recover from the procedure.

In some cases, recovery may take up to two weeks or more.

The most common side effects of ventriculostomy include:

• Infection
• Bleeding
• Cerebrospinal fluid leakage
• Hydrocephalus (accumulation of fluid in the brain)
• Brain tissue damage
• Cognitive and motor deficits
• Seizures or stroke
• Nerve damage

It is important to follow all instructions given by your healthcare provider after a ventriculostomy procedure. This may include:

• Taking medications as prescribed.
• Keeping the wound clean and dry.
• Monitoring for signs of infection, including fever, redness, swelling, or drainage from the wound site.
• Following up with regular appointments with your healthcare provider to monitor your progress.
• Avoiding strenuous activities or heavy lifting until cleared by your healthcare provider.
• Wearing a protective helmet if necessary to prevent head injury.

Ventriculostomy is a safe and effective procedure for relieving increased intracranial pressure caused by hydrocephalus. It can be used in both children and adults, and it has been found to improve quality of life in many patients. However, it is important to understand the risks associated with ventriculostomy, as well as the potential complications that can occur. With proper care and monitoring, ventriculostomy can be an effective treatment for hydrocephalus and help improve quality of life for those affected.