Definition and Overview
Ventriculostomy or ventricular drain is a quick surgical procedure performed in the head to attach a device to drain cerebrospinal fluid (CSF) buildup in the brain. This device may be placed externally, and it can be either temporary or permanent.
The procedure is done on the ventricles of the brain, a group of cavities where CSF accumulates. For a number of reasons, they can be obstructed or contain an excessive amount of CSF that increases intracranial pressure. The device often stays attached until cranial pressure normalises.
Who Should Undergo and Expected Results
Ventriculostomy is recommended for patients when there’s CSF buildup in the brain. CSF is a transparent fluid found in the central nervous system (brain and spine) that provides additional protection for the brain’s cortex. After the CSF is released, it should be reabsorbed into the bloodstream to help maintain the ideal cranial pressure.
There are many reasons why CSF accumulates in the brain ventricles. These include hydrocephalus, a general term used for conditions wherein the spaces in between the ventricles widen, leaving less room for CSF to flow or be reabsorbed. A landmark symptom is the prominent big head.
Hydrocephalus may be acquired or genetic. The latter occurs during foetal development while the former means that it developed after the baby is born. A specific procedure performed to treat it is called endoscopic third ventriculostomy.
Intracranial pressure can also be due to a traumatic brain injury. This is considered a medical emergency as the pressure can increase rapidly, increasing the risk of permanently damaging the brain tissues.
In other cases, ventriculostomy is performed to deliver the medications to treat brain ventricle or other brain-related problems and to diagnose CSF, which may indicate the presence of infection or other underlying conditions causing neurological symptoms.
It’s expected that as soon as the ventricular drain is added, brain pressure would go down and normalise.
How Does the Procedure Work?
Before the procedure is performed, a neurosurgeon conducts a pre-surgical consultation, wherein he assesses the patient’s overall neurological and physical health. If the patient is taking certain medications, he may have to stop some of them, especially if they can trigger blood loss or clotting during and after the operation.
Usually, the procedure lasts for about an hour and general anaesthesia is typically not a requirement. Only local anaesthesia is applied to the part of the scalp where an entry point will be made. The patient can also be given sedation for maximum comfort.
During the procedure, the patient lies on his back on the operating table. A part of the scalp is shaved and cleaned while the rest of the head is covered with a surgical drape. The surgeon then proceeds to create a hole in the head using a surgical drill to access the dura mater. In some cases, this is enough to improve cranial pressure. However, if ventricular drain should be continued, a tube is attached directly to the ventricle, and a bag is connected to the tube. The patient is also connected to a system that monitors the level of CSF and brain pressure.
If the tube is only temporary, it’s called an EVD (external ventricular drain). If it’s permanent, it’s called a shunt. The tube is kept in place with sutures while the drain stays in place.
Risks and Complications
One of the possible complications of the procedure is infection, which happens because of the wound site. If this infection is left untreated, it may result in sepsis or the systemic inflammation of the body that can cause multiple organ failure. There may also be bleeding. Patients are advised not to touch the bag while it’s still draining.
It’s also possible that the bag will leak or that too much of CSF is drained, a condition known as hypotension, which can cause serious headaches.
- Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 59.