Ventriculostomy
A ventriculostomy is a common surgical procedure to drain excess cerebrospinal fluid from your brain. It treats hydrocephalus and increased pressure on your brain from a traumatic injury. Your surgeon may use an endoscope (a tool with a light and camera) to perform an endoscopic third ventriculostomy.
A ventriculostomy is a surgical procedure to drain excess cerebrospinal fluid (CSF) from a ventricle (a fluid-filled cavity) in your brain. CSF surrounds your brain and protects it from injury. Too much CSF can put pressure on your brain. This can be life-threatening. Certain conditions like hydrocephalus and traumatic brain injuries cause CSF accumulation. Ventriculostomy is a common emergency surgery to relieve pressure on your brain.
A ventriculostomy treats the following conditions:
- Hydrocephalus.
- Intracranial hemorrhage.
- Increased intracranial pressure.
- Traumatic brain injury.
There are two main types of ventriculostomy:
- External ventricular drain: A surgeon places a catheter (flexible tube) through a small hole in your skull into a ventricle. Outside of your body, the end of the catheter connects to a drainage system that helps CSF move out of your ventricle.
- Endoscopic third ventriculostomy: A surgeon makes a small incision and then uses an endoscope (a thin, flexible tube with a light and camera on the end) in the bottom of your third ventricle. The third ventricle has a central location, which makes it easy to access and monitor. The hole lets CSF drain into surrounding tissue so your body can reabsorb it.
A ventriculostomy is a common emergency surgical procedure. In the United States, an estimated 20,000 people get a ventriculostomy each year.
Before a ventriculostomy, a surgeon will meet with you to prepare for the procedure. They’ll perform a physical exam and order several tests to learn more about your general health and symptoms. Your surgeon will review your test results and imaging scans to plan for surgery.
You may not have much time to prepare for a ventriculostomy, as it’s often an emergency treatment to relieve pressure on your brain. But your care team will explain the risks of the procedure and have you sign a consent form before they begin.
You may need to follow certain instructions before your surgery like:
- Take or stop taking certain medications as directed by your surgeon. They’ll usually recommend taking antibiotics and avoiding blood thinning medications.
- Undergo additional preoperative testing that your surgeon needs.
- Make arrangements for someone to help you at home after the procedure.
If you have any questions about the procedure or what to expect, ask your care team during the exam before your surgery.
On the day of your surgery, an anesthesiologist will give you anesthesia. You may receive general anesthesia or local anesthesia. General anesthesia puts you to sleep so you won’t feel any pain. Local anesthesia only numbs the area of your body where your surgeon will be working, so you’ll be awake but won’t feel any pain.
To clear the area on your head for the surgical incision (cut), your surgical team will shave and remove a small amount of your hair. It’s usually small enough that it won’t change your appearance too much.
To complete the procedure, your surgeon will:
- Make a small hole in your skull with a surgical drill.
- Insert an endoscope or a catheter into the hole.
- Carefully move the endoscope or catheter through your brain tissue to reach the ventricle.
- Create an opening in the ventricle to drain excess cerebrospinal fluid.
- Remove the endoscope or catheter from your brain and skull.
- Close the incision site in your head with stitches or staples.
A ventriculostomy usually takes about an hour to complete.
After a ventriculostomy, you’ll move to an area of the hospital to be monitored until your anesthetic wears off. If you have general anesthesia, you’ll wake up feeling groggy and tired. Your care team will ask you questions when you wake up to make sure your brain function hasn’t changed. They may also check your neurological function by asking you to move your fingers and toes, arms and legs while you rest in bed.
You’ll need to stay in the hospital for a couple of days after surgery to make sure you’re healing as expected.
Your care team will give you instructions to take care of your incision site and your general health when you go home. If you have any questions about follow-up care, talk to your providers.
A ventriculostomy is an often lifesaving procedure that can prevent too much cerebrospinal fluid from putting pressure on your brain. Your surgeon and care team can monitor intracranial pressure, manage CSF levels and administer medications through a ventriculostomy catheter if necessary.
The success rate of an endoscopic third ventriculostomy ranges from 60% to 85%.
Healthcare providers consider your ventriculostomy a success if it results in a safe intracranial pressure level, decreased ventricle size and eliminates the need to install a shunt. A shunt is an implanted catheter to move CSF away from your brain to another part of your body.
Many factors can contribute to the success of your procedure, including your age, general health and whether you had a shunt in place previously.
All surgical procedures come with possible risks. Your surgeon and care team will take extra precautions to prevent any possible complications. The risks of a ventriculostomy may include:
- Bleeding.
- Blood clot.
- Catheter misplacement (CSF doesn’t drain).
- Cerebrospinal fluid leak.
- Infection (ventriculitis).
- Draining too much CSF.
It could take up to six weeks to completely recover after a ventriculostomy. Your provider will give you the best time estimate after your procedure.
After a ventriculostomy, you’ll need to rest for a few weeks before you can get back to your regular activities. Most people need to take at least two weeks off from work or school after surgery.
Yes, it’s important that you follow up with your healthcare provider regularly after a ventriculostomy. This procedure may be a temporary (or permanent) fix to decrease the amount of cerebrospinal fluid in your brain, but the underlying condition or injury that caused the excess fluid will need frequent monitoring throughout your life. Your provider may suggest testing (like imaging scans and blood tests) every few months to keep track of your health.
When should I call my healthcare provider?
Contact your healthcare provider if you experience any of the following symptoms after a ventriculostomy:
- Fever.
- Bleeding.
- Swelling.
- Incision site leaking yellow fluid (pus).
- Severe pain.
- Confusion or memory loss.
References
- Deopujari CE, Karmarkar VS, Shaikh ST. Endoscopic Third Ventriculostomy: Success and Failure (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426452/). J Korean Neurosurg Soc. 2017 May;60(3):306-314. Accessed 6/19/2024.
- Hydrocephalus Association (U.S.). What to Expect With ETV Surgery (https://www.hydroassoc.org/etv-surgery/). Last reviewed 2021. Accessed 6/20/2024.
- Munakomi S, M Das J. Ventriculostomy (https://www.ncbi.nlm.nih.gov/books/NBK545317/). [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Accessed 6/19/2024.
- National Health Services (U.K.). Hydrocephalus Treatment (https://www.nhs.uk/conditions/hydrocephalus/treatment/). Last reviewed 2/6/2023. Accessed 6/19/2024.
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