Ventriculostomy is a neurosurgical procedure. It is done by surgically placing a tube through the skull such that it terminates in the ventricle of the brain. The place of entrance on the skull is called Kocher’s point. Ventriculostomy is done primarily to monitor the intracranial pressure as well as to drain CSF (primarily) or blood to relieve pressure from the CNS.

A ventriculostomy, also called an external ventricular drain (EVD) or ventricular catheter, is a catheter placed into the ventricles, fluid-filled spaces within the brain, and drains cerebrospinal fluid (CSF) externally. It is typically connected by tubing to a cerebrospinal fluid collection device which can be elevated or lowered at the bedside to vary the amount of CSF that is drained.

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A ventriculostomy allows both draining and sampling of the CSF and also can be hooked up to a pressure transducer which gives a reading of intracranial pressure. Additionally, in some conditions certain medications may also be given directly into the nervous system by injecting them through a ventriculostomy.

Endoscopic third ventriculostomy is a procedure in which a small perforation is made in the thinned floor of the third ventricle, allowing movement of cerebrospinal fluid of the blocked ventricular system and into the interpenduncular cistern (a normal CSF space). This procedure, called an intracranial CSF diversion, is a process whereby cerebrospinal fluid within the ventricle is diverted elsewhere in an attempt to bypass an obstruction in the aqueduct of Sylvius and thereby relieve pressure. The objective of this procedure is to normalize pressure on the brain without using a shunt. Endoscopic third ventriculostomy is not a cure for hydrocephalus, but rather an alternate treatment.

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Although open ventriculostomies were performed as early as 1922, the advent of shunt systems in the 1960’s displaced the ventriculostomy as the most common method of treating hydrocephalus. Even today, however, we are well aware that despite recent advances in shunt technology and surgical technique, there are many cases in which shunts are inadequate. Extracranial shunts are subject to complications such as blockage, infection, and over-drainage, necessitating surgical revisions for the shunt. For this reason, in selected cases, a growing number of neurosurgeons are recommending endoscopic third ventriculostomy in place of shunting.

Recently neuroendoscopy (telescopic surgery) makes treatment of Hydrocephalus possible without shunting in two thirds of patients (the success rate depends on the etiology (cause of) the Hydrocephalus and varies between one quarter to nearly one hundred percent). Management of Hydrocephalus by “Third Ventriculostomy” creates a natural bypass within the brain allowing the fluid to drain. This is a procedure that does not have the complications of shunt insertion. Infection is rare and the morbidity is very low. This low morbidity operation is a valid treatment for Hydrocephalus in the difficult conditions of developing countries where follow-up is inconsistent and retrieval of patients in case of complications is near to impossible.

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