Third ventriculostomy

Third Ventriculostomy is a neurosurgical procedure used for the treatment of hydrocephalus, a condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the cavities (ventricles) of the brain. This procedure creates an opening in the floor of the third ventricle, allowing CSF to bypass the obstructed pathways and flow directly towards the sites of absorption around the brain and spinal cord, thus relieving pressure.

Indications

Third Ventriculostomy is primarily indicated in cases of obstructive or non-communicating hydrocephalus, where the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles. It is most commonly recommended for patients with a blockage in the aqueduct of Sylvius, the channel that connects the third and fourth ventricles.

Procedure

Performed under general anesthesia, the procedure involves the use of an endoscope, a thin, flexible tube with a camera and light at the end, allowing the surgeon to visualize the ventricular system. A small hole is drilled in the skull, and the endoscope is guided into the third ventricle. The surgeon then creates an opening in the floor of the third ventricle, allowing CSF to escape into the basal cisterns, where it can be absorbed.

Risks and Complications

As with any surgical procedure, third ventriculostomy carries risks, including infection, bleeding, and damage to surrounding brain tissue. There is also a risk that the new opening may close, necessitating further surgery. However, for many patients, third ventriculostomy provides a viable alternative to ventriculoperitoneal shunt placement, which involves implanting a mechanical device and carries a higher risk of infection and malfunction.

Outcomes

The success of third ventriculostomy depends on various factors, including the patient's age, the cause of hydrocephalus, and the presence of any underlying brain conditions. In general, younger patients with a clear obstruction in the aqueduct of Sylvius tend to have better outcomes. Long-term follow-up is necessary to monitor for potential closure of the ventriculostomy site and the need for additional treatment.