Let's learn about Ventriculostomy - a simple surgery for brain pressure!

Have you ever heard of emergency surgery for high pressure inside the brain? Perhaps you've heard doctors talk about this when you or a friend has had to be hospitalized suddenly due to a head injury. The medical name for this is Ventriculostomy. Although the name is a bit complicated, let's talk about what happens in this case simply and in a friendly way.

What exactly is Ventriculostomy?

Simply put, Ventriculostomy is a surgical procedure that removes excess fluid from the brain and relieves pressure on the brain. Think of our brain as a very valuable, fragile object. Naturally, to protect this valuable brain, there is a liquid covering around it. In medical terms, we call this Cerebrospinal Fluid (CSF) . This CSF fluid surrounds our brain and spinal cord like a cushion to provide protection. However, sometimes, due to an accident (e.g., a head injury), bleeding in the brain, or genetic factors, this CSF fluid starts to be produced in excess, or it accumulates in one place instead of circulating normally. When this happens, the brain inside the skull starts to press. This is what we call increased intracranial pressure .

What conditions is ventriculostomy surgery performed for?

Generally, this surgery is performed as a treatment for any condition that increases pressure on the brain. Let's look at the main situations in which this surgery is necessary.

There are two main types of this surgery.

There are two main methods of performing a ventriculostomy. Your doctor will choose the method that is most suitable for you based on your condition.

1. External Ventricular Drain (EVD)

In this procedure, the surgeon makes a very small hole in the skull and inserts a catheter , a thin, flexible tube, into a ventricle inside the brain that is filled with CSF. The other end of the tube is taken out of the body and connected to a system with a special bag. This causes the excess CSF to collect in the bag, reducing pressure on the brain. This is usually a temporary solution.

2. Endoscopic Third Ventriculostomy (ETV)

This is a slightly different procedure. Here, the surgeon makes a small incision and inserts an endoscope , a thin tube with a camera and light at the front, into the brain. Then, a small hole is made in the bottom of the third ventricle of the brain. This hole allows the trapped CSF fluid to drain and be absorbed into the surrounding tissues. This allows the fluid to drain naturally.

What happens before the surgery?

This is often an emergency surgery, so you don't have much time to prepare. When you are admitted to the Emergency Department (ETU), the doctors will quickly assess your condition and decide whether to operate. However, before the surgery, the medical team will explain the surgery and its risks to you or your guardian, and will ask you to sign a consent form. You may also be asked to do the following before the surgery:

• Take certain medications (especially antibiotics ) prescribed by your doctor as prescribed.
• If you are taking blood thinners , you will be asked to stop taking them temporarily.
• Several additional tests (such as blood tests and CT scans) may be performed as needed for the surgery.

If you have any questions, don't be afraid to ask the doctor. It's normal to feel scared at a time like this.

What happens during the surgery?

Before the surgery begins, an anesthesiologist will give you anesthesia. You may be given general anesthesia, which puts you completely asleep. Or you may be given local anesthesia, which numbs only the area of ​​your head where the surgery will be performed. However, you will not feel any pain. Then, the surgical team will remove a very small amount of hair from the area where the surgery will be performed. This will not make a big difference to your appearance. The steps involved in the surgery are simple:

• A very small hole is made in the skull using a special surgical drill.
• A catheter or endoscope is carefully passed through that hole into the brain.
• It is directed into the ventricle, a chamber filled with CSF fluid, without damaging the brain tissue.
• An opening is made to allow excess fluid to drain.
• When the work is complete, the instruments are removed, and the hole made in the scalp and the skin incision are closed with stitches or staples.

This entire process usually takes about an hour.

What happens after surgery? And possible risks

After the surgery, you will be transferred to the intensive care unit (ICU) or a specialized ward and carefully monitored until the effects of the anesthesia wear off. When you wake up, you will feel a little groggy and tired. The medical team will ask you questions, ask you to move your limbs, and check whether your brain function is normal. You will have to stay in the hospital for a few more days. After you go home, you will be given instructions on how to care for the surgical wound and your health.