Why is this surgery done?
There are normal fluid spaces inside the brain called the ventricles . The spinal fluid that fills them is clear like water. When problems occur inside these fluid spaces, they can sometimes be treated with special cameras and instruments that work underwater inside these spaces. Common reasons for this procedure include:
- Blockages in spinal fluid flow (hydrocephalus) that can be treated by making a small opening between these fluid spaces (called a ventriculostomy or a septostomy depending where the opening is made)
- Removal of small tumors, such as a colloid cyst, inside the fluid spaces
- Assistance in placing tubing for a spinal fluid shunt in a precise location
- Taking a small piece (a biopsy) of a tumor (such as a pineal tumor) that goes into a spinal fluid space to find out what kind of tumor it is
How is neuroendoscopy done?
One or two small skin incisions are made and a small hole (called a burr hole) is drilled in the bone of the skull. A small tube is passed through the brain into the spinal fluid spaces (the ventricles). A camera is placed down this tube and special instruments go down tiny openings in the wall of the camera. The surgery is done looking at a screen that shows what the camera is looking at. Sometimes a temporary drain tube is left in the fluid space. The tube is then removed. A plate may be placed to cover the burr hole; other times it is left open. Finally, the skin is closed.
What are my risks? What are common complications?
As with any brain surgery, there are risks such as bleeding into the brain or into the fluid spaces, infection or damage to the brain where the surgery was done. For surgery to treat spinal fluid blockage, there is a chance that the opening closes up and additional surgery is needed. There is a chance small tumors may regrow in the future. For biopsy surgeries, there is a chance that the small piece of tissue obtained does not provide an answer.
What do I need to know before surgery?
You should be off of any blood thinning medication for this surgery. Smoking and alcohol use should be stopped before surgery. You do not need to shave your head for surgery! Minimal hair will be removed to perform this procedure in most cases. You may need appointments for medical clearance or to get special imaging studies before your surgery.
General discharge instructions
In most cases the patient will spend the first night in the neurosurgical intensive care unit to watch for any neurologic changes and to keep blood pressure well controlled. Most patients can be discharged home 1 – 2 days afterward, although that depends on the part of the brain where the surgery took place and the problems the patient was having before the surgery. The skin is usually closed with staples that will be removed about two weeks after surgery. Patients can wash their hair two days after surgery in most cases. If a drain was left, it will usually be removed 1 – 2 days after surgery.
What should I expect while recovering?
We recommend that patients do regular but light activity for the first few weeks after returning home. Heavy lifting or exercise should be avoided, but frequent walks are encouraged. There may be some pain or discomfort around the surgical area for a few weeks after surgery, but this is usually well controlled with the pain medicine you will be prescribed at discharge. Headaches may occur and generally go away over time.