Neurocritical Care Interventions

Ventriculostomy

A ventriculostomy is a small catheter, passed through the frontal lobe of the brain, which enters a fluid filled space in the brain, called the ventricle. A ventriculostomy requires a small incision in the scalp and a small hole to be drilled through the frontal bone of the skull. The purpose of a ventriculostomy catheter is to monitor brain pressure and drain cerebral spinal fluid (CSF) from the brain.

In cases where a patient is comatose after a brain hemorrhage or stroke, a ventriculostomy is useful in order to monitor for brain swelling. In an awake patient, brain swelling will result in sleepiness and progression to coma. While an awake patient can be examined continuously, a comatose patient cannot. Therefore, increases in brain pressure from swelling can be detected by a ventriculostomy, allowing other critical care interventions.

In cases where there is hydrocephalus, or accumulation of CSF in the brain, a ventriculostomy is used to drain CSF so that it will not back up and increase brain pressure. When hydrocephalus occurs suddenly, the rapid increase in brain pressure could be fatal. This can be seen after a brain aneurysm rupture. Ultimately, the patient may require a permanent drainage solution. Sometimes, it is advantageous to drain CSF even if there is not a fluid back up. In cases where there is swelling in the brain, draining CSF can reduce brain pressure by creating more room for brain swelling. In these cases, a ventriculostomy can be a life saving procedure.