02/21/2025
A 72-year-old male Dr. Munshi was consulted to evaluate for frequent falls and altered mental status. The patient had been experiencing a shuffling gait resulting in multiple falls and injuries. He had been admitted to rehab facilities for extensive physical therapy without any improvement in his ambulation. He was also noted to have worsening confusion and functional decline. He underwent a CT of the head, which demonstrated ventriculomegaly or dilated lateral ventricle. His evaluation also involved a lumbar puncture that showed normal opening pressures, measuring the pressure within the spinal cord. He underwent an MRI of the brain which demonstrated dilated lateral ventricles, a dilated third ventricle, with narrowing of the aqueduct of Sylvius, or the channel between the third and fourth ventricle. Dr. Munshi evaluated the patient and imaging, discussed the findings with the patient and family, and it was decided to proceed with a third ventriculostomy.
The patient tolerated the third ventriculostomy well, saw significant improvement in his gait and cognitive function, and did not require the placement of a permanent CSF diverting device.
Third ventriculostomy is a surgical procedure to create a bypass for cerebrospinal fluid to flow in the brain. It is done by introducing an endoscope, a thin tube with a camera, and light device, to allow visualization within the third ventricle. An opening is then made in the floor of the third ventricle to allow CSF to flow through into the subarachnoid space, where it then can be absorbed into the bloodstream. The benefit of this procedure is it allows minimally invasive techniques to allow a diversion of CSF through the brain to treat dilation of the ventricle without placing a permanent device, such as a ventriculoperitoneal shunt.
