CPT® Code 62200

An open ventriculocisternostomy is a neurosurgical procedure aimed at establishing a direct communication between the third ventricle of the brain and the subarachnoid space, specifically the cistern. This procedure is typically indicated for conditions that lead to obstructive hydrocephalus, where cerebrospinal fluid (CSF) cannot flow freely due to blockages. The surgery begins with a circular incision in the scalp, usually located in the right frontal area, allowing for the creation of a skin flap that is moved forward to expose the underlying structures. Following this, a craniotomy is performed, which involves removing a portion of the skull to access the brain. The dura mater, a protective membrane covering the brain, is then opened to reveal the lateral ventricle. A catheter is inserted into the lateral ventricle to measure intracranial pressures, which are critical for assessing the patient's condition. The catheter is subsequently advanced into the third ventricle, where a puncture is made in the floor to facilitate the creation of an opening that connects the third ventricle to the subarachnoid cistern. This opening is carefully enlarged to ensure adequate flow of CSF. In cases where CSF flow is insufficient, further exploration of the prepontine cistern may be conducted to identify and address any arachnoid bands that may be obstructing the flow. If an imperforate membrane of Liliequist is discovered, it is disrupted to enhance CSF drainage. Should the initial attempts not yield satisfactory results, a second communication may be established. Once a successful communication is confirmed, closing intracranial pressures are measured, and if they are found to be elevated, an external ventricular drain may be placed to manage the CSF flow effectively.