J Korean Neurosurg Soc.  2017 May;60(3):282-288. 10.3340/jkns.2017.0101.014.

Prevention of Complications in Endoscopic Third Ventriculostomy

• Jung TY
• Chong S
• Kim IY
• Lee JY
• Phi JH
• Kim SK
• Kim JH
• Wang KC

• KMID: 2382761
• DOI: http://doi.org/10.3340/jkns.2017.0101.014

Abstract

A variety of complications in endoscopic third ventriculostomy have been reported, including neurovascular injury, hemodynamic alterations, endocrinologic abnormalities, electrolyte imbalances, cerebrospinal fluid leakage, fever and infection. Even though most complications are transient, the overall rate of permanent morbidity is 2.38% and the overall mortality rate is 0.28%. To avoid these serious complications, we should keep in mind potential complications and how to prevent them. Proper decisions with regard to surgical indication, choice of endoscopic entry and trajectory, careful endoscopic procedures with anatomic orientation, bleeding control and tight closure are emphasized for the prevention of complications.

Keyword

Neuroendoscopy; Ventriculostomy; Peoperative complications/prevention & control

MeSH Terms

Cerebrospinal Fluid Leak
Fever
Hemodynamics
Hemorrhage
Mortality
Neuroendoscopy
Ventriculostomy*

Figure

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  Fig. 1 A recommendable trajectory for simultaneous ETV and biopsy is shown as an arrow on the midsagittal MR image in a patient with a pineal mass and hydrocephalus. It is set between two paths for endoscopic third ventriculostomy (dotted line) and biopsy (solid line). Note that the burr hole (colored ellipse) is elongated in an anterior-posterior direction. ETV: endoscopic third ventriculostomy, MR: magnetic resonance.

• 

  Fig. 2 A schematic drawing showing a case of brain damage caused by an instrument when the endoscope is too close to the ventricle wall before the instrument is identified through the endoscope (right). When the endoscope is placed sufficiently away from the wall (left), the instrument does not cause brain damage while it enters the endoscopic view.

Reference

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