gms | German Medical Science

Objective: Neuroendoscopy is an increasing subspeciality in neurosurgery. Until now the rate of complications is reported only by a few authors. The rate of complications in regard to the skin incision and dura closure and also in comparison to the indications given by other authors in the literature has never been analysed.

Methods: This study includes 115 patients who were operated using only neuroendoscoply. A rigid neuroendoscope (5.9 mm, Type Camaert, Wolf, Knittlingen) was used for the cranial interventions. Indications for neuroendoscopy were occlusive hydrocephalus, different intracranial cysts and intraventricular tumor biopsies in most cases. During endoscopic ventriculostomy microdopplersonography was used to detect the basilar artery if not visible. Neuronavigation was used especially in tumor biopsies and cystic lesions. Aqueductoplasty was done only in one case, colloid cysts were not operated by endoscopy. In 44 cases, a straight skin incision was performed and in 71 cases a curved skin incision with an additional galea flap and dura sutures (15 mm burr hole) was used. The number and type of different complications were analysed.

Results: Only one patient died due to meningitis after endoscopic ventriculostomy and CSF fistula. A CSF-fistula occurred in 4 out of 44 cases (9.1%) with straight skin incisions and in 4 out of 71 cases (5.6%) with curved skin incisions. Temporary neurologic deficit was observed in 3 cases (double vision, hemiparesis = 2.6%). One girl developed pubertas praecox after a neuroendoscopic operation on a suprasellär intraventricular cyst.

Conclusions: The reported complication rate (10.4%) was comparable to data obtained from the literature. The low rate of severe (“permanent”) complications (1,7%) can be explained by the restrictive indication for high risk interventions like aqueductoplasty and resection of colloid cysts. It is believed that curved skin incisions and a careful dura closure can decrease the rate of CSF-fistula in these operations.