gms | German Medical Science

Objective: Neuroendoscopic applications are still under evaluation. The combination of two different endoscopic procedures within one setting like third ventriculostomy and tumor biopsy could harbor increased risks of complications and failure of third ventriculostomy. Here, the authors present their experience with combined intraventricular procedures within one setting over the last two decades.

Method: This study analyses retrospectively data from neuroendoscopic intraventricular procedures between 1993 and 2014 in three different Departments of Neurosurgery. Inclusion criteria were a combination of at least two intraventricular endoscopic procedures, e.g. ventriculocisternostomy, cyst fenestration, tumor surgery or aqueductoplasty within one setting.

Results: One-hundred-thirty-two procedures fulfilled the inclusion criteria. The patients' age ranged from 3 month to 82 years (median 37 years). Tumor surgery and ETV was the most frequent combination (n=55). Intraoperative severe bleedings occurred only in 4 cases (3%). Eight transient deficits (6%) and 3 permanent deficits (2,3%) were seen. All deficits were associated with tumor pathologies. Nonetheless a high success rate was found in hydrocephalus treatment, showing a shunt independency in 84,8% of the cases. Also in biopsy procedures, the region of interest was successfully biopsied in 100%. An endoscopic re-operation was necessary in 14 cases (10,6%): especially among tumors and aqueduct stenosis.

Conclusions: A combination of different intraventricular endoscopic procedures is safe and reliable, bearing no higher risk than single neuroendoscopic procedures. Careful trajectory planning allows a combination of different procedures through one burr hole. Due to its small access point and enhanced intraoperative view endoscopy fulfills all requirements for a minimal invasive and safe operation technique.