gms | German Medical Science

Objective: To determine the rate of complications associated with neuroendoscopic interventions and to look for ways to minimize complications.

Methods: Data of 147 consecutive patients who underwent 151 neuroendoscopic interventions (69 ventriculostomies, 36 cyst fenestrations, 14 resections/biopsies and 32 other procedures) at a single institution were collected prospectively in a database. The male to female ratio was 1.16. The age of the patients ranged from 15 days to 79.1 years (median age 14.4 years). 20 patients were 1 year old or younger. All patients received a single-shot antimicrobial prophylaxis intraoperatively. Most procedures were performed with the aid of a rigid rod-lens endoscope (outer diameter of the sheath 6.0 mm). In some children a fiber optic endoscope (outer diameter 3.0 mm) was used. Additional instrumentation included a holding and steering device, a double balloon catheter, a bipolar fork electrode, a micro scissor and a micro biopsy forceps. All patients were closely followed postoperatively by clinical examination and MRI or CT scans and all complications were carefully collected and documented.

Results: 4 patients showed CSF leakage with consecutive wound revision in 2 cases (2.7%). One patient suffered from an epidural hematoma, which had to be operated upon. There were 5 patients (3.3%) with a bacterial meningitis. 2 patients (1.3%) required subdural shunting procedures after subdural collections were shown on postoperative imaging. In 11 patients (7.3%) the procedure was abandoned due to bleeding (4 cases), impaired vision (3), a nontranslucent cyst membrane (3), and a nontranslucent floor of third ventricle (1). There was one major complication which was attributable to failed ventricular puncture. This patient demonstrated an incomplete left-sided hemiparesis postoperatively which resolved nearly completely within 3 months. MRI revealed a small contusion in the vicinity of the basal ganglia. Thus, the overall complication rate was 15.2%. The permanent morbidity rate was 0.7% The mortality rate was zero.

Conclusions: With careful patient selection and cautious application of the technique the morbidity rate of endoscopic interventions is low –a precondition for this technique to compare favorable with shunting procedures. Meticulous closure of the burr hole wound is of special importance in young children to avoid CSF leakage. In some cases with glial cysts or narrow ventricles guidance by neuronavigation is helpful to avoid misdirection of the endoscope.