Long-term complications and definition of failure of neuroendoscopic procedures
- 233 Downloads
A lot has been published about neuroendoscopic procedures over the last decade. Most of these publications are about the effectiveness of endoscopic third ventriculostomy, the most frequently performed neuroendoscopic procedure. Little is published about the effectiveness of other, less frequently performed neuroendoscopic procedures. Over the years more reports about the complications of endoscopic procedures are published, but again most of these publications are about endoscopic third ventriculostomy and only a little is presented about the complications of all other neuroendoscopic procedures. Furthermore, most reports are about intraoperative and immediate postoperative complications; only a few reports evaluated the long-term complications of neuroendoscopic procedures. There are also a few publications that analyse the failures of neuroendoscopic procedures but a good definition of failure is not given. The reports mention, again, mainly endoscopic third ventriculostomy procedures, and are mostly directed at the short-term failure rates, defined as the need for a shunt to be placed. Less attention is paid to the effects of the endoscopic procedures in the longer term. Looking at longer terms emphasises the need for a better definition of failure.
To get more insight into the long-term complications and failures of neuroendoscopic procedures, we reviewed the literature and evaluated our own series of 485 different cranial endoscopic procedures. With the information gathered we tried to answer the questions mentioned above.
Most of the complications of neuroendoscopic procedures are transient, either spontaneously or by medical intervention. Only a few permanent complications are known, in our series 1.6%, and most of them are not typically related to the endoscopic procedure itself but are due to the ventricular approach necessary for and the management of the endoscopy. Mortality rates are less than 1%. A uniform definition of failure cannot be given for all neuroendoscopic procedures, because the procedures are too heterogeneous and the indications are widespread. Failures are mainly diagnosed within a few months of the procedure but neurosurgeons must be aware of failure in the longer term, because if not diagnosed they can give rise to increased morbidity and probably mortality.
KeywordsFailure Long term Morbidity Mortality Neuroendoscopy Success rate
- 9.Dandy WE (1922) Cerebral ventriculoscopy. Johns Hopkins Hosp Bull 33:189–190Google Scholar
- 13.Doczi T, Veto F, Horvath Z (1998) Clinical analysis of 89 consecutive 3rd ventriculostomies [abstract]. Minim Invasive Neurosurg 41:112Google Scholar
- 15.Fay T, Grant FC (1923) Ventriculoscopy and intraventricular photography in internal hydrocephalus. JAMA 80:461–463Google Scholar
- 16.Freudenstein D, Wagner A, Ernemann U, Duufner F (2002) Subdural hygroma as a complication of endoscopic neurosurgery. Two case reports. Neurol Med Chir (Tokyo) 42:554–559Google Scholar
- 23.Jones RF, Kwok BC, Stening WA, Vonau M (1994) The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invas Neurosurg 37:28–36Google Scholar
- 27.Kunz U, Goldmann A, Bader C et al (1994) Endoscopic fenestration of the 3rd ventricular floor in aqueductal stenosis. Minim Invasive Neurosurg 16:42–47Google Scholar
- 28.Lewis A, Crone KR (1994) Advances in neuroendoscopy. Contemp Neurosurg 16:1–6Google Scholar
- 30.Mixter WJ (1923) Ventriculoscopy and puncture of the floor of the third ventricle. Preliminary report of a case. Boston Med Surg J 188:277–278Google Scholar
- 34.Putnam TJ (1934) Treatment of hydrocephalus by endoscopic coagulation of the choroid plexus. Description of a new instrument and preliminary report of results. N Engl J Med 210:1373–1376Google Scholar
- 36.Sainte-Rose C, Chumas P (1996) Endoscopic third ventriculostomy. Tech Neurosurg 1:167–184Google Scholar
- 37.Sainte-Rose C, Hoffman HJ, Hirsch JF (1989) Shunt failure. In: Marlin AE (ed) Concepts in pediatric neurosurgery. Karger, Basel, pp 7–20Google Scholar
- 38.Scarff JE (1935) Third ventriculostomy as the rational treatment of obstructive hydrocephalus. J Pediatr 6:870–871Google Scholar
- 42.Teo C (1998) Third ventriculostomy in the treatment of hydrocephalus: experience with more than 120 cases. In: Hellwig D, Bauer BL (eds) Minimally invasive techniques for neurosurgery. Springer, Berlin Heidelberg New York, pp 73–76Google Scholar
- 43.Teo C, Rahman S, Boop F (1995) Complications of endoscopic surgery [abstract]. Childs Nerv Syst 11:539Google Scholar
- 45.Vries JK (1978) An endoscopic technique for third ventriculostomy. Surg Neurol 13:165–168Google Scholar