Ten years of experience with pediatric neuroendoscopic third ventriculostomy: features and perioperative complications of 210 cases.
Obstructive hydrocephalus remains a problem, and improvements in fiberoptic technology have promoted interest in neuroendoscopic ventriculostomy (NTV) as an alternative to standard cerebrospinal fluid shunts. The present study assessed 210 pediatric NTVs performed between 1994 and 2004 in patients aged 2 months to 10 years. Five children needed same-session ventriculoperitoneal shunting due to insufficient bypass of the obstruction. The other 205 procedures were technically successful, but 7 patients needed early-postoperative shunting and 10 required late shunting. During NTV, 86 (40.1%) of the patients developed arrhythmia. One patient arrested during balloon dilatation, but normal rhythm returned after deflation and epinephrine/atropine therapy, with no resultant morbidity. Twenty-six (10.2%) patients developed tachycardia (without hypertension) followed by bradycardia, and 6 children (2.8%) developed hypertension. In 1 case (0.5%), a branch of the basilar artery ruptured during fenestration and the hemorrhage was controlled after craniotomy. In 5 cases, mild venous bleeding was controlled by irrigation. The early complications included transient ocular divergence (n = 1), anisocoria (n = 2), and hyponatremia (n = 5). Five children were diagnosed with temporary diabetes insipidus in the late-postoperative period. The neuroendoscopic approach is considered safe for treating hydrocephalus in children, but complications can be severe or lethal and the anesthesiologist must respond accordingly.
Baykan
Nigar
N
Department of Anesthesiology and Reanimation, Subdivision of Pediatric Neurosurgery, Institute of Neurological Science, Marmara University, Istanbul, Turkey.
Isbir
Olcay
O
Gerçek
Arzu
A
Dağçnar
Adnan
A
Ozek
M Memet
MM
D000758:Anesthesia; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D001488:Basilar Artery / Q000293:injuries; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013129:Spinal Puncture; D020542:Third Ventricle / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy / Q000009:adverse effects
D000889:Anti-Arrhythmia Agents