Intracranial migration of bone dust after intraventricular neuroendoscopy complicating acute hydrocephalus and removal of bone dust: case report.
OBJECTIVE
To present the first case of neuroendoscopic removal of migrated intraventricular bone dust and gel foam after intraventricular endoscopic surgery.


METHODS
A 37-year-old man was admitted with a 2-year history of headache. Brain computed tomography (CT) scan and magnetic resonance imaging revealed a cavum vergae cyst. The patient was operated on by stereotactically guided endoscopic cyst fenestration with no intraoperative complications. Postoperative CT scan demonstrated regression of the cyst with no other pathological findings. Because of a postoperative fever, a lumbar puncture was performed after the brain CT scan to eliminate meningitis as a differential diagnosis. After the lumbar puncture, the patient complained of severe headache and vomiting followed by depression of consciousness. The follow-up CT scan showed the migration of bone dust from the burr hole site to the ventricular system and acute hydrocephalus. It is thought that the negative pressure gradient generated after the lumbar puncture might have been transmitted through the cerebrospinal fluid pathway, resulting in a suction effect and migration of the bone dust from the burr hole to the ventricle.


METHODS
An urgent reexplorative endoscopic procedure was performed, and most of the bone dust and gel foam were removed. The patient recovered with complete resolution of the previous symptoms.


CONCLUSIONS
We propose not using autologous bone dust for closure of the burr holes after endoscopic intraventricular procedures; instead, alloplastic materials designed especially for burr hole closure may be used. However, our main recommendation is to use an external ventricular drainage, which is maintained closed but can be opened if necessary. In addition, lumbar puncture should be avoided in cases in which bone dust is used for the burr hole reconstruction without dural closure.
Kafadar
Ali
A
Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Abuzayed
Bashar
B
Kucukyuruk
Baris
B
Cetin
Ercan
E
Gazioglu
Nurperi
N
D000328:Adult; D020863:Central Nervous System Cysts / Q000601:surgery; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery*; D004391:Dust; D004724:Endoscopy / Q000009:adverse effects*; D005548:Foreign-Body Migration / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D051299:Post-Dural Puncture Headache / Q000628:therapy; D011183:Postoperative Complications / Q000473:pathology* / Q000601:surgery*; D013129:Spinal Puncture / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
D004391:Dust