Complication avoidance in minimally invasive neurosurgery.
Although minimally invasive neurosurgery (MIN) holds the potential for reducing the approach-related impact on normal brain, bone, and soft tissues, which must be manipulated in more conventional transcranial microneurosurgery, the techniques necessary to perform minimally invasive, yet maximally effective neurosurgery place significant demands on the surgeon because in many ways the more limited exposure creates a number of unique ways these operations can go wrong. Safe and effective MIN requires the conscious institution of specific alterations to the surgeon's usual operative case flow, which are designed to make specific well-known mistakes impossible or at least very unlikely. Thus, it is important for the aspiring MIN surgeons to learn from the mistakes of their predecessors and to institute patterns of behavior that prevent a repetition of these mistakes. This article provides practical information regarding known pitfalls in intraventricular and transcranial neuroendoscopic surgeries and practical methods to reduce the incidence of these complications to the lowest rate possible.
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA 94117, USA. SughrueM@Neurosurg.UCSF.Edu
Michael E
ME
Sughrue
Steven A
SA
Mills
Ronald L
RL
Young
D002552:Cerebral Ventricles / Q000033:anatomy & histology / Q000502:physiology; D002983:Clinical Competence; D004724:Endoscopy; D004868:Equipment Failure; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000295:instrumentation; D010347:Patient Care Planning; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care