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J Neurol Surg A Cent Eur Neurosurg 2015; 76(06): 483-494
DOI: 10.1055/s-0035-1551828
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Avoiding Complications in Endoscopic Third Ventriculostomy

Yad Ram Yadav
1   Department of Neurosurgery, NSCB Medical College Jabalpur, Jabalpur, Madhya Pradesh, India
,
Vijay Singh Parihar
1   Department of Neurosurgery, NSCB Medical College Jabalpur, Jabalpur, Madhya Pradesh, India
,
Shailendra Ratre
1   Department of Neurosurgery, NSCB Medical College Jabalpur, Jabalpur, Madhya Pradesh, India
,
Yatin Kher
1   Department of Neurosurgery, NSCB Medical College Jabalpur, Jabalpur, Madhya Pradesh, India
› Author Affiliations
Further Information

Publication History

23 July 2014

15 January 2015

Publication Date:
03 July 2015 (online)

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Abstract

Endoscopic neurosurgical techniques hold the potential for reducing morbidity. But they are also associated with limitations such as the initial learning curve, proximal blind spot, visual obscurity, difficulty in controlling bleeding, disorientation, and loss of stereoscopic image. Although some of the surgical techniques in neuroendoscopy and microsurgery are similar, endoscopy requires additional skills. A thorough understanding of endoscopic techniques and their limitations is required to get maximal benefit. Knowledge of possible complications and techniques to avoid such complications can improve results in endoscopic third ventriculostomy (ETV). The surgeon must be able to manage complications and have a second strategy such as a cerebrospinal fluid shunt if ETV fails. It is better to abandon the procedure if there is disorientation or a higher risk of complications such as bleeding or a thick and opaque floor without any clear visualization of anatomy. Attending live workshops, practice on models and simulators, simpler case selection in the initial learning curve, and hands-on cadaveric workshops can reduce complications. Proper case selection, good surgical technique, and better postoperative care are essential for a good outcome in ETV. Although it is difficult to make a preoperative diagnosis of complex hydrocephalus (combination of communicating and obstructive), improving methods to detect the exact type of hydrocephalus before surgery could increase the success rate of ETV and avoid an unnecessary ETV procedure in such cases.

Keywords

complications - endoscopy - intraoperative complication - minimal invasive surgical procedure - neuroendoscopy
 

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