Table 6.6. Complications of neuroendoscopy (as coded & recorded in "ENDOSPREAD")

1 Intraoperative hemorrhage - operation abandoned

2 Intraoperative hemorrhage - operation continued

3 Hemorrhage - intraventricular

4 Hemorrhage - intracerebral

5 Hemorrhage - subdural

6 Hemorrhage - extradural

7 Infection - deep

8 Infection - superficial

9 Cranial nerve lesion - transient

10 Cranial nerve lesion - persistent

11 Neurological impairment - transient

12 Neurological impairment - persistent

13 CSF fistula - transient, requiring no more than suture

14 CSF fistula - persistent

15 Novel epilepsy <7 days from operation

16 Novel epilepsy >7 days from operation

17 Exacerbation of epilepsy <7 days from operation

18 Exacerbation of epilepsy >7 days from operation

19 Neuroendocrine - transient

20 Neuroendocrine - persistent

21 Cerebral infarct - asymptomatic

22 Cerebral infarct - symptomatic

23 ICU admission post-operatively

24 Death within 30 days of operation

25 EVD inserted - intraoperatively

26 EVD inserted - post-operatively

27 Intraoperative cardiac event

EVD, external ventricular drain minor intraoperative bleeding that stops with irrigation and does not compromise the patient or the procedure. Significant ones are those that do, or might, have serious or lasting sequelae for the patient. It must be acknowledged that, whilst defining these categories is useful to the surgeon, in the mind of patients and families even a relatively small event such as a transient leakage of cerebrospinal fluid that resolves with a single suture is a cause for concern. Whereas the incidence of insignificant complications declined with experience, the occurrence of significant ones did not. The most frequent and the most serious complications are listed in Table 6.7.

Of some concern are reports of what appear to be sudden and unexpected deaths in patients who have undergone NTV. It is unclear whether these were truly without prodrome or whether the patients had been lulled into a sense of false security following successful NTV, and simply failed to seek medical attention when headaches

Table 6.7. The frequent or serious complications of neuroendoscopy

Intraoperative complications

Intraoperative hemorrhage causing procedure to be abandoned

Traumatic cerebral artery aneurysm Intracerebral hematoma Life-threatening cardiac dysrhythmias Transient bradycardia Transient hypertension

Post-operative complications

Death within 6 weeks Cerebral infarction New cranial nerve palsy New neurological deficit Subdural collections CSF leak

Meningitis or ventriculitis Superficial infection Epilepsy

Hypothalamic damage or even visual symptoms recurred. They may therefore have been in no different a situation to the patient with a shunt who becomes a victim of failed follow-up.

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