Cinalli Giuseppe, Spennato Pietro, Ruggiero Claudio, Aliberti Ferdinando, Trischitta Vincenzo, Buonocore Maria Consiglio, Cianciulli Emilio, Maggi Giuseppe
Department of Pediatric Neurosurgery, Santobono Children's Hospital, Naples, Italy.
Childs Nerv Syst. 2007 Jun;23(6):633-44. doi: 10.1007/s00381-007-0333-6. Epub 2007 Apr 20.
The significant technological improvement of endoscopic instrumentation has allowed, in the last 10 years, a widespread diffusion of neuroendoscopic procedures. Nevertheless, severe, sometimes life-threatening, complications may occur during neuroendoscopic surgery, and the incidence and age specificity of complications in children have been underdescribed so far.
Complications recorded in a prospectively collected database of pediatric patients undergoing neuroendoscopic procedures were analysed; the medical histories of the patients and the surgical procedures were reviewed.
Complications occurred in 32 out of 231 (13.8%) procedures performed for the management of obstructive hydrocephalus (137), multiloculated hydrocephalus (53), arachnoid cysts (29) and intraventricular tumors (12). Subdural hygroma occurred in 11 cases, seven requiring subdural shunting. In one of these cases, infection of the subdural space occurred and required a craniotomy. Cerebrospinal fluid (CSF) infection occurred in 11 cases. In one case, a frontal abscess developed and was managed with craniotomy. CSF leak occurred in nine cases, intraventricular haemorrhages in two, technical failures in seven, subcutaneous CSF collection (managed with lumbo-peritoneal shunt) in one, thalamic contusion and post-operative transient akinetic mutism in one. This patient suddenly died 6 months later, probably as a consequence of closure of the stoma. Two patients developed secondary compartmentalisation of the ventricles after complicated endoscopic third ventriculostomy. In nine cases, these complications were associated. Overall, no patient died after the procedure (operative mortality 0), one patient died 6 months after the procedure for unexplained events (sudden death rate 0.4%), and three patients presented permanent disability as a consequence of surgical complication (permanent morbidity 1.3%).
Complication rate of neuro-endoscopic procedures is not negligible even in experienced hands. The majority are minor complications which do not affect the final outcome, but sporadically major events may occur, leading to significant problems in surgical management and, occasionally, to permanent disabilities. Careful selection of patients on pre-operative imaging studies and intensive training of surgeons are mandatory to improve results.
在过去十年中，内镜器械的重大技术改进使得神经内镜手术得以广泛开展。然而，神经内镜手术期间可能会出现严重的、有时甚至危及生命的并发症，迄今为止，儿童并发症的发生率及年龄特异性鲜有描述。
分析前瞻性收集的接受神经内镜手术的儿科患者数据库中记录的并发症；回顾患者的病史及手术过程。
在231例手术中，32例（13.8%）出现并发症，这些手术用于治疗梗阻性脑积水（137例）、多房性脑积水（53例）、蛛网膜囊肿（29例）和脑室内肿瘤（12例）。11例出现硬膜下积液，其中7例需要进行硬膜下分流术。其中1例发生硬膜下腔感染，需要开颅手术。11例发生脑脊液感染。1例出现额叶脓肿，通过开颅手术治疗。9例发生脑脊液漏，2例发生脑室内出血，7例出现技术故障，1例出现皮下脑脊液聚集（通过腰大池-腹腔分流术处理），1例出现丘脑挫伤及术后短暂性运动不能性缄默症。该患者6个月后突然死亡，可能是由于造口闭合所致。2例患者在内镜下第三脑室造瘘术后出现继发性脑室分隔。9例中，这些并发症相互关联。总体而言，术后无患者死亡（手术死亡率为0），1例患者术后6个月因不明原因事件死亡（猝死率为0.4%），3例患者因手术并发症出现永久性残疾（永久性发病率为1.3%）。
即使是经验丰富的医生，神经内镜手术的并发症发生率也不容小觑。大多数为轻微并发症，不影响最终结果，但偶尔会发生重大事件，导致手术处理出现严重问题，偶尔还会导致永久性残疾。术前仔细根据影像学检查选择患者并加强外科医生培训对于改善手术效果至关重要。
