Guo Genrui, Cao Hongbin
Department of Anesthesiology, Hebei Children's Hospital, Hebei Medical University, Shijiazhuang, Hebei, China.
Department of Neurosurgery, Hebei Children's Hospital, Hebei Medical University, Shijiazhuang, Hebei, China.
Saudi J Anaesth. 2025 Jul-Sep;19(3):286-291. doi: 10.4103/sja.sja_596_24. Epub 2025 Jun 16.
In recent years, the use of endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) for the treatment of pediatric hydrocephalus has gained increasing attention, particularly in North America and Africa. It has shown potential to enhance the efficacy of ETV alone and reduce the need for ventriculoperitoneal shunt placement. However, research on the potential side effects of CPC, particularly concerning postoperative sympathetic nervous system responses, remains limited. In our clinical practice, we observed that ETV + CPC may induce transient sympathetic storms, a phenomenon not yet reported in the literature, posing new challenges for postoperative anesthetic management and monitoring.
This study aims to report the phenomenon of transient sympathetic storm following ETV + CPC, analyze its potential mechanisms, and raise awareness among anesthesiologists and neurosurgeons to enhance recognition and management of this condition.
A retrospective analysis was performed on three pediatric patients with communicating hydrocephalus who underwent ETV + CPC at our hospital between January 2016 and December 2016 and subsequently developed transient sympathetic storm. The clinical features, intraoperative and postoperative conditions, and patient outcomes were analyzed to explore the relationship between the extent of CPC and the severity of sympathetic hyperactivity.
All three patients developed varying degrees of sympathetic hyperactivity after surgery, including tachycardia, rapid breathing, increased muscle tone, tension, and limb tremors. The first case (6-month-old boy) underwent right-sided CPC and had the mildest response. The second case (6-month-old girl) underwent right-sided and partial left-sided CPC, exhibiting moderate response. The third case (21-month-old girl) underwent extensive bilateral CPC and had the most severe response with the longest duration. Sympathetic hyperactivity was positively correlated with the extent and intensity of CPC.
Transient sympathetic storm may occur after ETV + CPC, presenting challenges for postoperative anesthetic and neurosurgical care. The severity of sympathetic hyperactivity appears to correlate with the extent and intensity of CPC. Its mechanism is hypothesized to involve thermal injury to the bilateral thalamus and associated vasculature. Further research is required to better understand the side effects and complications of CPC. This study also supports the hypothesis that bilateral thalamic injury may trigger sympathetic hyperactivity, providing new evidence and insights into the mechanisms underlying paroxysmal sympathetic hyperactivity.
近年来，内镜下第三脑室造瘘术联合脉络丛烧灼术（ETV+CPC）用于治疗小儿脑积水越来越受到关注，尤其是在北美和非洲。它已显示出增强单纯ETV疗效并减少脑室腹腔分流术放置需求的潜力。然而，关于CPC潜在副作用的研究，特别是关于术后交感神经系统反应的研究仍然有限。在我们的临床实践中，我们观察到ETV+CPC可能诱发短暂性交感风暴，这一现象尚未见文献报道，给术后麻醉管理和监测带来了新的挑战。
本研究旨在报告ETV+CPC术后短暂性交感风暴现象，分析其潜在机制，并提高麻醉医生和神经外科医生对该病症的认识，以加强对此病症的识别和管理。
对2016年1月至2016年12月在我院接受ETV+CPC治疗的3例交通性脑积水小儿患者进行回顾性分析，这些患者随后出现了短暂性交感风暴。分析临床特征、术中及术后情况以及患者结局，以探讨CPC范围与交感神经过度活跃严重程度之间的关系。
所有3例患者术后均出现不同程度的交感神经过度活跃，包括心动过速、呼吸急促、肌张力增加、紧张和肢体震颤。第一例（6个月大男孩）接受了右侧CPC，反应最轻。第二例（6个月大女孩）接受了右侧及部分左侧CPC，表现为中度反应。第三例（21个月大女孩）接受了广泛的双侧CPC，反应最严重，持续时间最长。交感神经过度活跃与CPC的范围和强度呈正相关。
ETV+CPC术后可能发生短暂性交感风暴，给术后麻醉和神经外科护理带来挑战。交感神经过度活跃的严重程度似乎与CPC的范围和强度相关。其机制推测涉及双侧丘脑及相关血管的热损伤。需要进一步研究以更好地了解CPC的副作用和并发症。本研究还支持双侧丘脑损伤可能引发交感神经过度活跃的假说，为阵发性交感神经过度活跃的潜在机制提供了新的证据和见解。
