Long-term complications and definition of failure of neuroendoscopic procedures

A lot has been published about neuroendoscopic procedures over the last decade. Most of these publications are about the effectiveness of endoscopic third ventriculostomy, the most frequently performed neuroendoscopic procedure. Little is published about the effectiveness of other, less frequently performed neuroendoscopic procedures. Over the years more reports about the complications of endoscopic procedures are published, but again most of these publications are about endoscopic third ventriculostomy and only a little is presented about the complications of all other neuroendoscopic procedures. Furthermore, most reports are about intraoperative and immediate postoperative complications; only a few reports evaluated the long-term complications of neuroendoscopic procedures. There are also a few publications that analyse the failures of neuroendoscopic procedures but a good definition of failure is not given. The reports mention, again, mainly endoscopic third ventriculostomy procedures, and are mostly directed at the short-term failure rates, defined as the need for a shunt to be placed. Less attention is paid to the effects of the endoscopic procedures in the longer term. Looking at longer terms emphasises the need for a better definition of failure.

To get more insight into the long-term complications and failures of neuroendoscopic procedures, we reviewed the literature and evaluated our own series of 485 different cranial endoscopic procedures. With the information gathered we tried to answer the questions mentioned above.

Most of the complications of neuroendoscopic procedures are transient, either spontaneously or by medical intervention. Only a few permanent complications are known, in our series 1.6%, and most of them are not typically related to the endoscopic procedure itself but are due to the ventricular approach necessary for and the management of the endoscopy. Mortality rates are less than 1%. A uniform definition of failure cannot be given for all neuroendoscopic procedures, because the procedures are too heterogeneous and the indications are widespread. Failures are mainly diagnosed within a few months of the procedure but neurosurgeons must be aware of failure in the longer term, because if not diagnosed they can give rise to increased morbidity and probably mortality.