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Anesthesia for endoscopic ventriculostomy for the treatment of hydrocephalus. Case report
Friederike Wolff Valadares1, Michelle Nacur Lorentz, Eliana G Heyden
1Biocor Instituto, Belo Horizonte, MG. friedewo.bh@terra.com.br
Insights
Anesthesia for pediatric endoscopic third ventriculostomy is safe in children under two years old. Proper anesthetic and surgical techniques minimize complications for this neurosurgical procedure.
Area of Science:
- Pediatric Neurosurgery
- Anesthesiology
- Pediatric Anesthesia
Background:
- Endoscopic third ventriculostomy (ETV) is a common pediatric neurosurgical procedure.
- Anesthesia protocols for ETV in young children are not well-documented.
- This study evaluates anesthetic management for ETV in infants.
Purpose of the Study:
- To assess the safety and efficacy of anesthetic techniques for endoscopic third ventriculostomy in children under two years of age.
- To identify necessary precautions for anesthesia in this pediatric population.
Main Methods:
- Retrospective review of 38 children under 2 years undergoing ETV for obstructive hydrocephalus.
- Evaluation of anesthetic techniques (inhalational vs. intravenous), monitoring, and complications.
- Analysis of intraoperative and postoperative outcomes.
Main Results:
- Most patients (35/38) received inhalational anesthesia.
- Commonly observed complications included arrhythmias (6), vomiting (6), and fever (4).
- Serious complications were rare, with only one case requiring external derivation.
Conclusions:
- Endoscopic third ventriculostomy is associated with a low incidence of complications in infants and young children.
- Adherence to proper anesthetic and surgical procedures is crucial for patient safety.
Background And Objectives:
Endoscopic third ventriculostomy is becoming routine among neurosurgical pediatric procedures. However, reports on anesthesia for children undergoing such procedures are rare. The aim of this series of cases was to demonstrate the precautions that should be taken and efficacy of the method used.
Case Report:
Thirty-eight children younger than 2 years, who underwent neuroendoscopic third ventriculostomy for the treatment of obstructive hydrocephalus from 1999 to 2004 at the Biocor Instituto were evaluated retrospectively. The diagnosis, comorbidities, age, weight, anesthetic technique, monitoring, and intra- and postoperative complications were evaluated. Patients, ages 1 week to 20 months, presented obstructive hydrocephalus secondary to compression of the aqueduct of different etiologies. In thirty-five children anesthesia was induced by inhalational anesthetics and in 3 by intravenous anesthetics. Thirty-four patients were monitored with electrocardiogram, pulse oxymeter, capnograph, and esophageal thermometer, while in 4 children it included also continuous invasive blood pressure monitoring. Fifteen patients had balanced maintenance anesthesia with fentanyl and isoflurane, and 23 children received inhalational isoflurane. Thirty-five children were extubated after the procedure in the surgical room and three in the ICU. Six patients were transferred to the ICU after extubation. The following complications were observed: intraoperative cardiac arrhythmias without hemodynamic repercussions (6 cases); two patients presented intraoperative bleeding, but in only one the placement of an external derivation was necessary. The postoperative complications included: vomiting (6), fever (4), seizures (2), laryngeal spasm (1), and stridor (1).
Conclusions:
Third ventriculostomy has a low incidence of complications, even in patients younger than 24 months, as long as proper anesthetic and surgical procedures are used.
