Neurogenic pulmonary edema following Endoscopic third Ventriculostomy in patient with Hydrocephalous; case report

Neurogenic pulmonary edema (NPE) post endoscopic third ventriculostomy (ETV) is rare but fatal. Acute central brain injury complications are the most frequent cause.in this case uncommonly occur post ETV procedure. Prevalence of NPE varies 2-49 %.

A teen with hydrocephalus visited Operation Theater for ETV. An airway of Mallapathy ΙΙ & short neck. General anesthesia (GA) Induced & tracheal intubation succeeded on the second try. Until the surgery was over, the vital signs were normal. Patient recovered while suctioning oropharengial, pink frozen sputum observed through endotracheal tube (ETT). In the meantime, the O2 saturation ↓from 99 to 63 %, the heart rate (HR) ↓ but BP↑. Chest auscultation revel crackle. Spot diagnoses of NPE were treated with 100%O₂, 20 mg of furosemide intravenously, mild hyperventilation after a hr. O₂ saturation ↑ to 89 %. Patient moved to ICU with 100 % O₂ by mask 2 h later. X-ray confirms the diagnosis. Furosemide, head up & 100 % O₂ are still being used during treatment. 24 h later O₂ saturation maintained to 92 to 94 %. After 48 h patient transferred to regular ward with stable condition.

Rare yet lethal NPE is typically brought on by serious Brain injury. It happened here after the ETV surgery. We think that irrigation fluid and endoscopic stimulation may be the triggers. Hence there may be question with irrigation fluid and endoscopic stimulation.

Early detection and therapy of NPE following an ETV procedure helps to prevent serious complications. Considering the volume of endoscopic irrigation and optimize endoscopic stimulation.