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Basilar artery perforation as a complication of endoscopic third ventriculostomy
K Abtin1, B G Thompson, M L Walker
1Department of Neurological Surgery, University of Utah, Primary Children's Medical Center, Salt Lake City 84113, USA.
Abstract:
The morbidity and mortality associated with third ventriculostomy has decreased significantly over the past 75 years since its introduction by Walter Dandy. Now more commonly performed using an endoscopic method, the significant morbidity of third ventriculostomy has dropped to approximately 5%; essentially that associated with ventriculoscopy in general. However, the possible complication of massive subarachnoid hemorrhage resulting from perforation of the basilar artery or its branches in the course of fenestration of the floor of the third ventricle has only recently been reported. In our case, subsequent to a vascular injury, a pseudoaneurysm developed at the site of vascular perforation, which was then appropriately controlled. The patient has since made a full recovery. Our goal is to remind the endoscopist of this unusual complication and to discuss our management strategies.
Insights
Endoscopic third ventriculostomy is safer now, but a rare complication involves bleeding from the basilar artery. This case highlights managing pseudoaneurysms after vascular injury during the procedure.
Area of Science:
- Neurosurgery
- Endoscopic Procedures
- Vascular Complications
Background:
- Third ventriculostomy, a neurosurgical procedure, has evolved significantly over 75 years.
- Modern endoscopic techniques have drastically reduced associated morbidity and mortality.
- Fenestration of the third ventricle floor carries a risk of vascular injury.
Observation:
- A rare complication of massive subarachnoid hemorrhage occurred due to basilar artery perforation during endoscopic third ventriculostomy.
- A pseudoaneurysm formed at the site of vascular injury.
- The patient experienced a full recovery after appropriate management.
Findings:
- Vascular injury during third ventriculostomy can lead to pseudoaneurysm formation.
- Prompt recognition and management are crucial for favorable outcomes.
- Endoscopic fenestration of the third ventricle floor requires careful consideration of adjacent vascular structures.
Implications:
- Neuroendoscopists must be aware of this unusual but serious complication.
- Effective management strategies are essential for addressing post-procedural vascular injuries.
- This case underscores the importance of meticulous surgical technique in neuroendoscopy.