Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults

Abstract

Background: The emphasis regarding intracranial neuroendoscopy has been traditionally advocated and focused on the role in pediatric patients, although a significant usage has developed in adult patients. In this study, we examine and contrast the role of predominantly intracranial neuroendoscopy in both a pediatric and adult population with a minimum postprocedure follow-up of 5 years. Methods: A retrospective review was conducted for patients in the two hospitals that manage neurosurgical care for Southern Alberta, Canada, undergoing neuroendoscopic surgery between 1994 and 2008. The pediatric group was defined as age ≤17 years and the adult group as age ≥18 years. Results: A total of 273 patients who underwent a total of 330 procedures with a mean postprocedure follow-up of 12.9 years were identified. There were 161 adult and 112 pediatric patients, and both groups underwent surgery by the same surgeons. The most common procedure was endoscopic third ventriculostomy, accounting for 55% of procedures. One postoperative death occurred in an adult patient. Endoscopic third ventriculostomy success 1-year postprocedure was 81%, with only three late-term failures. Postoperative infection was the most common serious complication (two pediatric/four adult patients). Adult and pediatric patients had similar major complication rates (4.2% vs 5.7%, p = 0.547). Conclusions: Neuroendoscopy overall had a similar role in both pediatric and adult neurosurgical populations, with the most commonly associated complication being infection. Neuroendoscopy is an important therapeutic modality in the management of appropriate adult patients.RÉSUMÉ: Comparaison des interventions neuroendoscopiques intracrâniennes chez les enfants et chez les adultes. Contexte: Traditionnellement, l'emphase a été mise sur la neuroendoscopie intracrânienne chez les enfants et sur son rôle dans cette population de patients. Cependant, de telles interventions sont de plus en plus pratiquées chez des adultes. Nous examinons le rôle de la neuroendoscopie tant chez les enfants que chez les adultes et nous comparons son rôle dans ces deux populations de patients. Méthode: Nous avons procédé à une revue rétrospective des dossiers de patients ayant subi une chirurgie par neuroendoscopie entre 1994 et 2008 dans deux hôpitaux qui offrent des soins neurochirurgicaux dans la partie sud de l'Alberta, au Canada. Les patients du groupe pédiatrique étaient âgés de 17 ans ou moins et ceux du groupe adulte de 18 ans ou plus. Le suivi le plus court après l'intervention était de 5 ans. Résultats: Nous avons identifié 273 patients, dont 161 adultes et 112 enfants, qui ont subi au total 330 interventions, et chez qui un suivi moyen de 12,9 ans était disponible. Les deux groupes de patients ont été opérés par les mêmes chirurgiens. L'intervention la plus fréquemment effectuée était la ventriculostomie au niveau du 3e ventricule, ce qui représentait 5% des interventions. Un patient adulte est décédé en période post-opératoire. La ventriculostomie du 3e ventricule p...

Neurocognitive Complications after Ventricular Neuroendoscopy: A Systematic Review

“…Various ventricular endoscopic procedures, such as third ventriculostomy (ETV), CC resection or aspiration, tumor biopsy or resection, septum pellucidotomy, and foraminoplasty or stenting, have been described. Endoscopic procedures are often described as minimally invasive, since they lead to lower morbidity and mortality rates when compared to open microsurgical procedures [5,6]. In addition, endoscopic treatment of hydrocephalus is considered preferable to the placement of ventriculoperitoneal shunt (VPS) in patients above the age of six months, since it is at least as efficient and it avoids a lifetime shunt dependency and associated complications, occurring sometimes years after VPS placement [1,7].…”