Intraventricular migration of the bone dust. Is a second operation for removal necessary? Case report and review of the literature

Abstract

Abandoning usage of bone dust for sealing burr holes is a solution to avoid this complication. In addition, it should be kept in mind that intraventricular bone particles might grow and lead to obstructions. If such particles are detected, removal of the bones in certain locations before formation of neovascularization can be an option.

Intraventricular bone dust migration after neuroendoscopy: report of 2 cases

“…Their third case included a pathological analysis of retrieved bone fragments that demonstrated viable fat cells; this was considered evidence that these bone fragments were growing masses. 16 Similarly, in the case reported by Turhan and Ersahin, 18 the extracted bone particles were noted to be tightly adhering to the ependymal lining, with significant bleeding upon their removal and clear vascular structures observed in the bone. While migration of small bone fragments into the ventricles might take a benign course in the short term, it appears that this viable bone can grow and potentially cause complications later in the clinical course.…”

“…In addition to bone fragment migration, some reports have noted evidence of bone fragment revascularization and continued growth on follow-up imaging studies, adding the possibility of long-term complications. 8,18 In 2 cases reported by Thomson et al 16 there was a delayed appearance of radiopacities in the endoscopy tract, with progressive enlargement of these radiopacities on subsequent scans in one of these 2 cases. Their third case included a pathological analysis of retrieved bone fragments that demonstrated viable fat cells; this was considered evidence that these bone fragments were growing masses.…”

“…While this technique is effective and safe in most of cases, reports of complications arising after migration of bone fragments and dust have emerged. 5,8,16,18 In searching the literature, we found 5 cases of such complications, and 2 additional cases from 2 centers are presented in this report. A summary of all of these cases, including clinical and radiographic presentations and outcomes, is provided in Table 1.…”

“…Among the cases reported in the literature, 3 patients re-presented with worsening headaches and recurrent hydrocephalus that was deemed to be related to bone fragment migration into the ventricles and CSF outflow obstruction. 8,16,18 In all 3 cases, the patients were taken to the operating room for endoscopic removal of the bone fragments; complete resolution of symptoms was reported in 2 cases, and no outcome data were reported in the third. One of the 3 patients had undergone a lumbar puncture for aseptic meningitis prior to this complication, which theoretically may have contributed to bone fragment migration via a negative pressure mechanism.…”

Complication avoidance and its management in endoscopic neurosurgery

“…Such particles, if detected during the procedure, should be removed. [12] Although most of the blocked stoma complications in ETV patients occur in early post-operative period, delayed block; though very rare can be fatal. [13] Longer follow-up is desirable especially in patients who undergo ETV for infective hydrocephalus and Dandy-Walker malformation because late closure of the stoma may occur in these patients.…”