Neurocognitive Complications after Ventricular Neuroendoscopy: A Systematic Review

Abstract

In recent years, neuroendoscopic treatment of hydrocephalus and various ventricular pathologies has become increasingly popular. It is considered by many as the first-choice treatment for the majority of these cases. However, neurocognitive complications following ventricular neuroendoscopic procedures may occur leading mostly to amnesia, which might have a grave effect on the patient’s quality of life. Studies assessing neurocognitive complications after ventricular neuroendoscopic procedures are sparse. Therefore, we conducted a systematic review assessing the available literature of neurocognitive complications and outcome after ventricular neuroendoscopy. Of 1216 articles screened, 46 were included in this systematic review. Transient and permanent neurocognitive complications in 2804 ventricular neuroendoscopic procedures occurred in 2.0% (n=55) and 1.04% (n=28) of the patients, respectively. Most complications described are memory impairment, followed by psychiatric symptoms (psychosyndrome), cognitive impairment not further specified, declined executive function, and confusion. However, only in 20% of the series describing neurocognitive complications or outcome (n=40) was neurocognition assessed by a trained neuropsychologist in a systematic manner. While in most of these series only a part of the included patients underwent neuropsychological testing, neurocognitive assessment was seldom done pre- and postoperatively, long-term follow up was rare, and patient’s cohorts were small. A paucity of studies analyzing neurocognitive complications and outcome, through systematic neuropsychological testing, and the correlation with intraoperative lesions of neuronal structures (e.g., fornix) exists in the literature. Therefore, the neurocognitive and emotional morbidity after ventricular neuroendoscopic procedures might be underestimated and warrants further research.

A bi-foraminal craniometric-guided approach to endoscopic third ventriculostomy and biopsy of a pineal tumour

“…[ 6 , 7 ] A flexible endoscope, along with neuronavigation, can facilitate the use of a single bur hole in these cases, with a lower risk of forniceal contusions when compared to the use of a rigid endoscope. [ 10 ]…”

“…[6,7] A flexible endoscope, along with neuronavigation, can facilitate the use of a single bur hole in these cases, with a lower risk of forniceal contusions when compared to the use of a rigid endoscope. [10] In settings where neuro-endoscopic procedures are not commonly done, and where neuronavigation is unavailable, the use of ipsilateral single or dual-bur holes in cases such as these may unnecessarily risk intraoperative cortical bleeding, forniceal contusions and basilar artery injury. [11] Neurocognitive deficits post-endoscopic ventricular surgery have been described by Soleman and Guzman in their review article in 2020, with a 2% transient and 1% permanent rate of neurological impairment.…”

“…Short-term memory loss from forniceal contusions is documented after this procedure, but fortunately quite rare. [2,7,9,10] Infection, transient diabetes insipidus, intraventricular haemorrhage requiring temporary ventricular drainage and tumour seeding are other complications that may arise from this procedure. [1][2][3]9] CONCLUSION e bi-foraminal approach to combined ETV and biopsy for pineal tumours can be utilized to enable safe tumour biopsy.…”

Endoscopic and Endoscopically-Assisted Resection of Intraventricular Lesions Using a Neuroendoscopic Ultrasonic Aspirator

“…It is known that regardless of the use of NUA, the most common neurocognitive complication after ventricular neuroendoscopy is memory impairment (2% transient and 1% permanent memory impairment). Specifically, for the resection of a colloid cyst, it is significantly higher, accounting for 7.96% and 2.65%, respectively [18].…”

“…A comparative statement to other studies is not possible, since the postoperative cognitive outcome was not assessed in any of the studies mentioned above. Generally, based on a recently published systematic review analyzing cognitive outcomes after neuroendoscopic procedures, these outcomes are often underreported [18]. It is known that regardless of the use of NUA, the most common neurocognitive complication after ventricular neuroendoscopy is memory impairment (2% transient and 1% permanent memory impairment).…”