Anaesthetic considerations and perioperative features of endoscopic third ventriculostomy in infants: Analysis of 57 cases

Abstract

Aim: Endoscopic third ventriculostomy (ETV) is currently considered the best alternative to shunt systems in the treatment of triventricular hydrocephalus. However, there has been very few published data about the anaesthetic management and the complications of ETV procedure in infants. In this report, we detail our experience with 57 infants, who underwent ETV as an initial treatment for obstructive triventricular hydrocephalus between 2003 and 2010. Material and Methods: Anesthesia chart-records were retrospectively investigated and perioperative data were classified according to the stages of the procedure. Results: In this series, mean heart rate values showed a statistically significant difference in the period concerning the balloon dilatation of ventriculostomy orifice. An episode of bradycardia occurred in 2 patients during balloon dilatation. After the deflation of the balloon, bradycardia resolved immediately without administration of any medication. Video recordings of those two patients revealed that one of them had a narrow and opaque tuber cinereum, and the other had a shallow interpeduncular cistern. Conclusion: During ETV procedure in infants, bradycardia may be a serious complication especially when performing balloon dilatation of the ventriculostomy orifice. We believe that close communication between the surgeon and the anaesthetist is extremely essential in this stage of the procedure.