Abstract
Endoscopic neurosurgical techniques hold the potential for reducing morbidity. But
they are also associated with limitations such as the initial learning curve, proximal
blind spot, visual obscurity, difficulty in controlling bleeding, disorientation,
and loss of stereoscopic image. Although some of the surgical techniques in neuroendoscopy
and microsurgery are similar, endoscopy requires additional skills. A thorough understanding
of endoscopic techniques and their limitations is required to get maximal benefit.
Knowledge of possible complications and techniques to avoid such complications can
improve results in endoscopic third ventriculostomy (ETV). The surgeon must be able
to manage complications and have a second strategy such as a cerebrospinal fluid shunt
if ETV fails. It is better to abandon the procedure if there is disorientation or
a higher risk of complications such as bleeding or a thick and opaque floor without
any clear visualization of anatomy. Attending live workshops, practice on models and
simulators, simpler case selection in the initial learning curve, and hands-on cadaveric
workshops can reduce complications. Proper case selection, good surgical technique,
and better postoperative care are essential for a good outcome in ETV. Although it
is difficult to make a preoperative diagnosis of complex hydrocephalus (combination
of communicating and obstructive), improving methods to detect the exact type of hydrocephalus
before surgery could increase the success rate of ETV and avoid an unnecessary ETV
procedure in such cases.
Keywords
complications - endoscopy - intraoperative complication - minimal invasive surgical
procedure - neuroendoscopy
