Irrigation can cause prolonged intracranial pressure elevations during endoscopic treatment of intraventricular haematomas*¹

Abstract

Background. Irrigation may elevate the intracranial pressure (ICP) during neuroendoscopic procedures. It is unlikely that rinsing the ventricles during routine endoscopic ventriculostomy causes persistent neurological impairment or damage, but procedures such as the endoscopic evacuation of intraventricular haematomas (IVH) are performed in patients who may be prone to elevated ICP. We report a series of such patients in which we measured the ICP intraoperatively. Method. The charts and intraoperative ICP recording protocols of 22 patients were analysed for ICP elevations of more than 30 seconds. The measurements were performed remote from the endoscope using intraventricular catheters in 20 cases and epidural probes in 2 cases. These had been placed before the endoscopic operation for the purpose of monitoring unconscious patients or definitively diagnosing hydrocephalus. Thirteen patients suffered from intraventricular haemorrhages. Nine patients had an occlusive hydrocephalus without intraventricular blood. Findings. Intraoperatively, at least one episode of ICP exceeding 30 mmHg was observed in all of the IVH patients and in seven of the remaining patients. Seven out of thirteen patients suffering from IVH exhibited more than one episode with ICP exceeding 50 mmHg, ranging from 35 up to 180 seconds. Three out of nine patients without IVH presented with such episodes, but only one of these patients presented with more than one. Conclusions. Endoscopic procedures within the cerebral ventricles are considered relatively uncomplicated procedures. However, patients undergoing treatment of IVH may suffer prolonged elevated ICP which may be critical because of their age and co-morbidity.

Keywords::

• intracerebral haemorrhage
• intracranial pressure
• intraoperative monitoring
• intraventricular haemorrhage
• neuroendoscopy

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes

¹*Parts of this study have been presented at the 4th World Congress for Endoscopic Surgery of the Brain, Skull Base and Spine, Pittsburgh, PA, 28–30th April, 2010