Anesthetic management of surgical neuroendoscopies - Usefulness of monitoring the pressure inside the neuroendoscope

Neuroendoscopic procedures are increasing in frequency in neurosurgical pra ctice. We describe the anesthetic technique and the perioperative complicat ions found in 100 neuroendoscopic interventions performed at our institutio n. Cranial tumor biopsy or retrieval (62%) and cisternostomy for hydrocepha lus (33%) were the most frequent indications for neuroendoscopy. The mortal ity rate was low (1%). Intraoperative complications occurred in 36 patients , with arterial hypertension being the most frequent (53%). Postoperative c omplications occurred in 52 patients; anisocoria (31%) and delayed arousal (29%) were the most frequent. The pressure inside the endoscope was monitor ed intraoperatively in the last 47 patients. A saline-filled catheter from a pressure transducer connected to the neuroendoscopy system was used for p ressure monitoring. We recorded the highest peak of pressure values measure d during each procedure. Twenty-three patients (49%) had peak pressure valu es >30 mm Hg, 12 patients (25%) >50 mm Hg), and 3 patients >100 mm Hg. Only one patient had hemodynamic changes occurring simultaneously with the pres sure changes. We found an association between pressure inside the endoscope >30 mm HE and postoperative (P =.003) but not intraoperative complications . A relationship was found between surgical duration and postoperative comp lications (P =.002). Neither the pressure inside the endoscope or the intra operative morbidity were related to surgical duration. We conclude that the re may be a high rate of postoperative complications after neuroendoscopies , namely, new neurologic deficits. High pressure levels inside the endoscop e during neuroendoscopic procedures can occur without hemodynamic warning s igns. Pressure values >30 mm Hg are associated with postoperative morbidity , especially unexpected delayed recovery. Measuring the pressure inside the endoscope is technically easy and might be beneficial if performed in all neuroendoscopic procedures. Reducing the incidence of episodes of high peak pressure values might decrease the rate of postoperative complications.