Complications of endoscopic third ventriculostomy

Endoscopic third ventriculostomy is considered by many as one of the greatest breakthroughs in the management of hydrocephalus and is the most commonly performed neuroendoscopic procedure. Neurosurgeons have pushed the boundaries of this procedure beyond the classic indication of aqueductal stenosis to include hydrocephalus of many other etiologies. Even as this technique becomes more conventional within neurosurgery, there is a distinct learning curve associated with the procedure, and many of the complications can be quite serious in nature. These can occur intraoperatively (bradycardia, hemorrhage, neural structure injury) and postoperatively (hygroma, hematoma, CSF leak, infection, seizures). Clearly, a thorough understanding of these potential pitfalls is obligatory for the skilled surgeon. This chapter will review the etiology and relative frequency of complications associated with endoscopic third ventriculostomy. Emphasis is placed on complication avoidance, and recommendations are given to encourage prevention in every phase of the procedure.