CEREBRAL ENDOSCOPY ON A CONSCIOUS PATIENT  

RAMIREZ-CEBALLOS, JOSEANTONIO*

MARQUEZ-CASTILLO ROSAMAGDALENA**

*CENTRO NEUROLOGICO DE INVESTIGACION DIAGNOSTICO Y TRATAMIENTO S.C.

**HOSPITAL GENERAL "DR AURELIO VALDIVIESO"                                                           

OAXACA DE JUAREZ OAXACA  MEXICO

OBJECTIVE:  Surgeries are performed on minimally sedated patients with localanesthetic for stereotaxy, chronic hematoma drainage, and surgery forepilepsy.  We’ve shown that it is possibleto perform an endoscopy on conscious patients with minimal sedation carryingout a third ventriculostomy to resolve hydrocephalus.

MATERIAL AND METHODS:  We performed 10 endoscopic procedureson patients with hypertensive hydrocephalus, candidates for a thirdventriculostomy using a Wolf 2.4 mm. flexible endoscope.  The procedure was clearly explained toall of the patients, that they would not experience pain and would be consciousduring the surgery.

RESULTS: All 10 surgeries weresuccessfully performed, the patients cooperated adequately during the surgery,none of them required general anesthesia nor showed any discomfort during thesurgery.  The first 3 remainedunder observation for 36 hours and 7 of them were discharged 12 hours after thesurgery.  The post-surgical followup is 1 year for the first patient and the patient with least amount of followup time being 20 days without any signs of dysfunction.

 CONCLUSIONS:  Theprocedure represents a challenge for the neurosurgeon’s abilities as it needsto be performed in a short time and with a wide knowledge of the endoscopicanatomy that the use of flexible endoscopes requires;  diminishing the risk of surgical reinterventions for reasonsof obstruction, valvular dysfunction or infections, with a short recoveryperiod that could be compared to outpatient surgery which lowers the risk ofintrahospital infection and hospitalization costs.  It also provides an immediate recuperation keeping in mindthat the patient is less exposed to incidents or complications.  The follow up on patients has shown encouragingresults since none of them has required a surgical reintervention and the psychologicalimpact on the patient and family has been well accepted.

We consider this to be analternative for  the treatment ofhydrocephalus with secondary hypertensivity through the third neuroendoscopicthird ventriculostomy.