Abstract
Since the introduction of neuro-endoscopy by Walter Dandy and his colleagues in the early 1920's, several efforts has been made to improve this tool for treatment of hydrocephalus, brain tumors, arachnoid cysts, etc and has largely substituted craniotomy procedures. Several complications such as CSF leakage, intraventicular hemorrhage, infectious complications and transient and permanent psycho-neurologic deficits have been reported for neuro-endoscopic procedures in children. Here in, two cases of transient mutism following neuroendoscopy in children were reported, with special focus on pathophysiology, management and clinical course. Knowledge about the possible complications of a procedures, empowers the pediatric neurosurgeon with the ability to avoid them and also to successfully handle them once they take place. We report two patients who underwent neuro-endoscopy,first for treatment of arachnoid cyst via cystoventriculostomy and second for endoscopic third ventriculostomy(ETV) to treat hydrocephalus. Both children developed apathy and mutism following the procedure. However, this condition was transient and both children improved after a course of 5-6 days with conservative management. Mutism following neuro-endoscopic procedures in children may result from excessive traction on paraventricular white matter and disruption of fronto-subcortical circuits. It can be avoided with less intra-procedural dilation of venricles and less traction on white matter tracts with choosing a more accurate trajectory. However, this condition is transient and spontaneous resolution wil ensue in several days wth conservative management.
Highlights
Since the introduction of neuro-endoscopy by Walter Dandy and his colleagues in the early 1920's, several efforts has been made to improve this tool for treatment of hydrocephalus, brain tumors, arachnoid cysts, etc and has largely substituted craniotomy procedures
Mutism following neuro-endoscopic procedures in children may result from excessive traction on paraventricular white matter and disruption of fronto-subcortical circuits
It can be avoided with less intra-procedural dilation of venricles and less traction on white matter tracts with choosing a more accurate trajectory
Summary
Since the introduction of neuro-endoscopy by Walter Dandy and his colleagues in the early 1920's, several efforts has been made to improve this tool for treatment of hydrocephalus, brain tumors, arachnoid cysts, etc and has largely substituted craniotomy procedures. Conclusions: Mutism following neuro-endoscopic procedures in children may result from excessive traction on paraventricular white matter and disruption of fronto-subcortical circuits. Case 1 A 3 month old boy was referred to pediatric neurosurgery clinic due to increased head circumference.
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