Uncontrollable High-Frequency Tachypnea: A Rare and Nearly Fatal Complication of Endoscopic Third Ventriculostomy: Case Report and Literature Review

Abstract

Background: Endoscopic third ventriculostomy (ETV) is considered a safe procedure although it carries its rate of risks and complications that may occasionally be life-threatening.

Case Report: This is a report about a 48-year-old woman presenting with progressive gait unsteadiness, weakness of the lower extremities and cognitive impairment due to tri-ventricular hydrocephalus. This was treated with standard ETV. In the immediate post-operative period the patient developed a severe and uncontrollable tachypnea requiring sedation, intubation and mechanical ventilation.

Conclusion: Tachypnea may be an early complication after standard ETV and although its mechanism remains yet unclear, we speculate that it may be related to excessive traction and/or surgical manipulation of the floor of the third ventricle. Supportive care with mechanical ventilation is the mainstay of treatment until spontaneous normalization of the respiratory mechanism occurs.

third ventriculostomy - endoscopy - tachypnea - complication

References

• 1 Beems T, Grotenhuis JA. Long-term complications and definition of failure of neuroendoscopic procedures.  Childs Nerv Syst. 2004;  20 868-877
• 2 Brockmeyer D. et al . Endoscopic third ventriculostomy: an outcome analysis.  Pediatr Neurosurg. 1998;  28 236-240
• 3 Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculostomy.  J Neurosurg. 2002;  96 1032-1040
• 4 Anandh B. et al . Intraoperative bradycardia and postoperative hyperkalemia in patients undergoing endoscopic third ventriculostomy.  Minim Invas Neurosurg. 2002;  45 154-157
• 5 Handler MH, Abbott R, Lee M. A near-fatal complication of endoscopic third ventriculostomy: case report.  Neurosurgery. 1994;  35 525-527 discussion 527–528
• 6 Kim SK, Wang KC, Cho BK. Surgical outcome of pediatric hydrocephalus treated by endoscopic III ventriculostomy: prognostic factors and interpretation of postoperative neuroimaging.  Childs Nerv Syst. 2000;  16 161-168 discussion 169
• 7 Teo C. et al . Complications of endoscopic neurosurgery.  Childs Nerv Syst. 1996;  12 248-253 discussion 253
• 8 Abtin K, Thompson BG, Walker ML. Basilar artery perforation as a complication of endoscopic third ventriculostomy.  Pediatr Neurosurg. 1998;  28 35-41
• 9 Beni-Adani L. et al . Increasing chronic subdural hematoma after endoscopic III ventriculostomy.  Childs Nerv Syst. 2000;  16 402-405
• 10 Buxton N, Punt J. Cerebral infarction after neuroendoscopic third ventriculostomy: case report.  Neurosurgery. 2000;  46 999-1001 discussion 1001–1002
• 11 Buxton N. et al . Neuroendoscopic third ventriculostomy for failed shunts.  Surg Neurol. 2003;  60 201-203 discussion 203–204
• 12 Hopf NJ. et al . Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures.  Neurosurgery. 1999;  44 795-804 discussion 804–806
• 13 Kim BS. et al . Chronic subdural hematoma as a complication of endoscopic third ventriculostomy.  Surg Neurol. 2004;  62 64-68 discussion 68
• 14 McLaughlin MR. et al . Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report.  Neurosurgery. 1997;  41 1400-1403 discussion 1403–1404
• 15 Schroeder HW. et al . Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy. Case report.  J Neurosurg. 1999;  90 153-155
• 16 Bonanni R, Carlesimo GA, Caltagirone C. Amnesia following endoscopic third ventriculostomy: a single case study.  Eur Neurol. 2004;  51 118-120
• 17 Buxton N. et al . Neuroendoscopic third ventriculostomy for hydrocephalus in adults: report of a single unit's experience with 63 cases.  Surg Neurol. 2001;  55 74-78
• 18 Hader WJ. et al . Death after late failure of third ventriculostomy in children. Report of three cases.  J Neurosurg. 2002;  97 211-215
• 19 Javadpour M, May P, Mallucci C. Sudden death secondary to delayed closure of endoscopic third ventriculostomy.  Br J Neurosurg. 2003;  17 266-269
• 20 El-Dawlatly AA. et al . The incidence of bradycardia during endoscopic third ventriculostomy.  Anesth Analg. 2000;  91 1142-1144
• 21 Benabarre A. et al . Neuropsychological and psychiatric complications in endoscopic third ventriculostomy: a clinical case report.  J Neurol Neurosurg Psychiatry. 2001;  71 268-271
• 22 van Aken J. et al . Cardiovascular changes during endoscopic third ventriculostomy.  Minim Invas Neurosurg. 2003;  46 198-201
• 23 Guyton C. (ed.) Textbook of Medical Physiology.  Philadelphia, Saunders 2000; 
• 24 West JB. (ed.) Respiratory Physiology.  Baltimore, Lippincott Williams and Wilkins 2003; 
• 25 Harper RM. The cerebral regulation of cardiovascular and respiratory functions.  Semin Pediatr Neurol. 1996;  3 13-22
• 26 Dempsey JA. Regulation of Breathing.  San Francisco, Wiley 1994; 
• 27 B PJ. Autonomic Control of the Respiratory System.  Harwood Academic Publishers, Amsterdam, Barnes 1997; 
• 28 Georgopoulos D, Roussos C. Control of breathing in mechanically ventilated patients.  Eur Respir J. 1996;  9 2151-2160
• 29 Acker H. PO₂ chemoreception in arterial chemoreceptors.  Annu Rev Physiol. 1989;  51 835-844
• 30 Magarian GJ. Hyperventilation syndromes: infrequently recognized common expressions of anxiety and stress.  Medicine (Baltimore). 1982;  61 219-236
• 31 Sardinha A. et al . Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications.  J Bras Pneumol. 2009;  35 698-708
• 32 Boden AG, Harris MC, Parkes MJ. The preoptic area in the hypothalamus is the source of the additional respiratory drive at raised body temperature in anaesthetised rats.  Exp Physiol. 2000;  85 527-537

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