Intraoperative Monitoring

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Intraoperative monitoring: A consensus on standard monitoring requirements has not yet established in the literature. Routine monitoring includes electrocardiography, pulse oximetry, capnography, temperature and urine output monitoring. There are many authors who recommend invasive blood pressure monitoring by indwelling arterial catheter in all patients, irrespective of their age 18.Abrupt changes in cerebral blood flow due to changes in intracranial pressure (ICP) is possible during the procedure. Transcranial Doppler is the fastest and most reliable method to detect any fluctuations in cerebral blood flow due to changes in ICP 19.It has got high sensitivity to changes in cerebral blood flow. But practical objections restrict it’s routine …show more content…
But Injury of the Basilar artery is the most feared intraoperative complication. Artery is located under the floor of third ventricle and can be subjected to trauma by the catheter tip21.This can lead to massive intraventricular and subarachnoid haemorrhage, hemiparesis and midbrain damage. Manipulation of delicate structures around the third ventricle (hypothalamus & brain stem) can lead to intraoperative cardiac bradyarrhythmias, hypotension, hypertension and even cardiac arrest22.This procedure can also result in reduction of cerebral perfusion or even ischemia secondary to an increase in intracranial pressure. Other reported neurological complications are paralysis of III and VI nerves, delayed awakening, transitory mental confusion, headache, loss of memory, infection, convulsions, and pneumocephalus.Hypothermia is a potential complication that can result in delayed awakening and disordered coagulation.However, some of the reported post operative complications such as vomiting and respiratory problems are not specific to the procedure. Overall, a good long term outcome after ETV is between 70-80% in most case series 23.With expertise, complication rates are bound to come down. In fact it is now accepted as a therapeutic option ahead of shunt revision in cases of obstructive hydrocephalus

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