Anaesthetic Management of Patients Undergoing Intraventricular Neuro-Endoscopic Procedures

Endoscopic neurosurgery has a long history of solid progression of over a century (Enchev et al., 2008). In this period, several neuroendoscopic procedures were described, but although steady technical improvements increased the endoscopic functionality and indications, poor magnification and illumination kept neuroendoscopy difficult and unreliable, keeping it out of routine practice until the end of the 1980’s. Only after the invention of new lenses, electronics and fiberoptics allowed for the manufacturing of a new generation of endoscopes granting brighter illumination and improved resolution, neuroendoscopy came forward as routine treatment in neurosurgery (Li et al., 2005). Initially, neuroendoscopy was almost exclusively performed for endoscopic third ventriculostomy (ETV) for the treatment of obstructive hydrocephalus, and still the majority of neuroendoscopies is performed for ETV. Recently however, it is increasingly used for the management of all types of neurosurgically treatable disorders (Enchev & Oi, 2008), either as a primary surgical approach or as an adjunct, such that endoscopic procedures are common in most neurosurgical departments. A continued evolution of technological advances, introduction of robotic technology, steerable endoscopes and novel neurosurgical techniques are expected to increase its applications even further. These newly implemented surgical practices offer improved treatment options, commonly referred to as ‘minimally invasive’ in many clinical conditions. Since endoscopic techniques allow for intracranial interventions with minimal damage to healthy brain tissue, these advances are obviously a major benefit. Additionally, some interventions have a better outcome when performed endoscopically. However, in several of these interventions, direct surgical manipulation of cerebral structures and particularities of the endoscopic techniques are a constant hazard since they can severely disturb intracranial pressure, cerebral perfusion and oxygenation. This perturbation of cerebral homeostasis may imply important risks for irreversible brain damage, and severe haemodynamical effects which, if not taken proper care of, make these surgical improvements much less minimal invasive than previously supposed. A proper understanding of the physiological changes induced by and during these procedures is essential for optimal patient care. Neuroendoscopy has been successfully used for third