The impact of neuroendoscopy in the emergency setting--a retrospective study of imaging, intraoperative findings, and surgical outcome in 55 patients.

Objectives: To assess whether neuroendoscopy is an improved and effective diagnostic as well as therapeutic tool in the emergency setting compared with neuroimaging studies.

Patients And Methods: Sixty-two preoperative computed tomography (CT) and magnetic resonance (MR) scans from 55 adult patients admitted in the emergency ward were compared with equal number of neuroendoscopy observations by independent observers, who included cases of raised intracranial pressure related to hydrocephalus, shunt dysfunction, intracranial cysts, brain tumours, subdural effusions, etc.

Results: According to the results obtained, three groups were formed. Postoperative findings matched CT/MR images in 38.7% of all the procedures (Group 1). In 25.8%, neuroimages were different from endoscopy findings, nevertheless the differences did not justify any modification in the original surgical approach (Group 2). Finally, differences between endoscopical and preoperative studies in 34.48% of the procedures did justify modifications in the surgical plan (Group 3). Extensive fibrosis within the ventricular system associated with poor anatomic landmark visibility was found to be the main cause of surgical modification in the majority of these cases.

Conclusions: Usefulness of neuroendoscopy to increase the accuracy of intraoperative diagnosis, and therefore modify the surgical procedure in an emergency setting, is stressed.