Chapter 19

Iatrogenic Lesions in Neurosurgery

Alexandru Madaras and Nicolae Dorin Gherasim

Abstract

Complications in neurosurgery can occur during diagnostic procedures, such as lumbar puncture, lumbar drainage, suboccipital cisternal tap or cerebral/spinal angiography, or during neurosurgical procedures. Severe complications during or subsequent to lumbar puncture are extremely rare and include brainstem herniation, infection, subdural hematoma and subarachnoid hemorrhage. Insertion of a catheter into the lumbar subarachnoid space to drain the cerebrospinal fluid (CSF) can also be followed by infection or overdrainage. The complications of cisternal tap include hemorrhage in the cisterna magna and piercing of the medulla oblongata that can cause cardiac or respiratory arrest. The iodine-based contrast agents used for cerebral angiography can cause allergic reactions and epileptic seizures. Iatrogenic complications during surgical procedures can occur at any stage pre-, intra- or immediately postoperative. Complications occur during patient positioning, rendering this step of paramount importance to the success of surgery. Infectious and cosmetic complications can occur during skin disinfection, incision of the skin of the scalp and surgical incision of the skull. Dural lesions can lead to cerebrospinal fluid leak or fistulae. Corticotomy or corticectomy should be realized cautiously and external to functional areas. Ligation or coagulation of brain vessels can lead to cerebral infarction (arterial or venous) with loss of cerebral function. Iatrogenic lesions in different regions of the brain lead to specific neurological manifestations. Lesions in the anterior fossa can lead to anosmia, abulia or behavioral alterations. Lesions in the middle fossa can lead to aphasia and motor deficits, while lesion in the posterior fossa can lead to cranial nerve deficits or coma.

Total Pages: 316-321 (6)

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