Intraoperative Malfunction of Neuroendoscopic Biopsy Forceps: A Case Report With Technical Note.

Abstract

Background and importance: Pineal region tumors often present with symptoms of hydrocephalus, due to obstruction of cerebrospinal fluid outflow at the cerebral aqueduct. A commonly used option for neurosurgical management involves endoscopic third ventriculostomy with concurrent biopsy of the pineal lesion for both diagnostic and management purposes. This can be performed with 1 or 2 trajectories of a rigid endoscope or through a single burr hole with a flexible neuroendoscope. This case is presents an example of real-time considerations.

Clinical presentation: This is a case of a 16-year-old adolescent boy who presented with a pineal region mass causing obstructive hydrocephalus. He underwent flexible neuroendoscopic third ventriculostomy and biopsy. Intraoperatively, the biopsy forceps malfunctioned in a constitutively open position within the endoscope. Several steps were taken to troubleshoot and eventually remove the malfunctioned equipment without injury. This experience shows that such equipment malfunction can occur and demonstrates an approach to intraoperative problem-solving in flexible neuroendoscopy.

Conclusion: Intraoperative device malfunction is known occurrence for which every surgeon must be prepared. This case highlights an approach to work through such a scenario of instrument failure and the limitations of the equipment. Understanding of the tools at hand, intended use, and suitable alternatives or lack thereof can mitigate the risk of device malfunction affecting patient outcomes.