Neurologic Complications in Percutaneous Nephrolithotomy

다국어 초록 (Multilingual Abstract)

Purpose: Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL.
Materials and Methods: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia,and quadriplegia.
Results: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection.
Conclusions: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

참고문헌 (Reference)

1 Turker RJ, "Thoracic paraplegia after lumbar spinal surgery" 8 : 195-200, 1995

2 Langmayr JJ, "Quadriplegia after lumbar disc surgery" 21 : 1932-1935, 1996

3 Fernstrom I, "Percutaneous pyelolithotomy: a new extraction technique" 10 : 257-259, 1976

4 Vicentini FC, "Percutaneous nephrolithotomy: current concepts" 25 : 4-10, 2009

5 Seung Hun Song, "Paradoxical Air Embolism during Percutaneous Nephrolithotomy: A Case Report" 대한의학회 22 (22): 1071-1073, 2007

6 Bhardwaj A, "Neurologic deficits after cervical laminectomy in the prone position" 13 : 314-319, 2001

7 Droghetti L, "Air embolism: diagnosis with single-photon emission tomography and successful hyperbaric oxygen therapy" 89 : 775-778, 2002

8 Miller RA, "Air embolism, a new complication of percutaneous nephrolithotomy. What are the implications?" 90 : 337-339, 1984

9 Varkarakis J, "Air embolism from pneumopyelography" 169 : 267-, 2003

10 Hobin FP, "Air embolism complicating percutaneous ultrasonic lithotripsy" 30 : 1284-1286, 1985