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PubMed1995

Clinical indicators contributing to I.C.U. length of stay in elective craniotomy patients with brain tumour.

The immediate purposes of this study are (a) to indicate the I.C.U. and hospital length of stay in elective craniotomy patients with brain tumour, and (b) to identify the clinical indicators that contribute to the I.C.U. length of stay. The ultimate purpose is to contribute to a growing body of knowledge in providing quality and cost effective patient outcomes by creating appropriate vehicles for further research in the field of neuroscience. The following clinical indicators are identified: pre-op patient admission to ward or same day admit unit, O.R. cancellations, type of tumour, nursing staff availability, intubation on admission, I.C.U. length of stay, and post-op complications. The results of this pilot study, with sample size of 55 patients, could assist us in the nursing profession to develop an appropriate Care Map for craniotomy patients with brain tumour.

Adult↗
PubMed1997

Late tension pneumocephalus following frontal craniotomy.

Tension pneumocephalus is an uncommon but life-threatening complication of craniotomy which requires urgent diagnosis and treatment. It most often occurs perioperatively following subsequent anaesthesia using nitrous oxide. All previously reported postoperative cases followed posterior fossa or upper spinal cord surgery. Only two cases associated with frontal craniotomy have been reported since 1972, both occurring intraoperatively.

Aged↗
PubMed2003

Awake craniotomy in glioma surgery.

Awake craniotomy is the cheapest and most reliable method to ensure neurological integrity in cerebral gliomas that infiltrate or come close to the eloquent areas of the brain, allowing (a) the localization of eloquent cortical areas by electrical stimulation and epileptic foci by cortical recording, and (b) the monitoring of the functional integrity of awake patients while aiming at subtotal removal of the gliomatous tissue. In addition, awake craniotomy opens a brief but unique window to the living brain for (a) basic neuroscience, including verification of preoperative functional imaging data and recording of electrophysiological correlates of mental processes, and for (b) applied research, including development of innovative instrumentation for brain recording and monitoring as well as screening for potential areas to be modulated in movement disorders and chronic pain.

Brain Neoplasms↗
PubMed1990

Stereotactic craniotomy and intraoperative lesion localisation using the Brown-Robert-Wells frame. Technical note.

A simple technique of stereotactic craniotomy and intraoperative lesion localisation that uses the Brown-Robert-Wells (BRW) stereotactic frame is presented. The method optimises craniotomy placement and facilitates localisation of small intracerebral lesions. Using the system, 16 patients have had resection of intracranial neoplasms from deep and/or eloquent areas of the brain with no neurological morbidity.

Adult↗
PubMed2000

Chemo-resistant choriocarcinoma cured by pulmonary lobectomy and craniotomy.

This is a case report of a 31 year-old female with choriocarcinomatous metastasis in brain and lung. Her serum beta-HCG level rose six times following normalization during 61 months of diverse multiagent systemic chemotherapy. Pulmonary lobectomy was done in March 1997 (57 months after initial diagnosis) due to persistent pulmonary nodule and poor response to chemotherapy. Histologic examination disclosed metastatic choriocarcinoma. However, her serum beta-HCG level did not normalize. Meanwhile, repeated measurement of beta-HCG concentration in cerebrospinal fluid was normal and imaging studies did not indicate evidence of metastasis. Sixty-one months after initial diagnosis fulminant intracerebral hemorrhage made emergency craniotomy mandatory. Histologic examination revealed metastatic choriocarcinoma. Serum beta-HCG levels returned to normal immediately after craniotomy and she reached complete remission after whole brain irradiation in January 2000. She is free of disease 91 months from initial diagnosis. The role of surgery in the treatment of patients with metastatic choriocarcinoma has been diminished by the responsiveness to chemotherapy. However, local resection of metastases still seems to play a significant role in controlling complications of gestational trophoblastic neoplasia and even in curing the disease in a small subset of patients.

Journal Article↗
PubMed1995

Acute postoperative hydrocephalus following translabyrinthine craniotomy for acoustic neuroma resection.

Acute mental status changes following craniotomy for acoustic tumors demand prompt evaluation and treatment to avoid serious morbidity and mortality. Two cases of acute obstructive hydrocephalus complicating the postoperative period following translabyrinthine craniotomy are presented. Diagnosis is made with noncontrast computed tomography scanning. Treatment is rendered at the bedside with placement of a ventriculostomy. Diagnosis and management implications for acoustic tumor patients are discussed.

Journal Article↗
PubMed2001

Transorbital craniotomy through a suprabrow approach: A case series.

Six cases of posterior orbital mass lesions are described in which a suprabrow approach was utilized for transorbital craniotomy. This technique offers several advantages over traditional supraorbital and transcranial approaches to deep orbital tumors. The results were anatomically and cosmetically excellent in all cases. The surgical technique for transorbital craniotomy, along with its advantages and potential complications, are explained in detail. The clinical presentation, radiological features of the lesions, postoperative outcome, and complications are discussed.

Journal Article↗
PubMed1992

Cerebral blood flow measurements during blood pressure control with intravenous labetalol following craniotomy.

Cerebral blood flow measurements using a thermal diffusion technique were made in conjunction with an extensive cardiovascular evaluation, during and after administration of intravenous labetalol given for blood pressure control in craniotomy patients. Eighteen patients, ages 30-65 years, ASAII and III, scheduled for elective craniotomy, became hypertensive during emergence and recovery from a pentothal/fentanyl/vecuronium/N2O/isoflurane general anesthesia. Labetalol was administered in a stepwise manner every 10 minutes during an average period of 1 h. After this titration period, an 8-h maintenance period followed. During titration and maintenance periods, comprehensive systemic hemodynamic parameters were collected through intra-arterial and flow-directed pulmonary artery catheters. Cerebral cortical blood flow (CBF) was continuously recorded using a thermal diffusion cortical blood flow probe (Saber System). Data were analyzed using variance F tests to evaluate changes from baseline over time. Labetalol controlled postoperative hypertension in all cases with a total dose range of 0.4-6.8 mg/kg. During titration, statistically significant decreases in blood pressure were obtained, accompanied by a small decrease in systemic vascular resistance (SVR) and slight increase in cardiac index (CI). Heart rate decreased in a manner directly proportional to the dose of labetalol administered. In the maintenance period, further decreases in blood pressure and heart rate were observed, with significant decreases in central venous pressure, pulmonary capillary wedge pressure, and SVR and an increase in CI. All values remained within normal ranges and no adverse effects were observed. CBF decreased slightly during the study period, although not significantly (from 67 +/- 8 to 57 +/- 7 ml 100 g min). Blood pressure control achieved with labetalol in postoperative neurosurgical patients seems to be the result of mild alpha-adrenoceptor blocking effects (i.e., reduced SVR) and beta-adrenoceptor blocking effects (i.e., reduced heart rate) at higher doses. The 6-8 h duration of effect of labetalol was enough to control postoperative hypertension in all patients with no additional therapy. Compared with alternative drugs available for blood pressure control in similar clinical conditions, labetalol appears to be reliable, safe, and effective, by providing a lasting effect with no evidence of rebound hypertension, increased CBF, or cardiac dysfunction.

Journal Article↗
PubMedDate not supplied

Propofol 1% and propofol 2% are equally effective and well tolerated during anaesthesia of patients undergoing elective craniotomy for neurosurgical procedures.

BACKGROUND: The 2% formulation of the intravenous anaesthetic agent, propofol (Diprivan), delivers half the amount of lipid compared with the original 1% formulation. This may provide an acceptable alternative for patients who have an impaired ability to metabolise lipids. METHODS: This study was a multicentre, randomised, open comparison of parallel groups. Seventy-three adult patients undergoing elective craniotomy in neurosurgery were randomised to receive either propofol 1% (10 mg/ml) or propofol 2% (20 mg/ml) for induction and maintenance of anaesthesia. RESULTS: Analysis of induction time (199 s, 1%; 202 s, 2%; p > 0.05) and induction dose (1.13 mg/kg, 1.12 mg/kg; p > 0.05) shows that propofol 1% and propofol 2% are pharmacodynamically equivalent. Both formulations were similar regarding overall administration rates, recovery times, haemodynamic variables and tolerability. Plasma triglyceride levels, were lower in the propofol 2% group compared with the propofol 1% group, and significantly lower (p < 0.05) from 1 to 4 hours after induction. CONCLUSIONS: We conclude that propofol 2% is as effective and as well-tolerated as propofol 1% for anaesthesia and is an acceptable alternative to propofol 1% in patients undergoing elective craniotomy in neurosurgery. The lower lipid load suggests it may be of particular benefit to patients with disorders of lipid metabolism.

Adult↗
PubMed1988

Gastrointestinal bleeding after craniotomy: a retrospective review of 518 patients.

A retrospective review of the medical records of 518 patients who underwent craniotomy over a 3 year interval was carried out to determine the rate of gastrointestinal bleeding and its relationship to the Glasgow Coma Score. There were 288 [55.5%] males and 230 [44.5%] females in the series; the mean age was 51.5 +/- 18.9 years. Forty percent had brain tumours, 18% had subarachnoid hemorrhage, 14% had spontaneous intracerebral hemorrhage, 19% had head injury and 8% had other diagnoses. Forty-eight [9.3%] of the patients had significant gastrointestinal bleeding, the distribution of which was as follows: hematemesis [37/518], melena [11/518] and/or hematochezia [4/518]. A further 51 [9.8%] had evidence of "coffee ground emesis" only. Of those with a Glasgow Coma Score of less than 10, 21% had significant GI bleeding while only 7% of patients with a Glasgow Coma Score greater than 10 had such a bleed [p less than 0.005]. Further analysis showed that the incidence of GI bleeding in patients who underwent craniotomy increased with decreasing GCS. GI bleeding did not correlate with age, sex, steroid administration or casual use of anti-ulcer medication.

Adult↗
PubMed2005

Perioperative management of a patient with May-Hegglin anomaly requiring craniotomy.

May-Hegglin anomaly (MHA) is a rare type of autosomal dominant platelet disorder associated with mutations in the gene encoding nonmuscle myosin heavy chain 9 (MYH9). It is characterized by the presence of large platelets, leukocyte inclusions, and thrombocytopenia. The bleeding tendency is usually mild, but severe hemorrhages have been reported. This is the first reported case of a patient with MHA who underwent craniotomy for intractable seizure disorder of temporal lobe origin. Patients who have thrombocytopenia have a higher likelihood of developing intraoperative or postoperative intracranial hematoma and bleeding complications. The patient was administered desmopressin (DDAVP) prior to the neurosurgical procedure and had no complications. With this approach, the use of platelet concentrates could be avoided. We discuss the role of DDAVP in MHA and related platelet disorders and review the current literature.

Adult↗
PubMed2002

Applying circular posterior-hinged craniotomy to malignant cerebral edemas.

Malignant brain edemas are often fatal, regardless of whether they are treated conservatively with sedation, blood pressure management, mannitol-therapy, hyperventilation and hypothermia, or non-conservatively with routine trepanation. Unfortunately, temporal trepanation may result in significant brain damage through herniation of the cerebrum at the edges of the trepanation openings. In one case of a 26-year-old male with severe head injury, a circular posterior-hinged craniotomy (CPHC) was performed after an ineffective unitemporal trepanation for evacuation of an acute subdural hematoma. This ultimately successful operation prompted experimental and morphologic investigations on a new surgical procedure for lowering intracranial pressure (ICP). In 12 of 15 human cadavers, an experimentally ICP was lowered by a CPHC with between 9-21 mm of frontal elevation of the calvaria. Using computer simulation, the frontal elevations of the calvaria were "virtually" performed on 3D reconstructions from CT scans of skulls, and the intracranial volume gained was measured with a computer software program. The volume increase of the cranial cavity showed a relatively constant relation to the cranial capacity and was increased by 6.0% (+/-0.4%) or 78 cm(3) with a 10 mm elevation and by 12.4% (+/-0.7%) or 160 cm(3) with a 20 mm elevation. There were no significant differences with skulls of different ages or ethnic origin; however, a significant effect of gender (F = 7.074; P < or = 0.013) on the gained volume in percent of the cranial capacity for the 20 mm elevation was observed. This difference can be explained by the inverse relationship between volume increase and cranial capacity (r = -0.507; P < or = 0.004).

Adult↗
PubMed1976

Application with classic craniotomy in the treatment of focal epilepsy.

A new method of surgical treatment in dealing with severe forms of multifocal epilepsy--stereotactic intervention on subcortical structures during open craniotomy--is proposed. The method allows stereoelctrographic examinations to be performed during open operative interventions, helps discover subcortical epileptogenic foci, establish functional interrelationship of the chosen subcortical structure and the cortical epileptogenic focus and to undertake a differentiated intervention on the cortical, subcortical and both these foci at the same time.

Child↗
PubMed1989

"Skull punch" for craniotomy in neonates and infants.

We have designed a new instrument that we have called a "skull punch" which is useful and safe for making a burr hole for a purely osteoplastic craniotomy in neonates and infants. The instrument is described in detail.

Craniotomy↗
PubMed1990

Neurosurgery with craniotomy and CT stereotactic guidance in the treatment of intracerebral space-occupying lesions.

When intracerebral space-occupying lesions are small or located deeply within the brain parenchyma, it is sometimes difficult to localize them at surgery or to design the most direct and least hazardous surgical approach. Therefore, we have developed a method that combines conventional neurosurgical techniques with craniotomy using stereotactic guidance. We have used the Brown-Roberts-Wells (BRW) stereotactic system, which allows for computed tomography (CT) or magnetic resonance imaging (MRI) guidance and does not interfere with the absolute sterility mandatory each time a flap is created. Eleven patients were operated on using this method. The deep tumors were approached through a linear incision of the cerebral cortex. Then a needle, fixed in the right position on the arc system of the BRW, was inserted toward the surface of the lesion; the exposure was finally widened by inflation of a rubber balloon set on the stereotactic needle. This technique allows the two lips of the cortical incision to be glued at the end of the operation. Gluing with a fibrin glue avoids the postoperative subdural collections that often develop when the ventricle has been opened. Except for one case, the postoperative course was uncomplicated in these patients. No permanent postoperative neurological worsening was observed even after the removal of an intrathalamic tumor.

Brain Diseases↗
PubMed1984

Chronic subdural haematomas treated by enlarged burr-hole craniotomy and closed system drainage. Retrospective study of 120 patients.

In a retrospective study 143 chronic subdural haematomas in 120 patients were analysed. 64% of patients were 60 years or older. All haematomas were operated on by slightly enlarged burr-hole craniotomy and closed system drainage for three days postoperatively. A history of trauma was present in 63%. Most frequent symptoms in the older patients were mental changes and impaired consciousness. Postoperative mortality (within one month after surgery) was 4%. After a follow-up period of up to 2.5 years after surgery, 69% were neurologically normal, 20% had only minor complaints or slight deficits. Postoperative CT scans showed a gradual re-expansion of the compressed brain during the 2-3 weeks following haematoma removal.

Chronic Disease↗
PubMed1993

Modified bifrontal interhemispheric approach to aneurysms of the anterior communicating artery with the use of a trephine craniotomy. A review of personal experience with 25 cases.

A modified microsurgical bifrontal interhemispheric approach (small trephine craniotomy) for clipping of aneurysms of the anterior communicating artery (ACoA) is described. This approach has been used in a series of 23 patients with ACoA and 2 patients with distal anterior cerebral artery aneurysms. Feasibility, indications and problems related to this approach to ACoA aneurysms are assessed. Twenty-one patients (84%) made an excellent or good recovery. The result was poor in an 80-year-old patient who was in grade 3 pre-operatively. Three patients of this series died: one of them was pre-operatively in grade 4 and died from pneumonia; the other two died as consequence of unrelated ailments. Incidence and extent of vasospasm was within the normal range, corresponding to the amount and distribution of subarachnoid blood clots. From our experience it can be concluded that this approach is safe and feasible for patients with ACoA aneurysms graded 1-2 (Hunt-Kosnik's grading system) and evaluated as group 1-2 of Fisher's CT classification. But it is not recommended for patients with larger amounts of subarachnoid blood clots. Advantages of this microapproach to ACoA aneurysms are: a) minimal brain damage, b) adequate visualization and anatomical orientation, c) preservation of the olfactory nerves and the gyrus rectus, d) reduced operative time, e) easy clip application to aneurysms pointing in any direction.

Adult↗