Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Craniotomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 397 records · Page 22Linked to original sources
PubMed2004

[Anaesthetic management of awake craniotomy].

This review article presents a detailed analysis of patients' management for awake craniotomy, at the light of the available data in the literature and the authors' experience. Indications of this type of surgery are discussed as well as anaesthetic management itself, from preoperative assessment of the patient to peroperative concerns. Anaesthetic strategy, choice of anaesthetic agents, anaesthetic technique, and management of the airway and possible complications are discussed. The authors emphasize the tricky aspect of the procedure, the necessity of rigorous patient selection and good preparation. They emphasize the need for controlled studies to validate the proposed techniques.

Anesthesia, Local↗
PubMed2006

The experiences of nurses who participate in awake craniotomy procedures.

In awake craniotomy is a unique neurosurgical procedure in which the patient is conscious during part of the procedure. Little has been documented about how instrument nurses (ie, scrub persons) react to this complex procedure and to the tasks of caring for a conscious patient. A phenomenological investigation was conducted to document the experiences of nine instrument nurses. The nurses were challenged by having to manage the conscious presence of the patient, they placed great importance on controlling the surgical situation, and they reported that participating in this procedure had a compelling emotional effect on them.

Craniotomy↗
PubMed2000

Ethyl-2-cyanoacrylate fixation of the cranial bone flap after craniotomy.

BACKGROUND: This procedure was done in order to evaluate the efficacy and safety of ethylcyanoacrylate as an adhesive for fixation of the bone flap. METHODS: One hundred consecutive craniotomies in patients older than 16 years in which the bone flap was fixed with ethyl-2-cyanoacrylate were studied. The osteosynthesis and any complications in all cases were followed clinically and radiologically for 3 months. RESULTS: Clinical and radiographic observation demonstrated that osteosynthesis was produced in 100% of the cases with no complications related to this procedure. CONCLUSION: This technique proved to be safe, fast, and easy to accomplish, with immediate stability of the bone flap and excellent cosmetic results.

Adhesives↗
PubMed1998

Dural arteriovenous malformation of the anterior cranial fossa occurring after bifrontal craniotomy.

A case of dural arteriovenous malformation of the anterior cranial fossa developing after bifrontal craniotomy is reported. The nidus was fed mainly by the left anterior ethmoidal artery. It was drained into the right sylvian vein and superior ophthalmic vein with patency of the superior sagittal sinus. A left frontal hemorrhage resulted from the nidus itself. This is the first reported case of an acquired dural arteriovenous malformation of the anterior cranial fossa verified by angiography. This rare lesion is discussed with regard to its etiology.

Cerebral Angiography↗
PubMed1998

Restoration of small bone defects at craniotomy using autologous bone dust and fibrin glue.

BACKGROUND: Bone gaps or burr holes often result in small but undesirable scalp or skin depressions after craniotomy. Whereas a number of reports have discussed cranioplasties to avoid large bone defects, little has been written about the problem of small bone defects which, despite their minor size, could result in bothersome cosmetic problems. METHODS: This study was designed to assess a simple method to repair burr hole defects and bridge bone gaps with autologous bone dust and fibrin glue. Bone dust was collected when burr holes were created or craniectomy was performed. After replacement of the bone flap, the burr holes or bone gap were filled with a mixture of bone dust and fibrin glue. RESULTS AND CONCLUSIONS: The mixture of bone dust and fibrin glue was easily shaped to fit bone defects, resulting in favorable cosmetic outcomes 1 to 5 years after operation.

Bone and Bones↗
PubMed1980

Postoperative epilepsy: a double-blind trial of phenytoin after craniotomy.

In a double-blind trial of phenytoin for the prevention of postoperative epilepsy in craniotomy patients, epilepsy was observed in 7.9% (8/101) of patients treated with phenytoin and in 16.7% (17/102) of those receiving placebo. Therapeutic drug levels were associated with a significant reduction in the frequency of epilepsy. Three-quarters of the fits occurred within a month of cranial surgery. High rates of epilepsy have been observed after cranial surgery in patients with meningioma, aneurysm, and head injury with or without intracranial clots, and routine prophylaxis with phenytoin would seem to be indicated in such patients.

Clinical Trials as Topic↗
PubMed1997

Outcome analysis of the transglabellar/subcranial approach for lesions of the anterior cranial fossa: a comparison with the classic craniotomy approach.

The classic approach to anterior skull base lesions uses bifrontal craniotomies together with lateral rhinotomies. This approach requires frontal lobe retraction and is associated with postoperative anosmia and the development of frontal lobe encephalomalacia. The transglabellar/subcranial approach permits removal of anterior skull base lesions without frontal lobe retraction and avoids facial scars. No studies to date, however, have directly compared the two approaches in terms of patient morbidity. The present retrospective study compares the two approaches when used for the removal of anterior skull base lesions in terms of estimated blood loss, number of transfusions, number of days in the hospital and intensive care unit, and postoperative complications. Twenty patients with anterior skull base lesions were examined. The classic approach was used on 10, and the transglabellar/subcranial route was used on 10. When compared with the classic approach, the transglabellar/subcranial approach resulted in a lower estimated blood loss and subsequent transfusion rate, fewer days in the hospital and intensive care unit, and lower numbers and less severe types of complications. Furthermore, visualization of the tumors before resection with the transglabellar/subcranial approach allowed preservation of olfaction in virtually all of these patients. Although this study represents a small sample population, the results are sufficiently impressive to favor the transglabellar/subcranial approach for the removal of a variety of anterior skull base lesions.

Adult↗
PubMed1994

[Value of D(-) lactate determination for the fast diagnosis of meningitis after craniotomy. An initial study].

The early diagnosis of postoperative bacterial meningitis (BM) may be difficult. CSF cultures may remain sterile. Clinical features and routine laboratory data often fail to give an evidence. As early antibiotic therapy is essential in such patients, a rapid diagnosis is required. Different authors proposed the D(-) isomer of lactic acid as an early and effective marker of infection in the body fluids (including CSF). D(-) lactate is produced by bacteriae and fungi; L(+) lactate may be produced also by human tissues in anaerobic situations. We conducted a prospective study in a neurosurgical intensive care unit to evaluate this technique for the diagnosis of meningitis following craniotomy. Fifty-four patients were included, 40 in group A (not infected or infected out of the CNS), 4 in group B (suspected BM), 10 in group C (BM with positive CSF cultures). No patient suffered from septicemia, haemodynamic or ventilatory instability, nor metabolic disorder. Clinical data, CSF and blood samples (cytology, conventional biochemistry, D(-) and L(+) lactate, bacteriology) were collected at inclusion and, in group B and C patients, at day 2, 5 and at clinical recovery. D(-) lactate measurements were performed with an enzymatic method adaptated from a Boehringer Mannheim kit (for determination in foodstuff). Statistics were based on the comparison of group A vs C patients. D(-) and L(+) lactate concentrations in the CSF were significantly higher in group C patients, and blood concentrations were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Dural arteriovenous malformation occurring after craniotomy for pial arteriovenous malformation.

The etiology of dural arteriovenous malformation (AVM) is still uncertain, and the occurrence of postoperative dural AVM has rarely been proved angiographically. The authors present a case of dural AVM in the jugular and the sigmoid sinuses, which developed 1 year after resection of a pial AVM via the craniotomy. A possible mechanism underlying this case of dural AVM is discussed.

Aged↗
PubMed2003

Cerebellar haemorrhage following supratentorial craniotomy.

Distant cerebellar haemorrhage is a rare complication occurring in approximately 0.3-0.6% of all supratentorial craniotomy. A Medline and Pubmed search revealed only 98 cases in the English literature. We report three cases from our institution. An overall review of these 101 cases demonstrated that this complication commonly presented early in the postoperative course as decreased level of consciousness following aneurysm repair surgery or lobectomy for epilepsy. Asymptomatic presentation due to small haemorrhage was not uncommon. A transtentorial pressure gradient set up by excessive CSF loss is generally held responsible for disrupting the cerebellar venous blood flow and consequently leading to venous haemorrhage. Perioperative hypertension may also play a role. The outcome of patients who survived the complications was generally good, though not infrequently fatality resulted from the mass effect of extensive cerebellar haemorrhage demanded vigilance in its management.

Aged↗
PubMed1996

Effectiveness of antiepileptic prophylaxis used with supratentorial craniotomies: a meta-analysis.

Thirty publications on the effectiveness of prophylactic antiepileptic drugs (AEDs) with supratentorial craniotomies were reviewed (1980-1995). After a first selection, six controlled studies remained (11 publications). These six were evaluated according to previously defined methodological criteria. The criteria were divided into three main categories: (1) internal validity, (2) proper and relevant outcome-measures and (3) analysis. In this way a maximum of 145 points could be obtained for each study. Three studies were considered to be of satisfactory methodological quality (> or = 55% or 145 points) and the odds ratios were calculated as a measure of association between treatment and occurrence of convulsions. The odds ratios of these three studies were statistically pooled using the Mantel-Haenszel Estimator. From this test it appeared that prophylactically used AEDs showed a tendency to prevent postoperative convulsions, but this effect was certainly not statistically significant (P = 0.1 one-tailed). Points of attention concerning possible future investigations are stressed.

Brain Diseases↗
PubMed2006

Early postoperative cognitive recovery after remifentanil-propofol or sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial.

BACKGROUND AND OBJECTIVE: This study was designed to evaluate early postoperative cognitive recovery after total intravenous anaesthesia with remifentanil-propofol or sufentanil-propofol in patients undergoing craniotomy for supratentorial expanding lesions. METHODS: Sixty patients were consecutively enrolled, and randomly assigned to one of two study groups: remifentanil-propofol or sufentanil-propofol anaesthesia. To evaluate cognitive function the Short Orientation Memory Concentration Test (SOMCT) and Rancho Los Amigos Scale (RLAS) were administered to all patients in a double-blind procedure before surgery at 15, 45 min and 3 h after extubation. RESULTS: Mean extubation time was similar in the two groups (13 +/- 5 min vs. 19 +/- 6 min). A significantly larger number of patients in the remifentanil-propofol group than in the sufentanil-propofol group required antihypertensive medication postoperatively to maintain mean arterial pressure within 20% of baseline (18/30 vs. 4/29; P = 0.0004). Intergroup analysis showed no differences in baseline SOMCT scores (28 +/- 1 vs. 28 +/- 1) whereas mean SOMCT scores at 15, 45 min and 3 h after extubation were significantly higher in the remifentanil-propofol group (30 patients) than in the sufentanil-propofol group (29 patients) (22 +/- 3 vs. 16 +/- 3; P < 0.0001 and 27 +/- 1 vs. 22 +/- 3; P < 0.0001; 28 +/- 1 vs. 26 +/- 2; P = 0.0126). CONCLUSIONS: In conclusion, propofol-remifentanil and propofol-sufentanil are both suitable for fast-track neuroanaesthesia and provide similar intraoperative haemodynamics, awakening and extubation times. Despite a higher risk of treatable postoperative hypertension propofol-remifentanil allows earlier cognitive recovery.

Analysis of Variance↗
PubMed2000

Awake craniotomy: controversies, indications and techniques in the surgical treatment of temporal lobe epilepsy.

In 1886, Victor Horsley excised an epileptogenic posttraumatic cortical scar in a 23-year-old man under general anaesthesia and discussed his choice of anaesthesia: "I have not employed ether in operations on man, fearing that it would tend to cause cerebral excitement; chloroform, of course, producing on the contrary, well-marked depression." His concerns regarding anaesthesia are reiterated 100 years later as evidenced by the ongoing controversy over the choice of anaesthetic in surgical procedures for epilepsy. The current controversies regarding the necessity for local anaesthesia in temporal lobe epilepsy operations concern the utility of electrocorticography in surgical decision making, its relationship to seizure outcome and the value of intraoperative language mapping in dominant temporal lobe resections. The increasing sophistication of pre-operative investigation and localization of both areas of epileptogenesis and normal brain function and the introduction of minimally invasive surgical techniques and smaller focal resections are changing the indications for local anaesthesia in temporal lobe epilepsy. Thus, indications which were previously absolute are now perhaps relative. This article reviews the current indications for craniotomy under local anaesthesia in the surgical treatment of temporal lobe epilepsy.

Anesthesia, Local↗
PubMed1994

Complications of first craniotomy for intra-axial brain tumour.

Complications were examined in a single surgeon's series of 207 consecutive adult patients undergoing first craniotomy for intra-axial brain tumour. The study group consisted of 114 gliomas, 74 metastatic tumours and 19 miscellaneous lesions. There were 25 infratentorial tumours and 182 supratentorial tumours (39 deep and 143 superficial). The total number of patients sustaining complications was 52 for an overall complication rate of 25.1%; the rate was higher for infratentorial tumours (44.0%) than supratentorial tumours (22.8%) regardless of histology (p = 0.012). There were 5 deaths for a mortality rate of 2.4%. Forty-seven patients incurred operative morbidity (22.7%); 7 out of the 47 had multiple complications. Sixteen patients sustained transient worsening due to edema (7.7%) and 6 patients sustained permanent neurological deficit (2.9%). Medical complications were suffered by 17 patients (8.2%). Major complications which significantly altered the quality and/or quantity of survival were suffered by 9 patients overall (4.3%).

Adolescent↗
PubMed2000

Target-controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy.

We describe the target-controlled administration of propofol and remifentanil, combined with monitoring of the bispectral index, during an awake craniotomy for removal of a left temporo-parietal tumour near the motor speech centre. Target concentrations of the two drugs were adjusted according to the patient's responses to painful stimuli and surgical events, and the need for speech testing. Allowing the effect-site concentrations of propofol and remifentanil to decrease during surgery allowed the performance of cortical speech mapping and the testing of the patient's ability to speak. Although the bispectral index was not used as a guide for the administration of the drugs, its value correlated better with the patient's responsiveness than did the predicted effect-site concentrations of propofol. Side-effects, comprising hypotension, respiratory depression and airway obstruction, were related to rapid increases in drug infusion rates and were easily managed.

Analgesia↗
PubMed2002

The efficacy of lidocaine administered via the LITA tracheal tube in attenuating the extubation response in beta-blocked patients following craniotomy.

The Laryngotracheal Instillation of Topical Anaesthetic (LITA) tracheal tube has an additional pilot tube through which local anaesthetic can be instilled into the larynx via 10 small holes above and below the cuff We studied 40 patients undergoing supratentorial craniotomy. They were premedicated with two oral doses of propranolol 1 mg.kg(-1). The anaesthetic consisted of infusions of remifentanil, propofol and vecuronium. On insertion of the first skin clip at the end of surgery, 5 ml of either saline or 2% lidocaine was injected into the appropriate lumen of the tracheal tube. There was no difference between the groups in the degree of coughing or the haemodynamic response to tracheal extubation.

Adolescent↗