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 487 records · Page 27Linked to original sources
PubMed1996

Craniotomy for intracranial aneurysm and subarachnoid hemorrhage. Is course, cost, or outcome affected by age?

BACKGROUND AND PURPOSE: Age may influence cost or effectiveness of treatment for subarachnoid hemorrhage (SAH). This study examined the effect of age on both. METHODS: Patients (n = 219) who underwent craniotomy for intracranial aneurysm and SAH over 6 years at one tertiary care center were divided in two ways by age: single advanced age (< 65 years and > or = 65 years) and decade of age (23 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 to 81 years). Data recorded for each patient included numbers of procedures and complications in the surgical intensive care unit (SICU), number of days in the SICU and the hospital, costs for SICU and ward care, total cost (SICU plus ward costs), and the Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission and discharge, the Hunt-Hess grade at admission and immediately preoperatively, and quality of life score, a measure of outcome. Mortality rates by age group were calculated. RESULTS: The only variable significantly affected by decade of age was mortality rate, which increased as decade of age increased (3% to 17%). With the 65-year comparison, mortality rate, cost, APACHE II score at admission and discharge, days before operation, and days in the SICU were significantly higher for age > or = 65 years. CONCLUSIONS: Whereas mortality is higher for the older age group, quality of life scores appear acceptable for those who survive. Even though the hospital costs of treating elderly patients for SAH may be higher than those for younger patients, this should not be used to justify withholding care from the elderly.

Adult↗
PubMed2001

Awake craniotomy in an adolescent.

We present our approach to management of awake craniotomy for epilepsy surgery for an adolescent. The importance of patient selection and preoperative preparation is stressed. Anaesthetic management included regional scalp block and preincisional surgical infiltration of local anaesthetic and light sedation with propofol, fentanyl and midazolam. The patient remained responsive to voice for all but a small part of the procedure.

Adolescent↗
PubMed1992

Oral clonidine pretreatment for haemodynamic stability during craniotomy.

We have studied the effect of clonidine pretreatment on cardiovascular responses to various stimuli during craniotomy. Fifty-eight patients (ASA Class I-II), scheduled for supratentorial surgery, were randomly given either oral clonidine, mean dose 3.6 micrograms/kg (n = 28), or oral diazepam, 0.2 mg/kg (n = 30), ninety to one hundred minutes before surgery. Anaesthesia was induced with thiopentone and maintained with nitrous oxide:oxygen, pentazocine and halothane. Pancuronium was used as a neuromuscular blocker. Mean arterial pressure and heart rate were recorded before and after several stimuli. In the clonidine group hypertensive response was significantly less on laryngoscopy (6.5% increases versus 11.2% in the diazepam group), intubation (9.2% versus 16.5%), Mayfield clamp application (14.5% versus 29.91%) and after skin infiltration with lignocaine-adrenaline solution (2.95% versus 5.42%). Heart rate response to laryngoscopy, intubation and skin infiltration was also significantly attenuated in the clonidine group. The sleep dose of thiopentone was smaller in patients pretreated with clonidine. Patients in the diazepam group required more medical intervention. No adverse effect occurred in any patient.

Administration, Oral↗
PubMed2002

Pros, cons, and current indications of open craniotomy versus gamma knife in the treatment of arteriovenous malformations and the role of endovascular embolization.

The successful treatment of an intracranial arteriovenous malformation poses both technical and conceptual problems to the neurosurgeon. Treatment decisions are made in light of current understanding of the natural history of these lesions. It is important to understand the pros, cons and current indication of open craniotomy vs. gamma knife in the treatment of arteriovenous malformations and the role of endovascular embolization. Surgical removal of an arteriovenous malformation is indicated when the operative risk is less than the morbidity and mortality associated with its natural history. The treatment goal of complete angiographic obliteration of arteriovenous malformations is achieved most effectively by microneurosurgery in low-grade lesions. Large lesions frequently require a combination of embolization and microsurgery. Although recent advances in technology and medical management have allowed previously inoperable arteriovenous malformations to be surgically excised, there is still a small group of arteriovenous malformations that cannot be excised safely due to their size and location. Stereotactic radiosurgery is clearly an important adjunct in the multimodality treatment approach for large arteriovenous malformations. Endovascular embolization can potentially increase safety and efficacy in the treatment of arteriovenous malformations when applied to selective cases with well-defined treatment goals.

Craniotomy↗
PubMed2001

Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage.

BACKGROUND: A modest benefit was previously demonstrated for hematoma evacuation within 12 hours of intracerebral hemorrhage onset. Perhaps surgery within 4 hours would further improve outcome. METHODS: Adult patients with spontaneous supratentorial intracerebral hemorrhage were prospectively enrolled. Craniotomy and clot evacuation were commenced within 4 hours of symptom onset in all cases. Mortality and functional outcome were assessed at 6 months. This group of patients was compared with patients treated within 12 hours of symptom onset using the same surgical and medical protocols. RESULTS: The study was stopped after a planned interim analysis of 11 patients in the 4-hour surgery arm. Median time to surgery was 180 minutes; median hematoma volume was 40 mL; median baseline NIH Stroke Scale score was 19 and Glasgow Coma Scale score was 12. Six-month mortality was 36% and median Barthel score was 75 in survivors. Postoperative rebleeding occurred in four patients, three of whom died. A relationship between postoperative rebleeding and mortality was apparent (p = 0.03). Rebleeding occurred in 40% of the patients treated within 4 hours, compared with 12% of the patients treated within 12 hours (p = 0.11). There was a clear correlation between improved outcome and smaller postsurgical hematoma volume (p = 0.04). CONCLUSIONS: Surgical hematoma evacuation within 4 hours of symptom onset is complicated by rebleeding, indicating difficulty with hemostasis. Maximum removal of blood remains a predictor of good outcome.

Adult↗
PubMed1987

Low-dose synthetic narcotic infusions for cerebral relaxation during craniotomies.

Thirty patients undergoing craniotomies were given infusions of fentanyl 1 microgram X kg-1 X hr-1, sufentanil 0.1 microgram X kg-1 X hr-1, or normal saline in a double-blind study of cerebral relaxation. Significantly better relaxation scores were achieved in patients given a narcotic infusion, but there was no difference between the scores with the two narcotics. Infusions of narcotics at these low rates did not delay recovery or alter the requirement for other anesthetic agents. Narcotic infusion rates that do not delay recovery or alter depth of anesthesia significantly improve cerebral relaxation.

Brain↗
PubMed2005

Hyperglycemia in patients administered dexamethasone for craniotomy.

Hyperglycemia should be avoided during neurosurgery in order to decrease the risk of neurological injury. Dexamethasone has been associated with increased blood glucose during surgery. In this prospective, nonrandomized study, we documented the blood glucose concentration changes for 12 h in 34 nondiabetic patients undergoing craniotomy and compared patients who received intraoperative dexamethasone (10 mg IV on induction and 4 mg IV 6 h later), with or without preoperative dexamethasone, with patients who did not receive dexamethasone. Blood glucose concentrations increased from the preinduction value in all groups. Patients not taking dexamethasone before surgery, but who were given it intra- and postoperatively, had the largest peak blood glucose concentrations (11.0 +/- 2.0 mmol/L, mean +/- sd; P < 0.01) compared with patients who received no dexamethasone (7.8 +/- 2.1 mmol/L) or those who had been taking dexamethasone before surgery and continued it during surgery (8.5 +/- 1.2 mmol/L). The peak blood glucose concentrations in this group occurred 9 +/- 2 h after the induction of anesthesia. We recommend that the blood glucose concentration be monitored for at least 12 h in nondiabetic patients having neurosurgery who are newly administered dexamethasone.

Anti-Inflammatory Agents↗
PubMed2006

Precordial Doppler probe placement for optimal detection of venous air embolism during craniotomy.

Verification of appropriate precordial Doppler probe position over the anterior chest wall is crucial for early detection of venous air embolism. We studied responses to normal saline (NS) and carbon dioxide (CO2) test injections at various probe locations during elective craniotomy. All patients received four IV injections (10 mL of NS and 1 mL of CO2 via central and peripheral venous catheters). Doppler sounds were simultaneously recorded with two separate probes. In Group A, probes were placed in left and right parasternal positions. In Group B, the left probe was intentionally malpositioned as far laterally over the left precordium as was compatible with an audible signal. In Group A (n = 23), a left parasternal Doppler signal was easily obtainable in 23 of 23 patients, versus 18 of 23 patients for the right parasternal probe (P < 0.05). In Group B (n = 17), central CO2 injection yielded a positive right parasternal response rate of 88% compared with 29% over the far left precordium (P < 0.015), where central NS injections yielded a 76% response rate (P < 0.015 versus central CO2 injection). Left parasternal placement is at least as sensitive to clinical venous air embolism events as right parasternal placement. Peripheral saline injection represents a viable alternative (83% response rate). Vigorous central injection of 10 mL of NS however, risks false positive verification of left lateral precordial probe placement.

Adult↗
PubMedDate not supplied

Regional cortical blood flow at craniotomy.

Regional cortical blood flow was monitored at craniotomy in 32 patients with a thermal diffusion flow probe in an attempt to assess the effects of surgical conditions on flow. Changes in flow due to vascular manipulation, retraction, hypotension, and hyperventilation were readily apparent. Eleven patients with supratentorial tumors had intermittent measurements of cerebral blood flow; the expected differences in blood flow with halothane anesthesia and hyperventilation were observed. Fourteen patients with aneurysms were monitored continuously and demonstrated a reduction in flow during hypotension; in two of these cases, the reduction was to disastrously low levels. Flow reduction occurred secondary to branch occlusion by the aneurysm clip in a patient with three middle cerebral artery aneurysms and was corrected by changing the clip position. Direct measurement of regional flow may be of value in estimating the safety of temporary clips and the degree of hypotension that can be tolerated.

Brain Diseases↗
PubMed1983

Tension pneumocephalus after posterior fossa craniotomy: report of four additional cases and review of postoperative pneumocephalus.

Four cases of tension pneumocephalus after either posterior fossa craniotomy or translabyrinthine resection of acoustic neuroma with or without nitrous oxide anesthesia are described. Three of the operations were performed with the patient in the sitting position, and one was done with the patient in the lateral position. Of the three cases operated in the sitting position, no nitrous oxide was used at any time during anesthesia in one. Two patients failed to regain consciousness after the termination of anesthesia, and the other two developed the sudden onset of neurological symptoms 1 to 1.5 hours after the operation. In all cases computed tomography disclosed a large subdural collection of air. Re-exploration of the surgical wound or twist drill aspiration of the subdural air resulted in prompt recovery of neurological status in three patients, whereas the other patient's neurological status improved gradually without any specific treatment. The role played by nitrous oxide, the mechanisms by which air enters the intracranial space, the contributory factors, and the predisposing surgical conditions of tension pneumocephalus are reviewed and discussed. Dependent drainage of the cerebrospinal fluid, especially in a patient with coexisting hydrocephalus, seems to be the most important factor for the development of this complication.

Aged↗
PubMed1986

Craniotomy versus transsphenoidal excision of large pituitary tumors: the usefulness of magnetic resonance imaging in guiding the operative approach.

Fifteen patients with large pituitary tumors were studied with computed tomography (CT) and magnetic resonance imaging (MRI). CT was performed using General Electric 8800 and 9800 scanners (General Electric Co., Medical Systems Division, Milwaukee, Wisconsin). MRI was performed utilizing a Technicare superconducting scanner (Technicare, Cleveland, Ohio) at 0.5 tesla. Based on the operative findings, the tumors were divided into two groups. Tumors in Group 1 (n = 12) were described by the surgeon as soft or partially necrotic and easily removed by suction and curettage. Tumors in Group 2 (n = 3) were firm and required sharp dissection or the laser for removal. The tumors were divided into four categories based on MRI signal: (a) isointense with surrounding brain on spin echo (SE) 30 and SE 90, (b) increased signal intensity on SE 30 and SE 90, (c) decreased signal intensity on SE 30 and increased signal intensity on SE 90, and (d) isointense signal on SE 30 and increased signal intensity on SE 90. All three of the firm tumors were isointense with brain on MRI appearance. The tumor consistency (firm vs. soft) was not differentiable on CT scan. The transsphenoidal approach is less satisfactory than craniotomy in cases of firm, fibrous pituitary tumors. Based on our preliminary data, if the MRI signal in the tumor is isointense, then the surgeon should be prepared to deal with a fibrous tumor and might elect a transcranial rather than a transsphenoidal approach.

Adult↗
PubMed1988

Pseudoankylosis of the mandible after temporal bone attached craniotomy.

Mandibular hypomobility after intracranial surgical procedures is seldom encountered. A case of limited oral opening after temporal bone attached craniotomy is described. The condition is due to fibrosis of the temporalis muscle resulting in a pseudoankylosis of the temporomandibular joint. The appropriate operative intervention is transoral coronoidectomy, which restores normal joint function.

Adult↗
PubMed1994

Efficacy of prophylactic antibiotics for craniotomy: a meta-analysis.

A meta-analysis of published randomized studies comparing prophylactic antibiotics to placebo in craniotomies was performed. Ten studies were examined; eight met criteria for inclusion into the meta-analysis. The analysis showed an advantage of antibiotics over placebo at the P < 10-8 level. Tests for homogeneity of effect size between the individual studies showed similar effects of antibiotic treatment between trials, despite variation in the randomization methods and antibiotic regimens used. No statistically significant difference was detected between antibiotic regimens that did or did not cover gram-negative organisms or between single- and multiple-dose regimens. Cumulative meta-analyses showed that this conclusion could have been confidently drawn by 1988, after only four of the eight eligible trials had been published. Trials published since that time have reinforced these conclusions but have not significantly altered them. Future studies should compare proposed new antibiotic regimens with one of those already demonstrated to be effective, not with a placebo.

Anti-Bacterial Agents↗
PubMed1994

Brain stem compression secondary to adipose graft prolapse after translabyrinthine craniotomy: case report.

Three cases of fat graft prolapse into the cerebellopontine angle with clinical deterioration are presented. These patients had undergone translabyrinthine craniotomy for cerebellopontine angle tumors and had autologous abdominal fat strips placed to obliterate the dural defect and the mastoid cavity. Two patients suffered significant morbidity, and one patient died. Clinical presentation, computed tomographic scan findings, methods of treatment, and avoidance of this complication are discussed.

Adipose Tissue↗
PubMed2003

Unlocking the brain: attempts to improve mental function of microcephalic retarded children by "craniotomy".

"Is it sufficient glory to don a white apron and swing a carbolized knife and is therein a sufficient indication to let daylight into a deformed cranium and on top of a hopelessly defective brain, and to proclaim success because the victim consented not to die of the assault? Such rash feats of indiscriminate surgery, if continued, moreover in the presence of fourteen deaths in thirty-three cases, are stains on your hands and sins on your souls. No ocean of soap and water will cleanse those hands, no power of corrosive sublimate will disinfect the souls." These passionate words, delivered by Abraham Jacobi, the father of American pediatrics, at the International Congress in Rome in 1893, and later in the article "Non nocere" (42), epitomize the growing antagonism to the attempts by many prominent surgeons to improve the gloomy fate of severely retarded, microcephalic children by "liberating" their brains from their presumed bony chains by "linear craniotomy." This article portrays how the fallacious 19th-century concepts of the relationship between the capacity of the cranial cavity and intelligence, backed by "scientific racism" together with the changing attitude toward retarded and malformed children, generated a surgical solution for microcephalic idiocy. It describes how hopeful surgeons, neurologists, and pediatricians, encouraged by the advances in anesthesia and asepsis, lost their judgment and disregarded logic and evidence. They generated a wave of enthusiasm and hope that soared from the United States and France through the British Isles, Europe, and as far as Ceylon and Australia to end in a ripple of bitter disgrace under caustic criticism, leaving a scar on the recently budding field of neurological surgery.

Child↗
PubMed2004

Changing neurosurgical workload in the United States, 1988-2001: craniotomy other than trauma in adults.

OBJECTIVE: Changes in neurosurgical workload can justify requests for hospital resources and guide planning by neurosurgical training programs. Most previous studies have used non-population-based data sources, such as surveys of professional society members, to explore the neurosurgical workload in the United States. METHODS: This is a retrospective cohort study of patients in Diagnosis Related Group (DRG) 1 ("Craniotomy other than trauma, age > 17") using the Nationwide Inpatient Sample. Statistical methods were adjusted for complex survey methodology to generate total United States caseload estimates. RESULTS: The total United States DRG 1 caseload increased from 70,800 admissions in 1988 to 105,300 admissions in 2001, a 50% relative increase (P < 0.001). For most diagnostic categories, the relative caseload increase was similar to that for the whole group. Patient age and sex distributions remained stable over time. Medical comorbidities, such as hypertension, chronic pulmonary disease, diabetes, and obesity, became more frequent. Elective admissions increased and in-hospital mortality rates decreased. Length of hospital stay decreased during the first half of the study period and then stabilized. Combined with increasing caseload, this caused total annual inpatient DRG 1 days to increase progressively after 1996. The number of United States hospitals with DRG 1 admissions decreased over time. Per-hospital annual DRG 1 caseloads increased, especially at high-volume centers. For the largest 100 hospitals by DRG 1 caseload, total admissions increased from 8.5% of all United States admissions (1988) to 9.4% (2001), whereas DRG 1 caseload increased disproportionately, from 27% to 38% of the United States aggregate caseload. This is evidence that progressive centralization of DRG 1 admissions took place during the study period. CONCLUSION: We documented an increase in total caseload and centralization of care for DRG 1 in the United States during the period 1988 to 2001. Defining the reasons for the changes in neurosurgical workload we observed will require further research.

Adolescent↗
PubMed1989

Management of craniotomy in young rabbits.

A safe and easy-to-manage technique for various craniotomy procedures in young rabbits has been developed. This technique, which minimizes the need for special instrumentation, has been tested in 90 animals with a minimal mortality and morbidity: one death perioperatively caused by sagittal sinus bleeding and one rabbit disclosing a brief period of postoperative illness, respectively. The technique, including postsurgical strategy, is described in detail.

Animal Welfare↗