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PubMedDate not supplied

Effect of scalp infiltration with lidocaine on the circulatory response to craniotomy.

BACKGROUND: The purpose of the present study was to evaluate the influence of infiltration anesthesia of the projected line of incision in the skin of head on the hemodynamic response of the circulatory system, and the essential dose of opioids in 100 patients who underwent craniotomy. MATERIAL AND METHODS: The patients were divided into 4 groups: IA - brain tumors, no infiltration anesthesia; IB - cerebral aneurysms, no infiltration anesthesia; IIA - brain tumors + infiltration anesthesia; IIB - cerebral aneurysms + infiltration anesthesia. In the patients from groups IIA and IIB, the projected line of skin incision was injected with a 1% lidocaine solution (9.94+/-1.95 ml) five minutes before commencing surgery. RESULTS: No statistically significant differences were found between the various groups in regards to their weight, the time between infusion of the first dose of fentanyl and skin incision, the mean heart rates at time points T1 (prior to induction of anesthesia), T2 (prior to skin incision) or T3 (after skin incision), or mean arterial pressure values (MAP) at time points T1 or T2. A significant increase in MAP values (P<0.05) caused by skin incision was recorded in groups IA (from 95.2+/-9.85 to 119+/-10.6 mm Hg) and IB (from 88.4+/-11.5 to 100.3+/-11.4 mm Hg). In group IIA, MAP increased insignificantly, while in group IIB the MAP values did not change. CONCLUSIONS: Infiltration anesthesia of the projected line of skin incision in the head enabled maintenance of stability in the circulatory system and lower doses of opioids administered before commencing surgery.

Administration, Topical↗
PubMed2002

Sudden development of right and left lung asymmetry in a pediatric patient following craniotomy.

A 7-year-old girl presented to the pediatric intensive care unit following a craniotomy that left her with dysphagia, poor cough, and problems with retained secretions. Pulmonary function and blood oxygen saturation worsened for 3 days after surgery. Noninvasive positive-pressure ventilation and increased fraction of inspired oxygen improved oxygenation. Glycopyrrolate was administered to decrease secretions but had little effect. The first chest radiograph showed left lung hyperinflation. The right lung showed loss of volume and elevation of the right hemidiaphragm. There was no mediastinal shift. Another chest radiograph 3 hours later showed substantial improvement. We discuss the causes of acute lung volume asymmetry and possible interpretations of the radiographs.

Cerebral Ventricle Neoplasms↗
PubMed2002

[Awake craniotomy with propofol sedation and a laryngeal mask airway: a case report].

A 47-year-old man with brain tumor close to the speech center was scheduled for biopsy under awake craniotomy. Anesthesia was maintained with continuous infusion of propofol and intermittent fentanyl. Airway was secured with a laryngeal mask throughout the surgery. During cortical stimulation, his phonation was clear and there was no evidence of hypoxia.

Anesthesia, General↗
PubMed2002

Pontine hemorrhage after frontal craniotomy. Report of a case.

This report describes the complication of pontine hemorrhage in a patient who had undergone supratentorial craniotomy for treatment of a frontal intracerebral hematoma. A literature review revealed no previous cases of pontine hemorrhage in this clinical scenario. Abnormal findings on neurological examination in the early postoperative period should alert the physician to the possibility of this complication.

Cerebral Hemorrhage↗
PubMed2001

[The effect of small doses of 7.5% NaCl on brain bulk during elective craniotomies].

In 16 patients (ASA I i II) aged 16-76 years (48 +/- 15; mean +/- SD) operated on because of intracranial expanding mass, the effect of hypertonic saline (7.5%--1 ml/kg b.w.) on brain bulk (BB) was evaluated. Patients were anaesthetised with a slight hypocarbia (PaCO2 = 33.3 +/- 3.5 mmHg). BB was scored after opening the dura (T0) and 15 min. (T15) after hypertonic saline (HS) infusion. Five points BB scale was used. Brain bulk reduction (D BB) was calculated as a difference: BB15-BB0. Tomographic signs of intracranial expansion (TSIE) in preoperative CT were scored using the scale from 5 to 15 points assessing (1 to 3 points) the size of mass lesion, the size of perifocal oedema, midline shift, displacement of ventricles and basal cisterns compression. Systolic (SBP), diastolic (DBP) blood pressures and heart rate (HR) were monitored. Serum natrium (SNa), kalium (SK) and osmolarity (Sosm) were measured at T0, T15 and Tp0 (one hour after operation). Student's t-test, Wilcoxon test and Spearman correlation were used for statistical analysis. P < 0.05 was considered as statistically significant. HS caused significant decrease in BB (p = 0.002). In 12 patients with a solid brain tumor a negative correlation between BB and TSIE was found (r = -0.68). A slight but significant decreases in SBP and DBP at Tp0 and T15 as well as decrease in HR due to HS were stated. SNa and Sosm increased at T15 and reminded elevated at Tpo. We can conclude that 7.5% saline in a dose of 1 ml/kg b.w. reduces brain bulk during craniotomy in patients with supratentorial mass lesions. In patients with a solid brain tumor this effect correlates negatively with a size of expanding mass. A slight changes in blood pressure and heart rate due to HS as well as moderate decrease in SK are within limits of clinical acceptance.

Adolescent↗
PubMed2003

[Microsurgical treatment for craniopharyngioma combined transorbital-subfrontal and temporal craniotomy].

OBJECTIVE: To summarize the experience in microsurgical removal of craniopharyngioma using combined transorbital-subfrontal and temporal craniotomy. METHODS: Eighteen patients with craniopharyngioma varied from 3.1 cm to 6.2 cm in diameter. The tumor was located in the suprasellar region in 7 patients, extended to the third ventricle in 6, and down to the intrasellar from the suprasellar region in 4, and in the third ventricle in 1. Complete or partial cystic tumor was seen in 13 patients, and solid tumor in 5, and calcified tumor in 12. All the patients were operated on via combined transorbital subfrontal and temporal approach. The tumor was dissected in the spaces I, II and IV with great attention to the preservation of the perforating arteries from the carotid, posterior communication and anterior choroidal arteries to the structure of the hypothalamus. The solid portion of the tumor was removed by piecemeal. RESULTS: The tumor was totally removed in 14 patients and subtotally in 4. Postoperation, follow-up for 8 to 41 months showed no change in 3 residual tumors and one lost to follow-up. All patients Postoperative Karnofsky scales showed 80 - 90, in 12 patients, 60 - 70 in 5 patients, and 50 in 1. CONCLUSIONS: Combined transorbital-subfrontal and temporal approach can provide an excellent exposure to the sellar region, craniopharyngioma and its surrounding structures. This approach ensures less cerebral retraction for easy access to craniopharyngioma, including other large neoplasm of the middle cranial base with ventricle or posterior cranial base extension. Microsurgical techniques play an important role in removing tumor and preserving hypothalamic function.

Adolescent↗
PubMed2003

[Malignant hyperthermia during emergency craniotomy: a case report].

An 18-year-old man underwent emergency craniotomy for acute epidural hematoma under general anesthesia using suxamethonium and isoflurane. Marked rises in end-tidal carbon dioxide, body temperature, and serum potassium occurred during the surgery. After intravenous dantrolene sodium administration, the body temperature dropped rapidly. No conspicuous postoperative elevation of serum creatine kinase levels were observed. Postoperative muscle biopsy specimen revealed increased calcium-induced calcium release.

Acute Disease↗
PubMed2003

Remifentanil-propofol versus sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial.

BACKGROUND AND OBJECTIVE: Remifentanil has unique pharmacokinetics that might allow faster recovery after neurosurgery. We investigated the effects of a propofol/sufentanil versus a remifentanil/propofol regimen on the primary end-point tracheal extubation time. METHODS: In the Neurosurgery Department of a University Hospital, 36 patients awaiting craniotomy for supratentorial tumour resection were randomly assigned to one of two study groups. In the sufentanil/propofol group, anaesthesia was induced with 0.5 microg kg(-1) sufentanil and 1-2 mg kg(-1) propofol. Propofol infusion and boluses of sufentanil were administered for maintenance. In the remifentanil/propofol group, anaesthesia was started with an infusion of remifentanil (0.2-0.35 microg kg(-1) min(-1)) and a bolus of propofol (1.5-2 mg kg(-1)). Patients received a propofol infusion and a remifentanil infusion for maintenance of anaesthesia. Recovery times were taken from cessation of the propofol infusion. In addition, data about self-reported nausea and vomiting, pain and analgesic requirements were collected. RESULTS: Patients in the remifentanil/propofol group were extubated earlier (mean times 6.4 (+/- SD 4.7) versus 14.3 (+/- 9.2) min; P = 0.003). The two groups were similar with respect to postoperative nausea and vomiting, and patient-reported pain scores. Fifty per cent of the remifentanil/propofol patients and 88% of the sufentanil/propofol patients required no analgesics within 1 h after operation (P = 0.03). CONCLUSIONS: The remifentanil/propofol regimen provided quicker recovery. The two regimens were similar in terms of postoperative nausea and vomiting and patient-reported pain scores, but patients in the remifentanil/ propofol group required more analgesics within 1 h postoperatively.

Aged↗
PubMed2005

[Evaluation of emergency craniotomy for the treatment of patients with intracranial metastases of choriocarcinoma].

OBJECTIVE: To study the diagnosis, management and prognosis of intracranial metastases of gestational trophoblastic tumour (GTT) patients who had emergency surgical decompression due to highly increased intracranial pressure. METHODS: Ninety-three patients with intracranial metastases of gestational trophoblastic tumour were hospitalized in our department of Peking Union Medical College Hospital from 1985 to 2004. Thirteen of them who underwent emergency craniotomy were retrospectively analyzed, and all of them presented with raised intracranial pressure and intracerebral haemorrhagic mass. RESULT: Of the thirteen patients who underwent surgery in combination with multiagent systemic chemotherapy, seven achieved complete remission (CR), five had partial remission (PR), and one died of disease progression. CONCLUSIONS: Emergency surgical treatment is the important method of choice for brain metastasis in patients displaying rapidly deteriorating signs. An undetermined intracranial haemorrhage in young female patients of reproductive age group should raise the suspicion of cerebral metastatic choriocarcinoma.

Adult↗
PubMed2005

[Our current technique for basic pterional craniotomy].

Pterional cnaniotomy is frequently used in neurosurgical practice, but still poses significant cosmetic and functional drawbacks. Here, we describe our modified technique to overcome such problems as the sterilization of the scalp without brush and razor, preemptive analgesia, preservation of the periostium for reconstruction, retrograde dissection of the temporal muscle, and complete sphenoidotomy using chisel or drills. The tips of our pterional craniotomy offer suitable size and depth of working field around the paraclinoidal regions, maintaining cosmetic satisfaction of the patients.

Anesthesia↗
PubMed2005

[A case of secondary anterior fossa dural arteriovenous fistula following posterior fossa craniotomy].

The etiology of dural arteriovenous fistula (AVF) remains uncertain. The authors present a case presenting with anterior fossa dural AVF, which developed after the resection of cerebellar arteriovenous malformation (AVM). The anterior fossa dural AVF, which was not observed on the preoperative angiography, was diagnosed on the follow-up angiography, after the resection of cerebellar AVM. A mechanism underlying the present case is not clearly understood. To the best of our knowledge, some cases of dural AVF secondary to craniotomy have been reported. It is postulated that intracranial vascular anomaly should be analyzed after the surgery.

Central Nervous System Vascular Malformations↗
PubMed1992

Craniotomy infections.

The incidence of craniotomy infections, usually less than 5%, is dependent on many factors, such as how the information is collected and how the percentage is calculated. Because these factors may vary from report to report, incidence figures should be read with skepticism. It is difficult to prove that a given factor contributes to infection. Most routines are based more on personal convictions than on solid evidence. CSF leak is one factor known to have great impact; it should be avoided with painstaking technique and, if it occurs, it should be treated promptly. Solid evidence favoring prophylactic antibiotics for persistent CSF leak is not available; but, until a well-designed randomized study tells otherwise, the high risk of meningitis justifies prophylaxis. Penicillin is adequate for leaks through the nose or the ear. For leaks through the skin, the antibiotic should be effective against staphylococci. The infection register should provide information about prevailing bacteria. In many hospitals, the prophylaxis should cover gram-negative bacilli. CRP is a useful diagnostic aid for detecting postoperative infections. The operation, however, also causes a CRP rise. Daily CRP monitoring, at least for patients with elevated temperature, is recommended. The third-generation cephalosporins are a welcome contribution to the treatment of bacterial meningitis. To avoid side effects, and to keep them potent when they are really needed, they should be used with caution. Most postoperative cases of meningitis are in fact aseptic. If the patient is moderately ill, chloramphenicol is still eligible as the first choice antibiotic. When the bacterial culture is negative, the antibiotic should be stopped. The standard treatment for bone flap infection is removal of the bone flap. The bone flap is essentially devascularized and comparable to a foreign body. The justification of vancomycin prophylaxis has been shown in a randomized study.

Anti-Bacterial Agents↗
PubMed2005

[Clinical observation on effect of huoxue jieyu decoction in treating depression after craniotomy: a report of 45 cases].

OBJECTIVE: To observe the therapeutic effect of Huoxue Jieyu decoction (HJD) on patients with depression after craniotomy. METHODS: Ninety patients were randomly divided into 2 groups according to the sequence of their consultation. The 45 patients in the treated group were treated with conventional symptomatic treatment plus oral administration of HJD, and the 38 patients in the control group were treated in the same way but with chlorimipramine (anafranil) instead of HJD. Hamilton depression (HAMD) scores before and after treatment, occurrence of adverse effects and long-term therapeutic effect of treatment were observed. RESULTS: The score of HAMD was insignificantly different in 2 groups before and after treatment (P >0.05), but the occurrence of adverse effects between them was significantly different (P < 0.01). CONCLUSION: The therapeutic effect of HJD on depression was similar to that of anafranil, but HJD has less adverse effect and more stabilized long-term effect.

Adolescent↗
PubMed2006

Remifentanil vs fentanyl with a target controlled propofol infusion in patients undergoing craniotomy for supratentorial lesions.

AIM: Remifentanil hydrochloride is an ultra-short acting m-opioid receptor agonist. This study compared the use of remifentanil with that of fentanyl during elective supratentorial craniotomy in a target controlled infusion (TCI)-propofol anesthesia regimen and evaluated the quality of recovery from anesthesia. METHODS: After written informed consent for this prospective study, 40 adult patients were randomly divided into 2 groups: in group F analgesia was provided with fentanyl 2-3 mg kg(-1) h(-1) and in group R with remifentanil 0.25 mg kg(-1) h(-1). Anesthesia was induced with thiopental and pancuronium bromide, and maintained with propofol-TCI, pancuronium, air and oxygen and fentanyl (group F) or remifentanil (group R), respectively. After tracheal intubation, infusion rate of remifentanil was reduced and then adjusted to maintain stable hemodynamics. Hemodynamics and recovery time were monitored for 60 min after surgery. Analgesic requirements, propofol intraoperative consumption, nausea and vomiting in postoperative period were monitored. Recovery was evaluated according to a modified Aldrete score. RESULTS: Baseline hemodynamics were similar in both groups. Mean arterial pressure differed between the 2 groups (P<0.05) with the greatest decrease in group R during dura opening (P<0.001). Postoperative mean arterial pressure was higher in group R. Patients in group R exhibited a faster recovery. The incidence of nausea and vomiting was similar in the 2 groups. Noteworthy, there was a reduction in the amount of propofol used in group R. CONCLUSIONS: Remifentanil appears to be a reasonable alternative to fentanyl during elective surgery of supratentorial lesions.

Adult↗
PubMedDate not supplied

Contralateral extradural hematoma following craniotomy for traumatic intracranial lesion. Case report.

The authors report the case of a patient in whom a contralateral extradural hematoma developed immediately after craniotomy for a traumatic intracranial lesion. Contrary to other reported cases but one, intraoperative brain bulging was not observed in this case. The pathophysiology of this complication is discussed. Immediate postoperative CT scan in patients who do not improve as expected is recommended for the early detection of this complication.

Accidents, Traffic↗
PubMed1991

Measurement of cerebral blood flow (CBF) with the Kety and Schmidt technique during craniotomy.

In this study cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were measured twice during craniotomy for supratentorial cerebral tumors by the Kety and Schmidt technique. The anaesthetic procedures included halothane, enflurane isoflurane and continuous infusion with midazolam, etomidate, althesin and neurolept anaesthesia (dehydrobenzpyridol). Moderate hypocapnia was used and the anaesthesia was supplemented with nitrous oxide and fentanyl. In general, both CBF and CMRO2 were decreased. However, with inhalation anaesthetics an increase in concentration resulted in an increase in CBF (halothane) or unchanged CBF (isoflurane and enflurane) and a decrease in CMRO2. With the hypnotic agents a dose related decrease in CMRO2 was observed, while CBF either was unchanged (midazolam) or decreased (Althesin and etomidate).

Adult↗