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PubMed1998

[Propofol anesthesia for craniotomy in patients who are awake].

During craniotomy, the patient's cooperation is needed during procedures in which continuous neurological examination and mapping of crucial regions close to the area to be resected area are required. We report our experience in 9 patients who underwent such procedures under intravenous propofol as the main sedating agent. This short-acting hypnotic was administered prior to and during the painful stages of the procedure. Patients were fully asleep when the skull was opened and the dural flap raised or excised. During the rest of the operation patients were lightly sedated but remained responsive and cooperative. This enabled precise intra-operative mapping of the brain and surgery-related neurological deficits were avoided. Respiratory depression or hemodynamic compromise were not encountered. All patients were comfortable during the operation and there were no additional neurological deficits after operation. We believe that propofol should be the main sedating agent used for these procedures.

Aged↗
PubMed1989

Per- and postoperative changes in the arterio-venous oxygen content difference (AVDO2) in patients subjected to craniotomy for cerebral tumours.

Sixteen patients with supratentorial cerebral tumours were subjected to craniotomy under thiopentone, fentanyl, nitrous oxide, halothane anaesthesia during moderate hypocapnia (PaCO2 level 4.0 kPa). The arterio-venous oxygen content difference (AVDO2) was measured peroperatively, and repeatedly during the first three hours after extubation. Peroperatively the level of AVDO2 averaged 8.0 vol% during opening of the dura, and decreased to 7.0 vol% during closure of the dura (P less than 0.05). Immediately after extubation the AVDO2 decreased to 4.3 vol% (P less than 0.05), and during the next 3 hours a gradual increase to 5.8 vol% (P less than 0.05) was disclosed. In individual cases the postoperative changes in AVDO2 correlated fairly well with changes in mean arterial blood pressure (MABP), but other factors including duration of the operation, age of the patients, size of the tumour, level of PaCO2 and adaptation to prolonged hyperventilation during operation are supposed to be responsible for the low levels of AVDO2 observed in the postoperative period.

Adult↗
PubMed1999

Craniotomy: the first case histories.

The oldest existing case histories of craniotomy are from the false Hippocratic writings, about 330 BC, and one is reconstructed about the death of Ptolemy VI in 145 BC. Greek surgeons had rational indications for trepanning, when the difficulties of the times are understood. All compound fractures were infected, so death from an extradural abscess was likely. Trepanning was intended to drain the extra dural space. Copyright 1999 Harcourt Publishers Ltd.

Journal Article↗
PubMed2006

Endoscopic nasal and anterior craniotomy resection for malignant nasoethmoid tumors involving the anterior skull base.

OBJECTIVES: The traditional approach to sinonasal tumors involving the skull base has been the anterior craniofacial resection. The first report by Ketcham et al (American Journal of Surgery, 1963;106:698-703) documented their experience with 17 anterior craniofacial resections for malignant tumors of the sinonasal tract. Later experience with this technique at several centers has resulted in the publication of many refinements of technique and further reduction in the morbidity and mortality associated with this procedure. In our hands, endoscopic techniques have allowed us to approach the intranasal aspect of skull base lesions without external incisions and yet still achieve an en bloc resection. The type of lesions suitable for this approach and the associated technical issues are discussed in this article. METHODS: Between 1999 and 2004, 18 patients with malignant nasoethmoid tumors underwent endoscopic nasal and anterior craniotomy resections. The average age of the patients 60.2 years, with a male-to-female distribution of 15 to 3. Mean follow-up period was 25.1 months. RESULTS: Two patients died from postoperative complications, three died from recurrent disease and two from unrelated causes. Eleven patients are free of disease with a mean survival of 19.8 months. CONCLUSIONS: Although we do not consider this approach a replacement for the traditional anterior craniofacial resection, it is an important adjunct in the skull base surgeon's armamentarium.

Journal Article↗
PubMed1996

Intraoperative angiography in cerebral aneurysm surgery: a prospective study of 100 craniotomies.

OBJECTIVE: To determine the frequency of unexpected major arterial occlusion and incomplete aneurysm clipping on intraoperative angiography after cerebral aneurysm clipping and to determine factors that predict these unexpected findings. METHODS: Data was collected prospectively on 100 consecutive craniotomies for the clipping of 107 aneurysms in 92 patients. Patient age and sex, aneurysm location and size, how the aneurysm presented, day of surgery after hemorrhage, intraoperative rupture, and postoperative course were recorded. After clipping, the surgeon recorded whether he thought the aneurysm was obliterated and whether he thought the clip occluded a major artery. Intraoperative angiography was then performed. The incidence of unexpectedly finding a major arterial occlusion or residual aneurysm was determined. Factors predicting these unexpected findings revealed by intraoperative angiography were identified by logistic regression. RESULTS: There were 11 giant (10%), 13 posterior circulation (12%), and 68 (64%) ruptured aneurysms. Unexpected angiographic findings necessitating at least one clip adjustment occurred in 12 cases (11%). Clip readjustments restored flow through six major arterial occlusions (6%) and completely obliterated 10 persistently filling aneurysms (10%). Logistic regression showed that factors predicting an unexpected arterial occlusion were giant aneurysm and basilar apex location (P < 0.05). Unexpected residual aneurysm was predicted by giant aneurysm and posterior communicating artery location (P < 0.05). CONCLUSION: Intraoperative angiography detects unexpected arterial occlusions and residual aneurysms in 12% of cases and can decrease complications of aneurysm surgery, although the yield in unselected patients is low. The subgroup of patients with giant, basilar apex, and posterior communicating artery aneurysms has a significantly higher incidence of untoward findings and may benefit from increased usage of intraoperative angiography.

Adolescent↗
PubMed1984

Total removal of a falcotentorial junction meningioma by biparietooccipital craniotomy in the sea lion position: a case report.

The successful total removal of a huge falcotentorial junction meningioma in a 59-year-old woman by biparietooccipital craniotomy with the patient in the sea lion position (prone with a hyperextended neck and with 20 degrees elevation of the upper and lower halves of the body) is reported, with some comments on the advantages of this approach and position. Taking advantage of the exposure of the dural sinus, the confluens sinuum pressure was measured by direct catheterization with the patient in various positions. The pressure was 3.6 cm H2O in the sea lion position, 2.4 cm H2O in the reverse jackknife position (supine with 20 degrees elevation of the upper and lower halves of the body), and -12 cm H2O in the sitting position.

Adult↗
PubMed2004

Remote hemorrhage from the site of craniotomy.

Postoperative intracranial hemorrhage is a serious and sometimes a fatal neurosurgical complication. Hemorrhage occurring at regions remote from the site of intracranial operations comprises an uncommon affection, most ignored by the assistant physicians. It bares a still incomprehensive pathophysiology, despite several theories trying to explain it. Looks like a common sense that the presence of the remote site hemorrhage cannot be related to concomitant presence of hypertension, coagulopathy or undiscovered lesions. We report three cases of postoperative hemorrhages occurring in a remote site of supratentorial craniotomies, two patients presented cavernous sinus meningeoma and one patient was submitted to intracranial vascular surgery.

Adult↗
PubMed2005

[Craniotomy guided by computed tomography with three dimensional reconstruction: technical note].

OBJECTIVE: Searching usefulness of computed tomography with three dimensional reconstruction in planning accurate cranial approaches to treat subcortical lesions. METHOD: Eight patients with neoplastic subcortical convexity-based lesions were surgically treated following spatial coordination obtained with three dimensional computed tomography reconstruction (CT 3D). RESULTS: Accurate approaches were accomplished, allowing a safe and optimized removal of neoplasms in all cases. CONCLUSION: The study manifests the benefits of CT 3D in planning suitable craniotomies, avoiding incongruous approaches.

Brain Neoplasms↗
PubMed2000

Recovery from Duret hemorrhage: a rare complication after craniotomy--case report.

A 44-year-old female presented with Duret hemorrhage due to transtentorial herniation by extradural hematoma as a complication after craniotomy for treatment of spontaneous middle cranial fossa cerebrospinal fluid leakage through the oval window. Brain computed tomography revealed linear hemorrhage in the midbrain and the rostral pons. She awoke after 2 weeks in a coma, despite showing ocular bobbing and bilateral intranuclear ophthalmoplegia. She was discharged from the hospital with minimal neurological defects. Duret hemorrhage is usually fatal, but this case shows that early surgical decompression is the most important factor to avoid the worst sequelae.

Adult↗
PubMed1987

Subdural empyema: a rational management plan. The case against craniotomy.

A review of the management of 34 patients with subdural empyema treated at the Derbyshire Royal Infirmary has been undertaken. It is concluded that craniotomy has little part to play in the management of patients with this condition. With modern, improved antimicrobials and prompt burr hole lavage complete recovery should be obtained in the majority of cases. The treatment of the severely ill patient is discussed.

Adolescent↗
PubMed1998

Medical case management after laminectomy or craniotomy: do all patients benefit from admission to the intensive care unit?

To define severity of illness to identify most effectively patients for whom admission to the intensive care unit (ICU) is unnecessary, the authors performed a retrospective cost-effectiveness analysis. The authors studied the records of 113 patients who were admitted to the ICU after undergoing laminectomy (or other spinal cord surgery) or craniotomy for removal of neoplasm; the Acute Physiology and Chronic Health Evaluation III prognostic system had identified these patients as having a 10% or less risk of requiring intervention while in the ICU. No patient required active intervention during a mean stay of 3.26 days in the ICU. Combined use of a "step-down" postoperative care unit and ICU can optimize allocation of medical resources while providing high-quality care for some neurosurgical patients who are at low risk of requiring postoperative intervention.

Journal Article↗
PubMed1982

Removal of retained ventricular shunt catheters without craniotomy. Technical note.

A technique is described in which insulated suction is used to extract infected retained ventricular catheters in cases of shunt infection. This procedure allows safe removal without craniotomy. Retained catheters are pulled through an insulated No. 11F or 13F suction tube attached to an electrocoagulation unit used for resection and coagulation of adhesions. The technique has been successful in two cases with retained catheters.

Bacterial Infections↗
PubMed1986

Post-craniotomy wound infection caused by Pseudallescheria boydii. Case report.

The authors describe the first reported case of post-craniotomy wound infection due to Pseudallescheria boydii. The patient was a 24-year-old man who sustained a direct blunt injury to the calvaria, resulting in a large subdural hematoma that was surgically evacuated. Subsequently, the surgical wound became infected with a fungus, P. boydii, and was successfully treated with intravenous miconazole.

Adult↗
PubMedDate not supplied

Cardiovascular and respiratory complications after elective supratentorial craniotomy.

The cardiovascular and respiratory complications and their treatment during the immediate postoperative period in the intensive care unit (ICU) are analyzed in 145 consecutive cases of supratentorial craniotomy. In this series, 87.5% of the patients remained in the unit less than 48 hours. In all, 67 cardiovascular disorders were observed in 49 subjects (33.7%). Supraventricular tachycardia, arterial hypotension and hypertension were, in order of frequency, the most common hemodynamic alterations. Fifty percent of the arterial hypertensions were treated with vasodilators. The etiological cause of hypotension was hypovolemia in 66.6% of the cases. Extubation was not performed in the operating room in 17.93% of the subjects, and seven patients in which it was had to be reintubated. The stay in the ICU was longer for those intubated (3.03 +/- 0.77 days). Mortality was 2.06%.

Adult↗