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At least 613 records · Page 34Linked to original sources
PubMed1985

Air embolism during craniotomy in the seated position: a comparison of methods for detection.

A case of air embolism sufficient to cause cardiovascular collapse is reported. This occurred during biopsy of the trigeminal nerve with the patient in the seated position. The use of an end-tidal carbon-dioxide monitor was a better indicator than a precordial doppler of the embolic problem. It allowed rapid detection and prompt resuscitation to be carried out. Air embolism is a significant and potentially fatal problem in clinical practice. It has been widely reported during neurosurgical, head and neck, and gynaecological procedures, and increasingly during laparoscopic procedures where carbon dioxide or air may be embolized systemically. A discussion of the incidence and pathophysiology as well as a review of the methods of diagnosis and management follows.

Aged↗
PubMed2003

[Secondary decompression trepanation in progressive post-traumatic brain edema after primary decompressive craniotomy].

Besides evacuation of epidural or subdural hematoma, early decompressive craniectomy with duraplasty has to be performed in the neurotraumatological care of patients with moderate [Glasgow Coma Scale (GCS) score 9-12 points] or severe traumatic brain injury (TBI; GCS score </=8 points) and threatening herniation. The efficacy of secondary decompressive craniectomy and duraplasty after primary trepanation is under debate due to missing evidence of improved outcome. The objectives of this study were to register the incidence of increasing brain edema after isolated TBI and primary craniectomy, to identify possible decision criteria for secondary decompressive trepanation, and to evaluate the neurological performance 6 months after discharge with the Glasgow Outcome Score (GOS). Of 131 patients who suffered from isolated TBI and had to be primarily operated between January 1997 and December 2001, 58 (male:female = 48:10; median age of 50.9 years) were included in this analysis. In 11 patients (male:female = 9:2; median age of 40.0 years) a secondary unilateral extensive or contralateral decompressive craniectomy had to be performed in the clinical course. Four of the 11 patients (36.4%) did not survive TBI; they died at a median of 1 day after revision or 6 days after TBI, respectively. In the group of secondary decompressive craniectomy we recorded admission (80.0 min after TBI) 35 min later ( p=0.009) than in the group of primary trepanation. Prehospital otorrhagia was observed more frequently ( p=0.036). In univariate analysis, arterial hypotension ( p=0.018) and otorrhagia at admission ( p=0.035), intracranial pressure (ICP) immediately after primary operation ( p=0.024), and decrease of maximal postoperative cerebral perfusion pressure (CPP; p=0.031) below the median cutoff value of 70 mmHg correlated with the event of secondary decompression craniectomy. Multivariate analysis identified decreased maximal CPP after primary trepanation as the only independent prognostic parameter (score 10.496; df=1; p=0.043) for the necessity of secondary trepanation and unfavorable GOS 6 months after discharge. In patients with isolated moderate or severe TBI, prehospital arterial hypotension as well as otorrhagia negatively influenced the mortality and morbidity. Therefore, early adjustment of arterial hypotension and the rapid transport into a neurotraumatological center are to be required for prehospital management of TBI patients. The decrease of maximal CPP below 70 mmHg despite administration of catecholamines representing the only independent prognostic parameter during monitoring in the intensive care unit seems to indicate the necessity of an operative revision as well as an unfavorable GOS 6 months after discharge.

Adult↗
PubMed2000

Systemic and cerebral haemodynamics during craniotomy under mild hypothermia in patients with acute subarachnoid haemorrhage.

BACKGROUND: Mild hypothermia provides cerebral protection against ischaemic insults in various animal models. We compared systemic and cerebral oxygenation between mild hypothermic and normothermic management in 60 patients with acute subarachnoid haemorrhage who underwent clipping of cerebral aneurysms. METHOD: The temperature in the pulmonary artery was maintained at 36 degrees C in 28 patients and was reduced to 34 degrees C in 32 patients. Parameters in the systemic and cerebral haemodynamics from pulmonary artery and internal jugular vein catheters were compared between the two groups immediately after the induction of anaesthesia (TI). and just before temporary occlusion or aneurysm clipping (T2). FINDINGS: Cardiac index, oxygen delivery index, oxygen consumption index, and oxygen saturation of the jugular bulb were significantly lower at T2 in hypothermic group (H) (2.9 +/- 0.6 L/min/m2, 400.8 +/- 106.3 ml/min x m2, 87.0 +/- 14.8 ml/min x m2, 55.2 +/- 6.6%, respectively) than normothermic group (N) (3.7 +/- 0.6, 521.0 +/- 105.5, 109.9 +/- 21.7, 60.9 +/- 6.6) (p < 0.05). The arterial lactate and arteriojugular difference in oxygen content were significantly higher in H (2.3 +/- 1.3 mmol/L, 6.5 +/- 1.5 ml/dl, respectively) than in N (1.7 +/- 1.0, 5.6 +/- 1.2) (p < 0.05). Arteriojugular differences in carbon dioxide tension and hydrogen ion content were significantly lower at T2 in H (-10.8 +/- 2.1 mm Hg, -6.4 +/- 1.3 nmol/L, respectively) than in N (-8.9 +/- 2.8, -5.3 +/- 1.0) (p < 0.05). INTERPRETATION: The balance between oxygen supply and demand systemically and in the brain may worsen during aneurysm surgery for patients with acute subarachnoid haemorrhage under mild hypothermia. Oxygenation of the brain and the whole body should be monitored closely during this surgery, and adequate circulatory assistance is recommended under mild hypothermia.

Acute Disease↗
PubMed1988

Preservation of craniotomy bone flaps under the scalp.

Bone flaps are occasionally not replaced because of brain swelling or for other reasons. Various methods for preserving the free bone flaps have been described. Reimplantation of a free bone flap after a period of preservation outside the body, however, may be complicated by infection, and facilities for proper preservation under sterile conditions may not be available. We present a new technique for preserving the bone flap under the scalp until brain swelling has resolved. The bone flap is reimplanted 12-48 days later. No serious complications related to this technique have been encountered in the 37 patients in which it was used.

Adolescent↗
PubMed2004

[Pain and postoperative analgesia after craniotomy].

Neurosurgery has for a long time been considered as a minimal painful surgery. This explains why there are few references in the literature concerning postoperative neurosurgical pain. Recent papers have demonstrated that even if postoperative pain is less important than in other specialities, such pain exists and should be taken care of. Rapid neurological recovery is now possible because of the progress in the surgical techniques and the introduction of new anaesthetic drugs. This implies a strict postoperative analgesic strategy in order to avoid both direct and indirect complications associated with pain. In this respect, the use of remifentanil or other techniques like target-controlled injection of opioids should absolutely be considered. In most cases, class I and II analgesics seem to provide optimal pain relief. However, for some patients, the use of an opioid may be required.

Analgesics↗