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At least 739 records · Page 41Linked to original sources
PubMed1997

Intracranial tumor in children: MR imaging findings within 24 hours of craniotomy.

PURPOSE: To evaluate whether very early magnetic resonance (MR) imaging enables distinction of residual tumor from benign postoperative change in children. MATERIALS AND METHODS: Forty-six postoperative MR examinations were performed in 43 children with intracranial tumors within 24 hours of the completion of surgery during a 2-year period. These examinations were categorized according to whether residual tumor could be definitely identified or excluded, or whether the diagnosis was uncertain. RESULTS: Contrast enhancement occurred in 33 of 46 MR examinations performed within 24 hours of surgery. In 18 instances, this was associated with obvious residual tumor. In 15 patients, only small amounts of linear or patchy enhancement were seen. Of these, seven patients (46%) were disease-free for an average of 4.5 years. Assessment for postoperative enhancement was hampered in seven patients because of the presence of methemoglobin in the tumor bed. Contrast enhancement was not observed in two patients before surgery. CONCLUSION: Surgically induced, MR-detectable contrast enhancement and extracellular methemoglobin formation occurs within 24 hours of the completion of intracranial surgery. This can interfere with the detection of small amounts of residual tumor.

Brain↗
PubMed1996

Craniotomy guidance using a stereo-video-based tracking system.

In open intracranial neurosurgery, it is desirable to minimize exposure and to approach the target in the most accurate way possible. The VISLAN system described here employs a completely passive hand-held locator which is tracked by a video system and does not require a mechanical linkage nor cables. The system also tracks easily recognizable, constant, anatomical landmarks of the patient. By this means the initial registration of pre-operative imaging and the detection of, and correction for, patient movement can be accomplished. High-resolution MRI segmented interactively is used to define external surface and brain anatomy. Thus, a pre-operative patient representation (POPR) is planned. During the surgical procedure the patient's head is illuminated by structured light and stereo-video pictures obtained from two television cameras mounted above the head. The system is calibrated and registered with the POPR using a chamfered matching algorithm. The locator is also tracked in space by the video system, and its tip position shown in relation to the POPR on the video monitor.

Craniotomy↗
PubMed1997

Stereotactic craniotomy with the exoscope.

A three-dimensional computer graphic program has been developed to guide the surgeon through the resection of a brain tumor. It consists of a video camera mounted on a stereotactic frame which visualizes the operative field in real time. Superimposed on the video monitor is a computer generated model of the tumor or other resection target mass. The mass can be displayed in several modes. The computer image of the mass is adjusted to correspond to the surgeon's eye view, with appropriate settings for the stereotactic apparatus indicated. Prior to incision, the image of the mass is superimposed on the scalp to guide placement and size of the scalp and bone flaps. As the resection proceeds, a cross-section of the mass is illustrated on the video picture of the operative field. The distance from the camera to the surface is measured, and the cross-section at that depth is displayed. A small window indicates the surgeon's eye view and the tangential view of the mass with an indication of the cross-section currently being displayed. As resection proceeds, the distance to the bottom of the resection cavity is measured repeatedly. The image is updated to indicate only that level of the tumor under resection. As the far side of the tumor is encountered, the mass disappears from the monitor, signaling completion of the resection.

Brain Mapping↗
PubMed2003

Craniotomy for treatment of unruptured aneurysms is not associated with long-term cognitive dysfunction.

BACKGROUND AND PURPOSE: Many studies have reported frequent cognitive deficits associated with subarachnoid hemorrhage (SAH) and aneurysm repair. One study found more severe cognitive deficits after clipping than coiling of aneurysms, raising the possibility that deficits are due to surgery instead of SAH itself. This possibility was directly addressed by evaluating the cognitive effects of surgery without SAH. The goal of this study was to identify changes in cognitive function associated with surgical clipping of unruptured intracerebral aneurysms. METHODS: A consecutive series of 25 patients who underwent surgical clipping of >or=1 unruptured intracerebral aneurysm were tested within 1 week preoperatively and again postoperatively (before hospital discharge and at 3-month follow-up if they had deficits at discharge) on a neuropsychological battery. Different forms of each test were used preoperatively and postoperatively to reduce practice effects. Paired t tests were used to examine differences between preoperative and postoperative test scores across individuals. RESULTS: On most tests, there was no significant change between preoperative and postoperative scores. A significant decline in accuracy before hospital discharge was found only in figure copying (P<0.04) and associative learning (P<0.01), and significant slowing was found on 1 test (P<0.01). Even on these tests, only 3 of 25 patients showed significant deterioration. All but 1 patient returned to baseline by the 3-month follow-up. CONCLUSIONS: We found no evidence of subtle cognitive deficits resulting from aneurysm clipping alone, suggesting that the common impairments after surgery for ruptured aneurysms are due to SAH itself, complications of SAH such as vasospasm or hydrocephalus, or perioperative stroke.

Adult↗
PubMed1991

Epilepsy after craniotomy and the place of prophylactic anticonvulsant drugs: discussion paper.

A retrospective study of 1000 patients who had undergone supratentorial neurosurgery and with prolonged follow-up revealed an overall postoperative incidence of epilepsy of 17%. The incidence varied with different pathologies but anticonvulsants given prophylactically in a randomized trial did not significantly alter the incidence. Routine anticonvulsant prophylaxis cannot be recommended.

Carbamazepine↗
PubMed1988

Morbidity and mortality of craniotomy for excision of supratentorial gliomas.

Extensive surgical resection of supratentorial gliomas increases survival. However, some reports suggest that the perioperative morbidity and mortality outweigh the potential benefit of the procedure. We examined prospectively morbidity and mortality in 104 consecutive patients who underwent surgery for supratentorial glioma, as well as other factors that might affect the short-term outcome. To determine if our experience was unusual, we compared these results with those obtained from another academic neurosurgical center by a review of the records of 109 patients also treated surgically for supratentorial glioma. Mortality was 3.3% and the medical plus neurologic morbidity was 31.7%. Functionally significant neurologic worsening occurred in 42 (19.7%) patients. Complications were more frequent in patients with moderate or severe preoperative disabilities than those with mild or no preoperative disability. Patients with complete resection had fewer acute neurologic complications, and no greater risk of being neurologically impaired at 1 week, than patients with biopsy or less extensive procedures. Morbidity and mortality correlated with location: deep-midline lesions had a higher overall rate of perioperative complications (p = 0.032) and mortality (p = 0.019) and bilateral lesions a higher rate of hemorrhage (p = 0.017) and hydrocephalus (p = 0.010). Older patients (greater than 55 years) and those receiving high daily dose of preoperative dexamethasone (greater than or equal to 24 mg) had a significantly higher risk of surgical mortality. Reoperation for recurrent tumor carried no greater risk of mortality, neurologic deterioration, and infection than a first operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗