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PubMed1991

[Suprasellar tumors in patients over 70 years of age. Value of limited frontotemporal craniotomy. Visual results. Apropos of 5 cases].

The authors report their experience of the surgical approach for suprasellar tumors (Jugum or tuberculum sellae meningiomas, 3 cases, and suprasellar craniopharyngiomas, 2 cases) in over than seventy years old patients (71-78 y). A limited craniectomy was performed at the fronto-temporal junction using three adjacent burr-holes. The duramater was cut with an Y-shaped incision. Cerebrospinal fluid was sucked out through a lateral subfrontal route, allowing an easy cerebral collapse in elderly patients, which can sometimes avoid even retraction. Such an supra-orbital craniectomy allowed a subfrontal approach, opening of the sylvian fissure and control of the inter optic, inter carotido-optic and latero-carotidian spaces as well as a good access to the inter pedoncular cistern. In 4 cases the craniectomy was performed after fronto-temporal skin incision, but a trans eyebrow skin incision was used in 1 case. All patients had uneventful postoperative course. Follow-up was from 3 to 5 years. A visual improvement occurred in all cases. Benefits of this surgical method are discussed and compared with use of a bone flap in patients over than 70 years.

Aged↗
PubMed1991

[Lesions of the pineal and tentorial region. Occipito-parietal approach in three-quarter prone position with infrasagittal craniotomy].

Surgical treatment of pineal-tentorial region lesions remains a challenge. The difficulty in approaching the pineal region can be verified with the number of operative plans that have been proposed to reach this area: transcallosal, occipital transtentorial, infratentorial supracerebellar approaches and sitting, prone or Concorde positions. This emphasizes the surgeon's dissatisfaction with the surgical techniques described. Recently, a three-quarter prone position with the bone flap placed under the midline has been described (1, 3, 8). We have decided to test this approach that we have slightly modified and we report our results on 13 cases: 2 arachnoid cysts, 3 vascular malformations and 8 tumors (3 brainstem gliomas, 2 dysgerminomas, 1 quadrigeminal plate metastasis and 1 meningioma plus 1 metastasis of the falx). Keeping the table in a horizontal plane, risks of air embolus are eliminated. Using the natural effect of gravity, traction on the occipital lobe is no more necessary and hemianopsia no more occurs. We recommand the parieto-occipital route which is the shortest way to reach epiphysis and falco-tentorial notch. We confirm the results of american colleagues (1, 3, 8, 15) and we advise to use this approach which seems to us the best way to treat pineal-tentorial lesions.

Adult↗
PubMed1991

[Symptomatic chronic subdural hematoma. Analysis of 68 cases treated surgically with small craniotomy and placement of a closed drainage system].

Sixty eight cases of chronic subdural hematoma (CSDH) surgically treated (December 1984-December 1988) with twist drill craniostomy (3-4 mm) and application of a closed drainage system (CDS) are reviewed. The patients were distributed in four groups depending on the density of the hematoma: hypodense (36 cases), isodense (6 cases), of mixed density (22 cases) and hyperdense (4 cases). In about one third of patients (25 cases) the duration of symptoms was shorter than one week, in 21 cases it was between one week and one month, and in 22 patients it was longer than one month. 77.95% of cases had a preceding head injury. Headache and motor deficits were the leading symptoms, being present in 43 (63.2%) and 42 (61.7%) cases, respectively. Twelve patients (17.6%) were comatose on admission. Twelve patients required reoperation. Six patients died (8.8%). The preoperative neurological status and associated systemic diseases influenced the outcome. We think that limited craniostomy with CDS is the therapy of choice for symptomatic CSDH.

Aged↗
PubMed1990

[Chronic subdural hematomas treated by burr hole craniotomy with continuous drainage].

60 cases of chronic subdural hematoma (CSDH) are reported in this paper. 59 cases were treated through burr holes, irrigation and drainage and 57 cases were completely cured after operation. The cure rate is 95%. In this group only three cases died due to neurological condition in grade III-IV (Stupor and Coma). The external membrane of hematoma is very rich in neocapillary and deposit with hemosiderin and exudate by fresh red blood cell. These findings support that the enlargement of a CSDH are not caused by hyperosmotic fluid within the hematoma but by continuous bleeding from the neocapillary of its outer membrane. The result of this surgical treatment is satisfactory, the operative procedure is safe and easy to perform, and there are no severe operative complications or accidents.

Adolescent↗
PubMed1986

Chlormethiazole in the management of post-craniotomy seizures.

Epilepsy is an important problem in the period immediately following intracranial surgery. Rapid control of seizures is important to prevent damage to cerebral neuronal function. A method of managing epilepsy using intravenous chlormethiazole is reported. This regimen has proved to be safe and rapidly effective in the control of post-operative seizures.

Brain Diseases↗