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At least 19 recordsLinked to original sources
PubMed1996

Free rectus abdominis muscle flap for the treatment of complications after neurosurgical procedures.

Neurosurgical procedures may lead to mortal complications. Exposure of the dura mater, brain, or other intracranial structures; persistent cerebrospinal fluid fistulas; and connection between the extradural space and the nasopharynx and paranasal sinuses are complications that can be best treated with microvascular free tissue transfers. We report two patients with complications that occurred after neurosurgical operations. Both patients were treated by a team, including a plastic surgeon, ear, nose, and throat surgeon, and a neurosurgeon. Free rectus abdominis muscle flap was the choice of treatment for reconstruction.

Adult↗
PubMed1995

Shaving the hair--is it always necessary for cranial neurosurgical procedures?

Shaving of the hair and neurosurgical procedures are almost inseparably connected issues. This may add an additional psychological stress to the patient. Those departments which abandoned pre-operative shaving did not see higher infection rates. From January 1993 to September 1994 we performed 57 cranial procedures without any shaving, among them 5 shunt procedures. We found no disturbances of wound healing or septic complications. Therefore neurosurgical procedures without shaving are recommended for all benign cranial processes if a rapid rehabilitation of the patient to his normal daily life is to be expected.

Brain Diseases↗
PubMed1990

Preoperative and intraoperative echocardiography to detect right-to-left shunt in patients undergoing neurosurgical procedures in the sitting position.

In patients undergoing neurosurgical procedures at high risk for venous air embolism (VAE), the presence of a right-to-left shunt adds an additional risk for paradoxical air embolism (PAE). Although this is a rare complication, it can have devastating results. The most common form of right-to-left shunt is a patient foramen ovale (PFO), which can be detected by contrast echocardiography. This study evaluates the efficacy of preoperative precordial and intraoperative transesophageal echocardiography (TEE) to detect right-to-left shunting in patients undergoing neurosurgical procedures while in the sitting position. In 101 patients precordial contrast echocardiography was performed prior to surgery. The Valsalva maneuver was utilized as a provocative maneuver to facilitate demonstration of right-to-left shunting. Fifty-one of these patients also had intraoperative TEE monitoring. Right-to-left shunting was demonstrated in only six of the 101 patients examined. Of these, four were detected by TEE. This is less than the expected incidence based on the known incidence of PFO in the general population. The usefulness of preoperative ECHO as a screening test for PFO in patients undergoing neurosurgical procedures is limited, but when a PFO is found, valuable information is acquired to help manage these patients.

Cervical Vertebrae↗
PubMedDate not supplied

Regional anesthesia in a very low-birth-weight neonate for a neurosurgical procedure.

BACKGROUND AND OBJECTIVES: Peripheral nerve blocks can be successfully utilized in infants for neurosurgical procedures. Our objective was utilizing a series of peripheral nerve blocks for a neurosurgical procedure in a very low-birth-weight neonate. CASE REPORT: We report the use of supraorbital, great auricular, and greater occipital nerve block in a very low-birth-weight neonate (700 g) who was scheduled for a neurosurgical procedure. DISCUSSION: We were able to successfully utilize peripheral nerve blocks and were able to blunt physiologic responses to surgical stress without compromising hemodynamic stability using high-dose opioids.

Anesthesia, Conduction↗
PubMed2002

Intraoperative mild hypothermia therapy in patients scheduled for neurosurgical procedures.

BACKGROUND: Deliberate mild hypothermia has been proposed as a means of providing cerebral protection during neurosurgicals procedures complicated by cerebral ischaemia. Our prospective study was designed to examine the safety of deliberate mild hypothermia and to evaluate our techniques for cooling and rewarming. MATERIALS AND METHODS: With institutional approval, 20 patients scheduled for elective neurosurgery were enrolled into our prospective study. After the induction of anaesthesia, the core temperature was measured by urinary catheters with probes (Kendall). The patients were cooled (temperature of blankets set at 15 degrees C) and rewarmed (temperature set at 40 degrees C) by two circulating water blankets (Blanketrol III, Cincinnati Sub-Zero, Cincinnati). The variables are expressed as a mean +/- standard deviation. RESULTS: The time of anaesthesia was 316+/-53 min. The core temperature was 36.5+/-0.4 degrees C at the start of anaesthesia. The minimal temperature reached 34.4+/-0.4 degrees C. The patients were cooled at a rate of 1.1+/-0.3 degrees C/h and rewarmed at a rate of 0.9+/-0.4 degrees C/h. The temperature was 35.8+/-0.5 degrees C after the neurosurgical procedure. Deliberate mild hypothermia with rewarming did not cause delays in emerging from anaesthesia. On the control CT scan, no ischaemic changes were observed after surgery. CONCLUSIONS: Our findings indicate that patients can be cooled and rewarmed by two circulating water blankets, and core temperatures about 34 degrees C were easily achieved. The deliberate mild hypothermia is together with careful anaesthesia management a safe technique of cerebral protection from ischaemic insult during elective neurosurgical procedures. (Tab. 1, Ref. 11.).

Brain Ischemia↗
PubMed2006

Brain shift is central to the pathogenesis of intracerebral haemorrhage remote from the site of the initial neurosurgical procedure.

Intracerebral haemorrhage remote from the site of surgery is an uncommon and poorly understood complication after neurosurgical procedures. Although patients under anticoagulant therapy or with perioperative elevated blood pressure are usually considered potentially at high risk of postoperative intracerebral haemorrhage, the aetiology is still unclear for patients without these predisposing factors. In this paper, we suggest that brain shift, unavoidably occurring during all neurosurgical procedures, might play a central role in the aetiology of postoperative remote intracerebral haemorrhage. Brain shift is mainly caused by gravity, aggressive intraoperative dehydration, and cerebrospinal fluid aspiration. Brain shift produces stretching and transient occlusion of the corticodural bridging veins draining into the peripheral dural sinus. Consequently, venous infarcts occur in the venous drainage territories and haemorrhagic transformation results when perfusion is re-established within ischemic tissue. To minimize brain shift and consequent risk of remote intracerebral haemorrhage, we recommend avoiding the use of hyperosmotic agents and cerebrospinal fluid drainage systems during neurosurgical procedures. Moderate head elevation during and immediately after surgery may improve cerebral venous drainage and reduces the risks of this life-threatening complication.

Brain↗
PubMed2003

Risk factors for the occurrence of chronic subdural haematomas after neurosurgical procedures.

Chronic subdural haematoma (CSDH) is a rare clinical complication of neurosurgical procedures. CSDH occurs sporadically after aneurysm clipping surgery and revascularisation surgery but the risk factors are not known. The present study reviewed 6613 consecutive neurosurgical procedures performed from January 1987 to July 2001, and identified 621 cases of CSDH. Fifty of these 621 cases had a past history of neurological disorders treated by neurosurgery. This study evaluated these 50 cases in order to elucidate the clinical and radiological characteristics of CSDH after neurosurgery and to investigate the etiology for identifying in the risk factors of CSDH as a postoperative complication. The incidence of CSDH after neurosurgery was 0.8% (50/6613). Twenty-seven of the 50 patients with a past history of neurosurgery had undergone aneurysm clipping surgery. The incidence after clipping surgery was 2.4%. Twelve of these 27 cases also underwent ventriculoperitoneal shunting. Three patients had postoperative CSDH after arachnoid cyst opening and/or shunting. The incidence was highest at 7.5%. Three patients had postoperative CSDH after brain tumour surgery. The incidence was low at 0.4%. However, the ventricular cerebrospinal fluid (CSF) space was opened during tumour removal in 2 of these 3 patients. Communication of the subarachnoid space to the subdural space is considered to be one of the causative factors and excessive CSF shunting facilitates formation of CSDH after neurological surgery. Repair of arachnoid tearing during neurosurgery and avoidance of excessive CSF shunting may reduce the risk of CSDH after neurosurgery.

Adult↗
PubMed2006

Intraoperative MRI for interventional neurosurgical procedures and tumor resection control in children.

INTRODUCTION: Despite the introduction of neuronavigational systems, radical tumor removal is still problematic in many neurosurgical procedures. Thus, direct intraoperative imaging for tumor resection control was implemented with an intraoperative magnetic resonance imaging (ioMRI) scanner installed in the operating room. Whereas most procedures with ioMRI were carried out in adults, we summarize 7 years of experience using ioMRI in children for interventional neurosurgical procedures or for tumor resection control. METHOD: An open magnetic resonance scanner (Magnetom Open 0.2 T) was installed in the neurosurgical operating room. For tumor resection control, ioMRI was performed in 35 procedures. After the ioMRI scans were analyzed with respect to quality, the identification of residual tumor was considered by the attending neuroradiologist and neurosurgeon. If residual tumor tissue was present, a new three-dimensional (3D) dataset was acquired to update the neuronavigation; subsequently, the tumor resection was extended. In all these procedures, the results of the ioMRI were checked by an early postoperative high-field magnetic resonance imaging (MRI) study. In addition, ioMRI was carried out in ten other children to monitor interventional neurosurgical procedures. RESULTS: In all children, ioMRI was adequate both for tumor resection control and monitoring of interventional procedures. Primary radical removal of tumor was reached in 40% as confirmed by ioMRI, but in 60% of the patients, the tumor resection procedure was extended after residual tumor was detected using the new 3D dataset for navigational update. By using ioMRI, radical tumor removal improved up to 83% as confirmed by early postoperative MRI. Procedure-related complications were not seen in our series. For all MR-guided biopsies, histology findings could be confirmed, and aspiration of intracranial cysts or abscesses could be monitored online. CONCLUSION: IoMRI using the open magnetom is suitable for detecting residual tumor tissue, can compensate for the phenomenon of brain shift using a new intraopertive 3D dataset for extended tumor resection, and is capable of monitoring interventional neurosurgical procedures. By using ioMRI for tumor resection control, the degree of tumor resection could be significantly improved.

Adolescent↗
PubMed2004

Acute parotitis following sitting position neurosurgical procedures: review of five cases.

Acute bacterial parotitis subsequent to major abdominal surgery is well documented, reportedly occurring in as many as 0.1% of patients. Postoperative parotitis has been reported between 1 to 15 weeks after surgery, commonly appearing within 2 weeks of the procedure. However, postoperative parotitis has not been reported previously after neurosurgical procedures. The authors report five cases of postoperative parotitis after neurosurgical operations in the sitting position with mild flexion and rotation of the head. This group of patients accounted for 0.16% of all craniotomy and 1.9% of all sitting position neurosurgical procedures performed in the authors' institution from 1996 through 2001. Neck flexion and head tilt in the sitting position might have an influence on acute parotitis. The authors found that the side of the parotitis was on the opposite side of the head rotation. Dehydration therapy may also be a contributing factor. The objective of this paper is to state that parotitis is a possible complication in neurosurgical patients operated on in sitting position and to discuss its pathophysiology and treatment options.

Acute Disease↗
PubMedDate not supplied

Endoscopic repair of cerebrospinal fluid leaks after neurosurgical procedures.

OBJECTIVES: Endoscopic repair of cerebrospinal fluid (CSF) leaks has proven to be effective and safe. CSF rhinorrhea is a well-known complication of neurosurgical procedures in the anterior cranial fossa. We present a series of endoscopic repairs of CSF rhinorrhea secondary to neurosurgical procedures. STUDY DESIGN: Retrospective review of 13 cases. METHODS: Thirteen patients are included in the study. Eleven had CSF leaks after hypophysectomy, one after clipping of an anterior circle of Willis aneurysm, and one after posttraumatic frontal lobe debridement. Leaks were identified intraoperatively during the neurosurgical procedure (n = 8) or with intrathecal fluorescein injection during a separate procedure (n = 5). Repair was performed by exposing the skull base defect, debriding the defect margins, and sealing the defect with a free mucosal graft or abdominal fat. RESULTS: Leaks were identified in the sphenoid (n = 12) and posterior ethmoid (n = 1) sinuses. Nine patients had lumbar drains placed. One patient had recurrence of CSF rhinorrhea 2 months after initial repair requiring a revision procedure. No other recurrences were noted. One patient developed postoperative meningitis requiring intravenous antibiotics and a prolonged hospital stay. No other postoperative complications were observed. CONCLUSIONS: Endoscopic repair is a safe and effective treatment for CSF rhinorrhea encountered as a neurosurgical complication.

Adolescent↗
PubMed1999

Attitudes toward neurosurgical procedures for Parkinson's disease and obsessive-compulsive disorder.

Similar neurosurgical procedures exist for Parkinson's disease (PD) and obsessive-compulsive disorder (OCD). Because PD is seen as a brain disease and OCD as a disease of the mind, neurologists and psychiatrists may be more aware of and more optimistic toward neurosurgery for PD than for OCD. A questionnaire was sent to randomized American Psychiatric Association and American Academy of Neurology members, and 569 of 1,188 eligible members (47.9%) responded. Some 82.8% of the psychiatrists and 27.4% of the neurologists were aware of neurosurgical procedures for OCD, whereas 84.7% of psychiatrists and 99.4% of neurologists were aware of neurosurgery for PD (P < 0.001). Of psychiatrists, 74.1% would refer appropriate patients for OCD neurosurgery, 67.4% for PD neurosurgery (P = 0.15); of neurologists, 25.6% would refer for OCD, 94.3% for PD (P < 0.001). Specialty affected willingness to refer for OCD neurosurgery. Specialty and degree of contact with neurosurgeons affected willingness to refer for PD neurosurgery. There is poor physician awareness of neurosurgical options for OCD compared with PD, as well as a risk-benefit bias against OCD surgery by the neurologists surveyed.

Adult↗
PubMed1980

[Doppler effect and the Swan-Ganz catheter. Advantage in diagnosis and treatment of gaseous embolism by neurosurgical procedure (author's transl)].

During the neurosurgical procedure in the sitting position a prospective study was performed with a Swan-Ganz catheter on 99 subjects. Gaseous embolism occured in 11 subjects (11%). The frequency increased twofold in the surgery of pontocerebellar angle tumors. Haemodynamic study of 10 gaseous embolisms showed a rise in pulmonary arterial pressure (15.3 +/- 5.2 to 32.4 +/- 32.4 +/- 7.7 mm Hg; p < 0.005) with a rise in pulmonary resistances (22 +/- 1.2 to 9.0 +/- 3.1 units; p < 0.005) and in right ventricular systolic work index (7.8 +/- 1.3 to 14.4 +/- 6.3 gm/m2; p < 0.02). The fall in mean arterial blood pressure was inconstant and moderate (89 +/- 19 to 78 +/- 23 mm Hg; p < 0.05) as was the fall in cardiac output (5.6 +/- 0.9 to 5.0 +/- 0.8 l/min; p < 0.01). Increasing FIO2 hid hypoxemia but, in five subjects, the intrapulmonary shunt rose from 7 to 31%. The therapeutic aspects are reviewed.

Anesthesia↗
PubMed2000

Cerebral protection before, during and after neurosurgical procedures.

Not only the pathology but also the neurosurgical procedure itself can lead to an impairment of cerebral structures. This may cause neurological symptoms like confusion, disorientation or cognitive deficits which have hardly been noticed until now. Neuroprotective substances can help to reduce this. As an example of the effectiveness, based on our own experiences and international trials, two different medical drugs, Nimodipine and Cerebrolysin, are presented. In conclusion one has to realize that nowadays neurosurgeons have to focus their interest more and more to neuroprotective adjuvant treatment possibilities.

Amino Acids↗
PubMed2004

Intraoperative diffusion-tensor MR imaging: shifting of white matter tracts during neurosurgical procedures--initial experience.

PURPOSE: To prospectively evaluate the location of white matter tracts with diffusion-tensor imaging (DTI) during neurosurgical procedures. MATERIALS AND METHODS: Ethical committee approval and signed informed consent were obtained. A 1.5-T magnetic resonance imager with an adapted rotating surgical table that is placed in a radiofrequency-shielded operating theater was used for pre- and intraoperative imaging. DTI was performed by applying an echo-planar imaging sequence with six diffusion directions in 38 patients (20 female patients, 18 male patients; age range, 7-77 years; mean age, 45.6 years) who were undergoing surgery (35 craniotomy and three burr hole procedures). Color-encoded maps of fractional anisotropy were generated by depicting white matter tracts. A rigid registration algorithm was used to compare pre- and intraoperative images. RESULTS: Intraoperative DTI was technically feasible in all patients, and no major image distortions occurred in the areas of interest. Pre- and intraoperative color-encoded maps of fractional anisotropy could be registered; these maps depicted marked and highly variable shifting of white matter tracts during neurosurgical procedures. In the 27 patients who underwent brain tumor resection, white matter tract shifting ranged from an inward shift of 8 mm to an outward shift of 15 mm (mean shift +/- standard deviation, outward shift of 2.5 mm +/- 5.8). In 16 (59%) of 27 patients, outward shifting was detected; in eight (30%), inward shifting was detected. In eight patients who underwent temporal lobe resections for drug-resistant epilepsy, shifting was only inward and ranged from 2 to 14 mm (9 mm +/- 3.3). In two of the three patients who underwent burr hole procedures, outward shifting occurred. CONCLUSION: Intraoperative DTI can depict shifting of major white matter tracts that is caused by surgical intervention.

Adolescent↗
PubMed2004

Transesophageal echocardiography as a guide for patient positioning before neurosurgical procedures in semi-sitting position.

With an incidence of a patent foramen ovale in nearly one fourth of the normal population, neurosurgical procedures in the semi-sitting position are associated with the risk of paradoxical air embolism. The present study was undertaken to evaluate an anesthetic concept to detect a patent foramen ovale with the help of transesophageal echocardiography in anesthetized patients before neurosurgical procedures in the semi-sitting position. Transesophageal echocardiography was performed after induction of anesthesia before surgery to avoid additional physical and psychologic stress for the patients. Thirty-five neurosurgical patients scheduled for elective surgery in the semi-sitting position were examined with help of contrast transesophageal echocardiography. The data of the examined patients were analyzed with respect to efficiency, logistic efforts, and adverse events. Contrast transesophageal echocardiography was combined with a ventilation maneuver to increase right atrial pressure. A patent foramen ovale was detected in 3 of 35 patients. These patients were operated on in a supine position. Oral insertion of the echoprobe was possible in all patients without difficulties. A short-lasting hypertension was observed in 5 patients despite adequate analgesia and sedation. The average time of examination was 25 minutes. None of the patients showed paradoxical air embolism as judged by postoperative neurologic assessment. Contrast transesophageal echocardiography combined with a ventilation maneuver is an effective method in detecting a patent foramen ovale. Moreover, transesophageal echocardiography is a clinical guide to patient positioning. The method of anesthetic management presented to examine anesthetized patients immediately before surgery means less physical and psychologic stress for the patients and causes approximately a 30-minute delay of surgery.

Adult↗
PubMed1994

The recurrence of pain after neurosurgical procedures.

Various reasons exist for the frequent failure of neurosurgical procedures to control pain. Three main classes of factors are involved in this failure--those relating to the surgeon and the surgery, those dependent on the disease, and those dependent on the nervous system itself. In the first class, technical and conceptual difficulties may explain the recurrence of pain after neurosurgery, including our incomplete understanding of the function of recognized pain pathways, the failure of the surgeon to apply known information, and technical limitations in our ability to carry out neurosurgery. Factors dependent upon the disease itself include alterations in the physical extent of the disease, and in the types of pain caused by it. Factors dependent on the nervous system include nerve and tract regeneration, changes in the anatomy of the CNS in response to both the disease and the neurosurgery, and, importantly, somatotopographic reorganization including the opening of alternative pathways.

Humans↗