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At least 217 records · Page 12Linked to original sources

PubMed1981

[Postoperative epidural hematoma - five case of epidural hematomas developed after supratentorial craniotomy on the contralateral side (author's transl)].

Postoperative epidural hematomas developed far from the operative field are generally recognized as a complication of ventriculo-peritoneal shunt, ventricular drainage or suboccipital craniotomy. It is very rare but may occur after supratentorial craniotomy on the contralateral side. Five such cases are presented with a review of the relevant literature. The mechanism of this complication is not clearly understood. In hydrocephalus, these massive epidural hematomas are probably caused by dura-skull detachment when the brain volume is strikingly reduced by a decompressive procedure. On rare occasions, pins of head rest may detach the dura and cause epidural hematomas. When sudden brain swelling during craniotomy is encountered, attention should be directed not only to intracerebral hemorrhage but also epidural hematoma developed on the contralateral side.

Adult↗

PubMed1993

Cerebral arterial diameters during changes in blood pressure and carbon dioxide during craniotomy.

Forty-five measurements of diameters of 12 human cerebral arteries were performed during 10 craniotomies under moderate changes in mean blood pressure and end tidal CO2. The mean change in blood pressure was 30 +/- 16 mm Hg (standard deviation) and that of end tidal CO2 was 14 +/- 6 mm Hg (standard deviation). These changes were induced with nitroprusside, phenylephrine, and adjustment of ventilator rate. Measurements were made through the operating microscope focused at the highest power, with meticulous attention to constant angle and distance from the artery. The mean diameter change in the large cerebral arteries (carotid, middle cerebral artery, vertebral artery) was less than 4%, but the smaller arteries (anterior cerebral artery, M2 segment of middle cerebral artery) showed diameter changes as large as 29% and 21% to end tidal CO2 and blood pressure changes, respectively. These data suggest that at the time of craniotomy, diameters of the large cerebral vessels do not significantly change during moderate variations in blood pressure and CO2, but that larger changes may occur in smaller vessels. This constancy of diameter suggests that the transcranial Doppler velocities obtained during intraoperative monitoring of craniotomies may closely reflect blood flow through the insonated artery.

Aneurysm, Ruptured↗

PubMed1989

Transcranial Doppler monitoring of cerebral blood velocity during craniotomy.

Transcranial Doppler techniques were used to monitor blood velocity in cerebral arteries continuously during 14 neurosurgical operations performed on 13 patients, including 12 craniotomies. Stable Doppler signals were obtained for prolonged periods of time, and they correlated with intraoperative events. Monitoring during spontaneous blood pressure and CO2 variations allowed assessment of autoregulatory capacity. In particular, 5 of the 7 patients receiving craniotomy for aneurysmal subarachnoid hemorrhage had impaired autoregulation. A 30 to 50% decrease in Doppler velocities was seen in 7 patients after etomidate administration. Early experience suggests that transcranial Doppler monitoring during craniotomy is feasible and can indicate the effects of operative events on blood flow as well as provide an assessment of cerebral autoregulation.

Adult↗

PubMed1990

Changes in serum CPK, LDH, and their isoenzymes in the perioperative period in patients undergoing craniotomy.

The perioperative changes in the serum concentration of creatine phosphokinase (CPK) and its isoenzymes MM, MB, and BB and of lactic dehydrogenase (LDH) and its isoenzymes LDH1 to LDH5 were determined during craniotomy in order to distinguish operation-induced changes in these enzymes from those due to acute myocardial infarction and malignant hyperthermia. Twenty-eight male patients, 29 to 76 years of age (mean +/- SD = 58 +/- 13.2 years), undergoing craniotomy for tumor reseaction (n = 26) or cerebral artery aneurysm clipping (n = 2) were included in this study. Ten serial blood samples were obtained from each patient: one sample before and another after induction of anesthesia, and eight samples after the incision, over a period of 70 h. The preinduction serum CPK level of 97 +/- 32 U/L (mean +/- SD) increased gradually and significantly and reached the peak level of 542 +/- 116 U/L 34 h after incision (p <0.05). Whereas all of the CPK isoenzymes increased in terms of U/L after incision, only the MM fraction (expressed as percent of total CPK) increased, and the MB and BB fractions (expressed as percent of total CPK) decreased. The preinduction serum LDH level of 150 +/- 42 U/L (mean +/- SD) increased gradually after incision and reached the peak level of 210 +/- 32 U/L 58 h after incision (p <0.05). LDH2 as a percent of total LDH decreased significantly, but the LDH1/LDH2 ratio did not change. LDH4 and LDH5, as percents of total LDH, increased significantly. The large increases in total serum CPK and the concomitant decrease in MB percent after craniotomy may minimize and/or mask the percentage increase in the MB level following acute myocardial infarction. The perioperative serum CPK level as a marker in the diagnosis of malignant hyperthermia should be interpreted in light of the present results and in conjunction with clinical symptomatology.

Journal Article↗

PubMed1989

Postoperative subarachnoid hemorrhage from an intracranial aneurysm after craniotomy for astrocytoma--case report.

The authors present the first reported case of a glioma associated with a right posterior cerebral artery (PCA) aneurysm. A 37-year-old male underwent craniotomy and total removal of the glioma, which appeared, according to encephalographic findings, to be responsible for the initial symptom of loss of consciousness. The risk of craniotomy-induced bleeding from the aneurysm was thought to be low, since it was unruptured and was packed with coagulum. However, subarachnoid hemorrhage due to rupture of the PCA aneurysm occurred just after craniotomy, and clipping was performed 15 days after the first operation.

Adult↗

PubMed1996

Modified petrosal approach using cosmetic osteoplastic craniotomy with NEURO-SAT guidance.

The petrosal approach has become a routine procedure for petroclival lesions, but there are some disadvantages such as the time-consuming craniotomy during surgery and depressed deformity of the mastoid area after surgery. To solve these disadvantages, we modified the petrosal approach. Before surgery, the three-dimensional points of the sigmoid sinus and semicircular canals are calculated on computed tomography scan and are input to a computer. A single temporooccipital bone flap is made, and the outer table of bone overlying the mastoid is preserved by forming a narrow groove with a small air drill and cutting the outer table with a chisel. After removing these two free bone flaps, mastoidectomy is performed guided by NEURO-SAT (neuronavigation by computer-assisted frameless stereotaxy). The mastoid bone can be drilled out safely and quickly. The two bone flaps are connected and replaced at the end of the procedure. Osteoplastic petrosal craniotomy guided by NEURO-SAT can achieve a quick craniotomy and satisfactory cosmetic result.

Abducens Nerve↗

PubMed1989

Stereotactic craniotomy: methods and results using the Brown-Roberts-Wells stereotactic frame.

Combining the power of stereotactic precision with open craniotomy in a stereotactic craniotomy technique decreases surgical time, morbidity, and postoperative hospitalization. Indications for its use are deep intrinsic masses 3.5 cm or less in diameter; small, superficial lesions otherwise difficult to localize; and lesions associated with motor, visual, or speech areas. Using the standard Brown-Roberts-Wells system allows a) precisely planned cortical entries, b) gross total lesion excisions under direct vision, c) use of probe-guided resection margins, d) small craniotomies through linear incisions, and e) use of local anesthetic alone for resections. The method and results of this universally available and relatively inexpensive technique are discussed in reference to 20 patients.

Adolescent↗

PubMed1989

An evaluation of two configurations of tricalcium phosphate for treating craniotomies.

Biodegradable beta-tricalcium phosphate disks (TCP) of two configurations were inserted into 15-mm-diameter craniotomy wounds and nontreated control sites were evaluated in 60 rabbits. There were no adverse tissue reactions and no apparent difference in the clinical appearance of the 12- and 24-week implanted disks. By 36 weeks and continuing to 48 weeks, the omnidirectional TCP (OTCP) implants were degrading more rapidly than the unidirectional TCP (UTCP) implants, with degradation progressing centripetally and replacement by woven bone and maturing lamellar bone. Host-implant interface of both TCP configurations was a bone bond without interposed soft tissue. TCP disks may be clinically useful for craniotomy repair.

Animals↗

PubMed1998

Subdural monitoring of ICP during craniotomy: thresholds of cerebral swelling/herniation.

It is possible to define thresholds for cerebral swelling or herniation during craniotomy. In 178 patients subjected to craniotomy for space occupying processes subdural ICP was measured before opening of dura. The subdural ICP was correlated to the degree of cerebral swelling or herniation after opening of dura. At subdural ICP < 7 mm Hg cerebral swelling/herniation after opening of dura rarely occurs, while at ICP > or = 10 mm Hg cerebral swelling/herniation occurs with high probability. These ICP thresholds are independent of the pathophysiology (SAH, cerebral tumor), the anaesthetic agent (isoflurane, propofol) and the PaCO2 level (< or = 4.0 kPa, > 4.0 kPa). Generally, a good correlation between the tactile estimation of dural tension and the tendency to cerebral swelling or herniation after opening of dura was found. However, in 8.5% the surgeons were unable to predict swelling/herniation.

Anesthesia, General↗

PubMed1994

Magnetic field guided endoscopic dissection through a burr hole may avoid more invasive craniotomies. A preliminary report.

The neuroendoscope, coupled with radiofrequency or laser dissecting tools, can effectively resect obstructing membranes, biopsy and debulk tumor, and evacuate hematomas when the pathology is within the ventricular system. This less invasive approach through a burr hole usually avoids craniotomies. When the abnormal condition is within parenchyma or in the presence of opacifying bloody fluid, landmarks are not recognizable and the neurosurgeon quickly becomes disoriented. A more extensive craniotomy or a stereotaxic-guided procedure is then necessary. We describe our preliminary experience with a geographic intracranial navigation system using realtime measurement of electromagnetic field strength in multiple planes to precisely indicate the position of the tip of the endoscope. A transmitting antenna is positioned beneath the patient's head. A 1.5 centimeter cubic antenna receiver is mounted upon a lenscope with instrument channel. The scope is guided into the surgical field after insertion through a burr hole. A square wave pulsed electromagnetic field measurement is made 140 times per second with correction for the earth's magnetic field once per second. Intracranial position data for the dissecting tip in regard to X, Y, Z, pitch, roll and yaw are output to a digitized computer map of the patient's MRI or CT scan. Also displayed on the computer screen is the video image from the endoscope. The neurosurgeon thus has simultaneous realtime geographic and near-field localization as he dissects. Electromagnetic field guided accuracy is within 2.0 mm inside the allowable 24 inch working sphere about the patient's head. Coupled with near-field video precision, accuracy is within 1 mm of recognizable dissection planes.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Diseases↗

PubMed1985

Mean hemispheral cerebral blood flow changes after craniotomy. Significance and prognostic value.

The effects of craniotomy on cerebral haemodynamics remains controversial from a study of the literature. This report represents our experience with respect to CBF changes within 10 days of surgery. Our objective was twofold, first to study the effect of craniotomy on the cerebral circulation and second to determine whether the CBF pattern at different post-operative intervals could provide useful prognostic information. A total of 135 CBF measurements were performed at the bedside of 36 patients; 19 patients with an assortment of intracranial tumours and 17 patients with intracranial aneurysm in different clinical grades. Our results indicate a significant rise in CBF in the immediate post-operative period averaging 18% of the pre-operative value. We believe this reflects a normal reaction of the cerebral vasculature to the inevitable disturbance of surgery. Furthermore, this hyperaemia may be of prognostic value as it was observed in 85% of the patients with tumour discharged without post-operative deficit and in 80% of the patients with aneurysms discharged in clinical grade 1 or 2. This is in sharp contrast with its development in only 16% of the patients with tumour discharged with post-operative deficit and 16% of the patients with aneurysm discharged in grade 3 or 4. The study adds to the direct clinical utility of CBF determination as a prognostic tool.

Adolescent↗

PubMed1993

Comparison of fentanyl, sufentanil and alfentanil during awake craniotomy for epilepsy.

Neurolept anaesthesia is used during awake craniotomy for epilepsy surgery. This study compares analgesia, sedation and the side effects of the newer opioids sufentanil and alfentanil, with those of fentanyl in patients undergoing awake craniotomy. Thirty patients were randomized into three groups, each received droperidol, dimenhydrinate and the chosen opioid as a bolus followed by an infusion. The opioid doses used were fentanyl 0.75 microgram.kg-1 plus 0.01 microgram.kg-1 x min-1; sufentanil 0.075 microgram.kg-1 plus 0.0015 microgram.kg-1 x min-1, and alfentanil 7.5 micrograms.kg-1 plus 0.5 microgram.kg-1 x min-1. There were no differences in the requirements for droperidol, dimenhydrinate or in the incidence of complications among the three groups. The total doses of the opioids required were fentanyl 4.9 +/- 1.3 micrograms.kg-1, sufentanil 0.6 +/- 0.2 microgram.kg-1 and alfentanil 149 +/- 36 micrograms.kg-1. Two patients became uncooperative requiring general anesthesia. The conditions for surgery, electrocorticography and for stimulation testing were satisfactory in all other patients. We conclude that the newer opioids did not offer any benefit over fentanyl.

Adult↗

PubMed1988

Conscious-sedation analgesia during craniotomy for intractable epilepsy: a review of 354 consecutive cases.

The perioperative records of 354 consecutive patients undergoing craniotomy for surgical treatment of intractable epilepsy performed with conscious-sedation analgesia were reviewed retrospectively. There was no perioperative morbidity or mortality identified which could be attributed to the anaesthetic technique. The technique was not suitable for seven patients, in whom general anaesthesia was induced. The most frequent intraoperative problems were convulsions (16 per cent) and nausea and vomiting (eight per cent). Less frequent problems included excessive sedation (three per cent), "tight brain" (1.4 per cent) and local anaesthetic toxicity (two per cent). This study confirms that conscious-sedation analgesia provides suitable conditions for craniotomies when brain mapping is required.

Adolescent↗

PubMedDate not supplied

Craniotomy for suprasellar meningioma in a 28-week pregnant woman without fetal heart rate monitoring.

PURPOSE: To illustrate the anesthetic management of a craniotomy for suprasellar meningioma in a 28-week pregnant woman and to review the considerations for fetal monitoring during surgery. CLINICAL FEATURES: A 33-yr-old woman presented at 28 weeks of gestation with rapidly deteriorating vision in her right eye. Neuroradiological investigations revealed a large suprasellar meningioma extending into the frontal lobe. She underwent a craniotomy for excision of the tumour at 28 weeks gestation because of the risk of irreversible blindness. Anesthetic management was tailored for pregnancy and an intracranial tumour. Intraoperative blood pressure was maintained within 10% of baseline and respiratory variables were stable. No fetal heart rate monitoring was used during the surgery, as there was no plan to perform an emergency Cesarean delivery even in the event of change in fetal monitoring. The aim was to treat the mother aggressively for any untoward events. She made a good neurological recovery after the procedure and had a spontaneous vaginal delivery at 40 weeks of gestation without any neonatal complications. CONCLUSIONS: Anesthetic management of a brain tumour during pregnancy should be tailored to the individual patient according to the circumstances. It is possible to perform this type of procedure without fetal heart rate monitoring. The decision regarding fetal monitoring should be based on the consensus of the multidisciplinary care team and the mother.

Adult↗

PubMed2003

Remifentanil with morphine transitional analgesia shortens neurological recovery compared to fentanyl for supratentorial craniotomy.

PURPOSE: To compare the recovery profiles, efficacy and safety of remifentanil and morphine for transitional analgesia with fentanyl in patients undergoing elective craniotomy for supratentorial mass lesions. METHODS: Ninety-one patients were enrolled in this prospective, randomized, multicentre study. Anesthesia was induced with thiopental and remifentanil (1.0 micro g x kg(-1) bolus and a 1 micro g x kg(-1) x min(-1) infusion) or fentanyl (1 micro g x kg(-1) bolus and a 1.0 micro g x kg(-1) x min(-1) infusion). The opioid infusion continued until the level of anesthesia was deemed appropriate for intubation. Anesthesia was maintained with N(2)O/O(2), isoflurane 0.5 MAC and remifentanil 0.2 micro g x kg(-1) x min(-1) or fentanyl 0.04 micro g x kg(-1) x min(-1). At bone flap replacement, either morphine 0.08 mg x kg(-1) (remifentanil group) or saline (fentanyl group) was given. RESULTS: Systolic blood pressure was greater in those receiving fentanyl during induction (145.6 +/-17.5 mmHg vs 128.8 +/-18.3 mmHg; P = 0.006) and intubation (126.9 +/-17.1 vs 110.9 +/-16.5 mmHg; P < 0.001). Median time to tracheal extubation was similar but less variable in the remifentanil group (remifentanil = 8 min: range = 2-44 min; fentanyl = 8 min: range = 1-732 min). The fentanyl patients required a longer time to achieve the first normal neurological score (fentanyl = 38.0 min; remifentanil = 26.0 min; P = 0.035). Both the anesthesiologists and the recovery room nurses rated remifentanil better with respect to level of consciousness. Analgesics were required earlier in patients receiving remifentanil; median time 0.5 vs 1.08 hr, P < 0.001. CONCLUSIONS: Remifentanil is a suitable alternative to fentanyl in supratentorial craniotomy. Time to preoperative neurological recovery is faster and morphine provides some transitional analgesia without compromising the quality of recovery.

Adult↗

PubMed2005

Two cases of hyperkalemia after administration of hypertonic mannitol during craniotomy.

Mannitol is used commonly as an osmotic diuretic to reduce intracranial pressure during the perioperative period of craniotomy. The rapid administration of mannitol solution can cause an imbalance of electrolytes such as sodium and potassium. Here, we report two cases of mannitol-induced hyperkalemia. We demonstrate that administration of mannitol during craniotomy increases potassium iron concentration, and in some cases it may cause disturbance of cardiac function.

Adult↗

PubMed2005

Craniotomy during ECMO in a severely traumatized patient.

Extracorporeal membrane oxygenation (ECMO) can be a last resort treatment in acute respiratory distress syndrome after thoracic trauma. However, co-existent brain trauma is considered to be a contra-indication for ECMO. This is the first report on successful craniotomy under ECMO treatment in a multiply traumatized patient with severe thoracic and brain injuries. This successful treatment with beneficial neurological outcome suggests that ECMO therapy should not be withheld from severely injured patients with combined brain and thoracic trauma presenting with life-threatening hypoxemia. Moreover, even craniotomy may be performed during ECMO therapy without major bleeding and adverse effects on neurological function.

Accidental Falls↗

PubMed2006

Development and rapid growth of a desmoid tumor in the surgical corridor after suboccipital craniotomy for recurrent low-grade astrocytoma.

Desmoid tumors are histologically benign but locally invasive tumors that can occur in the head and neck. We present the rare case of a desmoid tumor that occurred in the surgical corridor after suboccipital craniotomy for recurrent low-grade astrocytoma. A 30-year-old woman underwent a repeat suboccipital craniotomy for recurrent low-grade astrocytoma. A gross total resection was achieved. Nine months later, a firm, palpable mass was noted near the surgical scar. No new neurologic deficits were noted on exam. A magnetic resonance imaging scan demonstrated a homogeneously enhancing lesion superficial to the dural graft. Surgical resection of the lesion was performed through the original midline incision. The mass was resected en bloc. Histology demonstrated clear surgical margins and a tumor of low cellularity consistent with a desmoid tumor. Desmoid tumors should be considered in the differential diagnosis for superficial masses occurring in the surgical bed after posterior cervical surgery.

Adult↗