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PubMed1982

Effect of craniotomy on regional brain blood flow and ECF pH changes during isocapnic hypoxia.

Regional cerebrovascular responses to 30 min of isocapnic hypoxia were examined in anesthetized rabbits. In some of the animals, a left-side craniotomy was performed and cortical ECF pH was measured either 1 mm or 2-3 mm below the surface. In the animals with open cranium, the increase in blood flow during hypoxia was greater in the right cortex than in the left cortex. In animals with closed cranium, the increases in blood flow were equal in both right and left crania. ECF pH measured 1 mm below the cortical surface decreased throughout the entire 30 min of exposure, while pH measured 2-3 mm below the surface was increased for the first 6 min, after which it began to decrease. Our results indicate that craniotomy reduces the local vasodilation in response to hypoxia which in turn favors a decrease in local ECF pH.

Animals↗
PubMed1982

Cortical blood flow during craniotomy for aneurysms.

A previously described thermal diffusion flow probe was used to monitor cortical blood flow in over fifty craniotomies for treatment of aneurysms. Hypotension, retractor pressure, vascular manipulation, and temporary vessel occlusion can be seen to affect cortical blood flow. By monitoring cortical blood flow, anesthetic and surgical techniques may be altered to prevent ischemic complications. We have only limited experience with early operation and with craniotomy in the face of vasospasm. Monitoring cortical blood flow may eventually allow operations in these instances to be accomplished more safely.

Aged↗
PubMed1986

Histopathologic and microdensitometric analysis of craniotomy bone flaps preserved between abdominal fat and muscle.

In this study we have investigated the preservation of craniotomy bone flaps within the abdominal wall and the use of such bone flaps for cranioplasty in the early postoperative period. The craniotomy flaps were implanted into a "pocket" between abdominal fat and muscle of adult rabbits, and were later used as autologous grafts in cranioplasty. The flaps were analyzed by histopathologic and microdensitometric methods. In 36 of the flaps, new bone formation near the periosteum was observed. The bone flap-cranium relationship was supplied by a bony tissue. Microdensitometric analysis showed increased optic densities in the experimental group.

Abdominal Muscles↗
PubMed1989

Craniotomy improves outcome in subdural empyema.

Renewed uncertainty regarding the best technique of surgical therapy (burr holes versus craniotomy) for subdural empyema prompted a review of the experience with this disease entity at UCLA. Based on data obtained from this review and from studies previously published in the literature, the keys to optimal outcome are rapid diagnosis, craniotomy with total removal of pus, and appropriate antibiotic therapy. The clinical syndrome of subdural empyema can overlap that of other intracranial infections; infants and young children present with a different syndrome than older children and adults. Computed tomography scanning is nearly always diagnostic but may be equivocal or normal; magnetic resonance imaging may become the diagnostic study of choice. Multiple organisms are often cultured, which requires multiple drug therapy.

Adolescent↗
PubMed1995

Computerized tomography (CT) localized stereotactic craniotomy for excision of a bacterial intracranial aneurysm.

BACKGROUND: The treatment of bacterial intracranial aneurysms include long-term antibiotic therapy and surgical clipping or resection. Direct surgical approaches to these aneurysms are often complicated by their peripheral location. METHODS: We report the use of a computerized tomography (CT) localized stereotactic craniotomy for the excision of a ruptured peripheral bacterial intracranial aneurysm. RESULTS: The Leksell Steiner-Lindquist microsurgical guide, with its fiberoptic helium-neon laser, allowed for rapid isolation of the distal aneurysm with minimal cerebral dissection. Since the inflammatory lesion was well demonstrated on postcontrast CT scan, this modality, rather than angiography, was used for localization. CONCLUSIONS: In the future, stereotactic craniotomy may facilitate aggressive surgical therapy for infectious aneurysms previously thought not suitable for direct operative approach.

Adult↗
PubMed2005

A new stabilizing craniotomy-duratomy technique for single-cell anatomo-electrophysiological exploration of living intact brain networks.

Standard large craniotomies induce undesirable brain motions during intracellular recordings in whole animal preparations. Practically all of the papers available in the literature outline a number of specific methodological approaches designed to avoid this inconvenience. Our study describes a new craniotomy-duratomy, which consists of the maintenance of a thin bone membrane and dura mater surrounding the small hole opened for lowering the recording micropipette. This new surgical preparation avoids brain movements by keeping the brain's volume constant within the cranial cavity and does not require additional technical procedures. It is an all-purpose surgical technique, although it was developed in anaesthetized rats while studying spatio-temporal dynamics of cellular interactions associated with thalamocortical oscillations. It significantly improves both the precision of stereotaxic approaches and the success rate of single-cell recordings (e.g., current-clamp intracellular and paired recordings) compared to standard craniotomy/electrophysiology techniques.

Animals↗
PubMed2004

[Postoperative infection following craniotomy in adults].

OBJECTIVE: The aim of this study was to determine the risk factors for postoperative infection after craniotomy, a threat for the vital prognosis, in order to define specific prevention measures. METHOD AND PATIENTS: An open prospective study was made on all adult patients undergoing craniotomy and followed 30 days postoperatively. The infections were defined according to CDCA criteria. The parameters studied were: age, sex, ASA and Glasgow scores, neurosurgical history, the type, the moment and the surface of shaving, antibioprophylaxis, and the type and duration of surgery as well as its emergency level. RESULTS: One hundred and seventy patients were included. Thirty presented with an infection (17.6%), nine with a skull infection, 13 with meningitis, three with empyema, and two with osteitis. The risk factors identified thanks to a univariate analysis were the emergency level of surgery (P < 0.01), duration of surgery >200 min, and duration of stay in ICU >72 h (P < 0.02).

Abscess↗
PubMed2005

Dexmedetomidine in awake craniotomy: a technical note.

BACKGROUND: Resection of lesions in eloquent areas of the brain are sometimes best done with the patient awake. An awake patient provides neurological feedback as the lesion is resected. This increases the chances of a complete resection without leaving a patient neurologically devastated. Unfortunately, this procedure is not always well tolerated by the patient. METHODS: We performed a case series of awake craniotomies using a dexmedetomidine infusion. RESULTS: All 17 patients included in our study tolerated the procedure well with no major complications. CONCLUSIONS: The addition of dexmedetomidine to our technique improves safety and comfort for patients undergoing awake craniotomy.

Adolescent↗
PubMed2006

Cortical seeding of a craniopharyngioma after craniotomy: Case report.

BACKGROUND: Cortical seeding of a craniopharyngioma has been rarely reported. We present a case that ectopically recurred along the tract of a previous surgical route. METHODS: A 27-year-old woman presented earlier with a suprasellar craniopharyngioma. A left frontotemporal craniotomy was done with subtotal resection of the tumor because it was strongly adhered to the optic chiasm. Histopathology confirmed the diagnosis of craniopharyngioma. Six months after, the patient presented with decreased visual acuity and diplopia. She was reoperated through the previous craniotomy with a total resection. One year after the second surgery, the patient presented with seizures that were difficult to control. Magnetic resonance imaging revealed a contrast-enhancing tumor with cystic and solid components on the left temporal lobe cortex. The primary tumor bed was intact. The patient was reoperated, and the temporal lobe tumor was totally removed. Histologic studies showed an adamantinomatous craniopharyngioma. The patient was free of neurologic abnormalities, and no new lesion was found in the magnetic resonance imaging performed 1 year after the last surgery. CONCLUSIONS: Although craniopharyngiomas exhibit a benign histopathologic pattern, a total resection combined with careful inspection and irrigation of the surgical field is the optimal treatment for preventing local and ectopic recurrences. It is strongly recommended that the concerned patients have a long-term clinical and neuroimaging follow-up.

Adult↗
PubMed1998

Herpes simplex encephalitis and bilateral acute retinal necrosis syndrome after craniotomy.

PURPOSE: Acute retinal necrosis (ARN) syndrome is associated with members of the herpes virus family, but the mechanisms of infection remain unclear. The purpose of this study is to report a unique case of acute retinal necrosis syndrome associated with herpetic encephalitis in order to elucidate possible factors involved in herpetic central nervous system disease. METHOD: Case report. RESULTS: A 64-year-old woman who developed acute herpes simplex virus encephalitis associated with bilateral acute retinal necrosis syndrome after craniotomy for resection of a suprasellar craniopharyngioma is presented. The results of lumbar puncture, magnetic resonance imaging, and ophthalmologic examination are consistent with herpetic infection. The origin of acute retinal necrosis syndrome and the association of acute retinal necrosis syndrome with encephalitis are reviewed. CONCLUSIONS: After craniotomy, we hypothesize reactivation of previously latent herpes simplex virus in the area of the inferior frontal lobe and optic chiasm. Reactivated virus may have migrated to the retina by axonal transport, through the optic nerves, to produce the acute retinal necrosis syndrome.

Acyclovir↗
PubMed2002

Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors.

OBJECTIVE: We describe a combined simultaneous approach to giant pituitary tumors and present a review of 10 patients undergoing this procedure with emphasis on patient selection, surgical technique, and results. METHODS: A retrospective review was performed of patients who had undergone a combined, simultaneous transsphenoidal and pterional craniotomy approach to a giant pituitary adenoma. Visual findings, endocrine presentation, and tumor type were compiled. Tumor stage and grade (Hardy classification) were based on MRI and intraoperative findings. RESULTS: Gross total resection of tumor was achieved in 4 of 10 patients, near total (>90%) in 2 of 10, and subtotal (80-90%) in 4. At the time of follow-up (average, 29.7 months; range, 17-44 months), stereotactic radiosurgery had been performed in 2 patients. Of the 9 patients who presented with visual field loss, all had improvement at 1-month follow-up. At 6 months follow-up, resolution was complete in 5 patients and partial in 4. No patient had worsening of vision. Hypopituitarism persisted in all 5 patients who presented with it preoperatively. CONCLUSION: The combined, simultaneous transsphenoidal and pterional approach described is indicated for a small subset of patients with giant (>3 cm) clinically nonfunctional pituitary tumors who meet the criteria of tumor configuration outlined where the surgeon cannot achieve complete resection by a single approach. We propose adding a new Hardy's scheme subtype, Stage B-a, to describe giant pituitary tumors with a dumbbell configuration. Combining both craniotomy and transsphenoidal approaches may achieve the goal of tumor resection with less need for multiple sequential operations.

Adenoma↗
PubMed2004

Spinal subdural hematoma following craniotomy: case report.

BACKGROUND: Spinal subdural hematomas (SSH) are a rare cause of spinal cord compression. SSH following clipping of an aneurysm has only been reported once. We now report such a case and discuss the mechanism of SSH development after aneurysmal neck clipping. CASE DESCRIPTION: A 32-year-old man complained of lumbago 7 days after craniotomy for the clipping of an aneurysm. Neurologic examination revealed no abnormality, but magnetic resonance imaging (MRI) demonstrated a lumbosacral spinal subdural hematoma. He received conservative management and his lumbago showed improvement. An MRI taken 19 days after surgery revealed a residual hematoma. CONCLUSION: The downward movement of blood from the cranial subdural compartment under the influence of gravity is the most appropriate explanation for SSH following craniotomy.

Adult↗
PubMed1998

Less invasive reconstruction of the temporalis muscle for pterional craniotomy: modified procedures.

BACKGROUND: I developed a modified pterional craniotomy technique which is less invasive for both the facial nerve and the temporalis muscle. METHODS: The keys to this procedure are subfascial dissection and reflection of the temporalis fascia without interfascial dissection, and posterior displacement of the temporalis muscle without muscular incision. The limited exposure from the bulky temporalis muscle can be avoided with this procedure. A small cuff of the fascia-periostium complex is left on a free bone flap along the superior temporal line to facilitate the subsequent muscle closure. RESULT: Since the facial nerve and temporalis muscle are not injured with this procedure, the functional and cosmetic results are satisfactory. CONCLUSION: To reduce functional and cosmetic complications, and the cost of pterional craniotomy, I believe that my procedure is recommended.

Craniotomy↗
PubMed1998

Minimally invasive bedside craniotomy using a self-controlling pre-adjustable mechanical twist drill trephine.

BACKGROUND: Craniotomy with a mechanical twist drill is a standard, minimally invasive procedure in neurosurgery, widely used for the drainage of chronic subdural hematomas and the placement of ventricular drains. Nevertheless, the use of a standard twist drill trephine bears the risk of causing cerebral lesions. METHOD: A commercially available mechanical twist drill system has been modified by a special self-controlling drill and a pre-adjustable distance holder that limits intracerebral penetration. After initial cadaver testing, the modified trephine has been used for 65 trephinations in patients (37 chronic subdural hematomas, 21 external ventricular drains, 6 frontal hygromas, 1 tumor cyst). RESULTS: There were no complications related to the modified trephine; cerebral lesions caused by drilling too deeply or by uncontrolled penetration were safely prevented. In our series no procedure related infections occurred, and the drilling time was reduced significantly. CONCLUSION: The described modified mechanical twist drill enables fast, easy, and safe craniotomy without jeopardizing the advantages of a mechanical twist drill. Therefore, it can be recommended particularly for difficult emergency conditions.

Brain Injuries↗
PubMed1999

Reconstruction of the temporalis muscle for pterional and cranio-orbital craniotomies.

BACKGROUND: Atrophy of the temporalis muscle can result after dissection and reattachment with pterional and cranio-orbital craniotomies. To prevent this sequel, a number of surgical modifications have been used to preserve the deep temporal nerve and artery, and also to allow for reconstruction of the temporalis muscle with minimal damage. In this report another surgical modification for reconstruction of the temporalis muscle is described that can be used in both pterional and cranio-orbital craniotomies. METHODS: The subperiosteum of the temporalis muscle is dissected sharply away from the temporal fossa preserving the deep temporal arteries and nerves. After the intracranial procedure, the bone flap is resecured and attached to the bone, and then several small holes are made along the superior temporal line, to which the temporalis muscle is directly reattached with sutures. RESULTS: We have used the technique described in over 100 cases without related cosmetic or temporalis atrophy. With this technique, muscle tension has been maintained with good stabilization and cosmetic appearance. CONCLUSION: In our technique, the temporalis muscle is anatomically reconstructed to the bone with easy attachment to the superior temporal line. The muscle tension is maintained with good stabilization and cosmetic appearance.

Craniotomy↗
PubMed2000

Craniotomy revisited: techniques for improved access and reconstruction.

OBJECTIVE: To describe simple modifications of the technique of opening and closure of the craniotomy to improve basal exposure and reconstruction. METHODS: The modifications involve: a) additional soft-tissue dissection which is carried downward to the base of the ear and to the orbital rim, exposing the orbital rim and malar eminence without removing the bone; b) cutting the bone flap so that 'bridges' of bone remain that help to stabilize the flap when it is returned to the cranium at the end of the operation; c) the wedging of bone chips between the bone flap and native cranium at the time the bone is being reaffixed so as to provide firm stability by diminishing movement of the bone flap; d) the use of bone dust and bone chips mixed with the patient's blood to seal and bridge the gap between the bone flap and the native bone; e) reattachment of the temporalis muscle with the bone flap sutures. An 'inlay' technique of duraplasty is also described. RESULTS AND CONCLUSION: These simple modifications of craniotomy provide better basal exposure and reconstruction with little additional operating time at no additional cost.

Craniotomy↗
PubMed2002

Malignant fibrous histiocytoma originating at the site of a previous fronto-temporal craniotomy.

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. MFH occurrence in the bones of the skull is extremely rare, and, to our knowledge, it has not been reported in a patient with a history of craniotomy. A 69 year old woman presented with a large mass in the left fronto-temporal bone. The patient's medical history included a left fronto-temporal craniotomy 8 years prior to the present admission for neck clipping of an aneurysm of the left middle cerebral artery. Following preoperative work up, the skull tumor was resected, and pathology showed that the mass was composed of spindle-shaped fibroblastic cells arranged in a storiform pattern, and of numerous multinucleated giant cells. A diagnosis of MFH was established. The patient died of intracranial hemorrhage from a subsequent tumor 22 months after resection of the first tumor.

Aged↗