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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↗
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↗
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↗
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↗
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↗
PubMed2002

Noninvasive carbon dioxide monitoring during neurosurgical procedures in adults: end-tidal versus transcutaneous techniques.

BACKGROUND: We prospectively compared transcutaneous (TC) versus end-tidal (ET) carbon dioxide monitoring during neurosurgical procedures in adults. METHODS: After calibration and an equilibration time for the TC-CO2 monitor, arterial blood gas (ABG) values were obtained as clinically indicated. The PaCO2 values were compared with the values recorded by the noninvasive monitors (TC and ET). RESULTS: The ET-CO2 to PaCO2 difference was 6.1 +/- 5.6 mm Hg, and the TC-CO2 to PaCO2 difference was 3.7 +/- 2.9 mm Hg. The difference between the PaCO2 and ET-CO2 was 3 mm Hg or less in 17 of 57 values, while the difference between the PaCO2 and TC-CO2 was 3 mm Hg or less in 35 of 57 values. Linear regression analysis of ET-CO2 versus PaCO2 revealed a slope of 0.381 +/- 0.007. Linear regression analysis of TC-CO2 versus PaCO2 revealed a slope of 1.17 +/- 0.008. CONCLUSION: Transcutaneous CO2 monitoring provides a more accurate estimate of PaCO2 than ET-CO2 monitoring during neurosurgical procedures.

Adolescent↗
PubMed1998

Intraoperative on-line monitoring of cerebral pH by microdialysis in neurosurgical procedures.

The objective of this study was to improve the ability to detect cerebrovascular complications in patients undergoing complicated neurosurgical procedures using on-line monitoring of cerebral pH with in vivo microdialysis. We employed on-line pH monitoring in patients with a variety of neurosurgical procedures including high-flow bypass surgery, aneurysm clipping, and temporal resection in epilepsy treatment. The pH was monitored with a microdialysis probe, usually inserted into the frontal cortex and pH of the dialysate was measured on-line with a pH electrode. We monitored 17 cases: 12 high-flow extracranial-intracranial (EC-IC) bypass procedures, 3 surgeries to clip large basilar tip aneurysms under protection of hypothermic circulatory arrest, and 2 surgeries for intractable seizure disorders. In the patients undergoing high-flow bypass, the pH remained stable in 5 patients and all had an uneventful outcome. In 3 patients, the pH decreased during surgery. One patient had a severe hemiparesis on awaking from anesthesia. The fall in pH in another patient was corrected when the blood pressure was raised during surgery. The pH was also responsive to changes in intraoperative ventilation and probably also to brain edema with elevation of pH values. In the three patients undergoing basilar tip aneurysm clipping under hypothermic circulatory arrest, the pH fell to 6.41 in one patient. This patient awoke with a mild hemiparesis. In the other two patients, the pH was stable during the hypothermia and neither patient had complications. In the patients undergoing temporal lobectomy and hippocampectomy, the pH fell rapidly with the onset of ischemia. We conclude that it is possible to monitor the cerebral extracellular pH with on-line microdialysis. The information obtained may alert the surgeon to the possibility of impending cerebral ischemia or other complications. However, further experience is needed before the technique can be recommended for general use.

Adult↗
PubMed1992

Severe limitation in mouth opening following transtemporal neurosurgical procedures: diagnosis, treatment, and prevention.

Five new patients and six previously described patients with severe limitation in maximum mouth opening following transtemporal neurosurgical procedures are described. Six patients underwent an operation for epidural hematoma and three for skull-base meningloma; two were treated with a pterional craniotomy for an aneurysm. Limited maximum mouth opening in these circumstances is caused by temporal muscle scarring and shortening. Aggressive physiotherapy is potentially beneficial if started early. If, however, diagnosis is delayed, the efficacy of physiotherapy declines, and surgical treatments such as temporal muscle detachment and coronoidectomy are fully indicated. The differential diagnosis, prevention, and treatment of limited maximum mouth opening following neurosurgical procedures are discussed.

Adult↗
PubMed2002

Waterjet dissection in neurosurgical procedures: clinical results in 35 patients.

OBJECT: Waterjet dissection represents a new minimally traumatic surgical method for dissection that can be used in various parenchymal organs, in which it allows highly precise parenchymal dissection while preserving blood vessels, resulting in reduced intraoperative blood loss. This study was performed to investigate the clinical application of this new technique in neurosurgical procedures, such as brain tumor resection and epilepsy surgery. METHODS: Thirty-four patients with gliomas (Grades II-IV), cerebral metastases, temporal lobe epilepsy, or cerebellar hemangioblastomas, and one patient with internal carotid artery (ICA) stenosis were treated surgically with the aid of the waterjet. Resection was performed using waterjet dissection in combination with conventional neurosurgical procedures. Intraoperatively, the waterjet was easy to handle, and no complications due to the device were observed. Dissection of tissue was possible for all pathological conditions, and pressures between 3 and 45 bars were used. In gliomas, metastases, epilepsy surgery, and hemangioblastoma, the tissue was dissected at pressures between 3 and 17 bars, which preserved blood vessels. Dissection of meningiomas and the ICA stenosis required higher pressures (between 20 and 45 bars); with these pressures, blood vessels were also dissected. CONCLUSIONS: These results indicate that the waterjet dissection procedure can be used intraoperatively without complications. This device appears to be particularly suitable for the dissection of highly vascularized gliomas or normal brain tissue, in which tissue dissection with sparing of blood vessels can be achieved. To prove that this is a useful addition to the neurosurgical armamentarium, reduction of blood loss or postoperative brain edema compared with conventional methods should be demonstrated in future studies.

Adolescent↗
PubMed2003

The use of hypothermia as a method of neuroprotection during neurosurgical procedures and after traumatic brain injury: a survey of clinical practice in Great Britain and Ireland.

Hypothermia has been employed as a method of neuroprotection for many decades. The evidence base for its use is limited, and the balance between benefit and risk is unclear. We felt that in light of this confusion it would be interesting to canvas the opinion of the members of The Neuroanaesthesia Society of Great Britain and Ireland. A questionnaire was sent to all 274 members enquiring into their use of hypothermia during a variety of different neurosurgical procedures and in the management of the head-injured patient. A 75% response rate was achieved. The results showed that over half (58%) of those who replied attempted to cool the patient during cerebral aneurysm surgery. Forty-one per cent of respondents attempt to induce hypothermia in the head-injured patient. However, for other neurosurgical procedures most felt that the disadvantages of cooling the patient outweigh the advantages. The use of hypothermia remains a contentious issue, and as yet there is no clear answer as to whether it should be employed as a method of neuroprotection.

Adult↗