Background: The eyebrow supraorbital keyhole approach could be considered a modified minimally invasive model for the classic pterional subfrontal approach in which an eyebrow incision and supraorbital mini craniotomy...Background: The eyebrow supraorbital keyhole approach could be considered a modified minimally invasive model for the classic pterional subfrontal approach in which an eyebrow incision and supraorbital mini craniotomy are performed for exposure of the anterior cranial fossa corridor. Methods: This study was retrospectively conducted on twenty four patients, age ranging from 20 to 65 years old, with anterior cranial fossa lesions who were meeting the eligibility criteria for eyebrow craniotomy in the period from August 2019 to January 2023. These patients were operated through eyebrow supraorbital approach in which microscopic endoscopic assisted technique were used. Extent of resection, clinical and cosmetic outcomes and complication incidence were assessed. Results: We included the twenty four patients who met inclusion criteria (17 females and 7 males) their ages ranged from 20 to 65 years. The most common pathology was meningioma in 19 patients. Two patients experienced supraorbital loss of sensation and only one patient experienced palsy of frontalis branch of facial nerve. Frontal sinus was breached in 3 patients with no patient experienced postoperative CSF leak. Total excision was accomplished for 23 patients. Four patients who had preoperative visual compromise, improvement of visual acuity and field defects was observed in 3 patients. No major intraoperative complications occurred. All patients filled cosmetic satisfaction questionnaire during their outpatient visits. For the eyebrow supraorbital approach, no incision related intolerable pain, no craniotomy defects or irregularities, no cosmetic complaints nor limitation of jaw opening were reported, and only minor symptoms in the form of limited eyebrow elevation, swelling and numbness in the forehead. Conclusions: The eyebrow craniotomy could be used safely as a more cosmetic and minimally invasive approach for a variety of anterior cranial fossa lesions. Endoscopic assistance has been found very useful for deeply seated lesions and hidden residuals with minimal brain retraction which couldn’t be accessed easily through microscopic field solely. Endoscopic assisted eyebrow supraorbital keyhole approach could be performed on a wider scale with great results but requires good selection of cases and more practice to expertise the needed skills.展开更多
BACKGROUND Deep vein thrombosis(DVT)of the lower extremity is one of the most common postoperative complications,especially after craniocerebral surgery.DVT may lead to pulmonary embolism,which has a devastating impac...BACKGROUND Deep vein thrombosis(DVT)of the lower extremity is one of the most common postoperative complications,especially after craniocerebral surgery.DVT may lead to pulmonary embolism,which has a devastating impact on patient prognosis.This study aimed to investigate the incidence and risk factors of DVT in the lower limbs following craniocerebral surgery.AIM To identify independent risk factors for the development of postoperative DVT and to develop an effective risk prediction model.METHODS The demographic and clinical data of 283 patients who underwent craniocerebral surgery between December 2021 and December 2022 were retrospectively analyzed.The independent risk factors for lower extremity DVT were identified by univariate and multivariate analyses.A nomogram was created to predict the likelihood of lower extremity DVT in patients who had undergone craniocerebral surgery.The efficacy of the prediction model was determined by receiver operating characteristic curve using the probability of lower extremity DVT for each sample.RESULTS Among all patients included in the analysis,47.7%developed lower extremity DVT following craniocerebral surgery.The risk of postoperative DVT was higher in those with a longer operative time,and patients with intraoperative intermittent pneumatic compression were less likely to develop postoperative DVT.CONCLUSION The incidence of lower extremity DVT following craniocerebral surgery is significant,highlighting the importance of identifying independent risk factors.Interventions such as the use of intermittent pneumatic compression during surgery may prevent the formation of postoperative DVT.展开更多
Introduction: The incidence of acute pain after craniotomy differs remarkably in previous studies, and the prevalence of persistent pain is not precisely known. We conducted 6-month follow-up surveys on the incidence ...Introduction: The incidence of acute pain after craniotomy differs remarkably in previous studies, and the prevalence of persistent pain is not precisely known. We conducted 6-month follow-up surveys on the incidence and intensity of acute and persistent pain after elective craniotomy. Methods: We carried out a prospective cohort study via a series of structured questionnaires to record acute pain intensity preoperatively and postoperatively, and the incidence of persistent pain 3 and 6 months after a craniotomy in a tertiary care center. Patients scheduled for elective craniotomy were interviewed the day before surgery, postoperatively before discharge from the hospital, and 3 and 6 months after surgery. Pain was assessed on a numeric rating scale (0 - 10) at rest and movement, as well as expectations of pain before surgery, efficacy of pain therapy, and satisfaction with pain treatment. The incidence of adverse events, sleep time and interruptions caused by pain, different pain types, and drugs used for pain treatment were also recorded. Results: A total of 152 patients were enrolled in the study and completed the preoperative questionnaire;123 (81%) completed postoperative questionnaire and 108 (72%) completed the 3- and 6-month follow-ups. The average pain score at the time of the postoperative questionnaire was moderate, 4 at rest and 5 upon movement. The percentage of patients experiencing mild pain at rest and upon movement was 52% and 49%, and moderate pain was 15% and 16%, respectively. Severe postoperative pain was detected in 5% and 8% of patients at rest and upon movement, respectively. Three months after surgery, 6% of patients reported mild pain at rest, 3% moderate pain at rest, and 1% severe pain at rest. Persistent mild and moderate pain at rest after 6 months was reported by 3% and 1% of patients, respectively. The most common adverse events were postoperative nausea and vomiting (11%) and abdominal discomfort (8%). During postoperative pain treatment in the intensive care unit or post-anesthesia care unit, 92% of patients received acetaminophen, 88% fentanyl, and 24% oxycodone. During neurosurgical ward care, ibuprofen was used in 61% of patients. Satisfaction with analgesia was high throughout the study period with a median satisfaction score of 9 postoperatively and 10 at 3 and 6 months on the 0 - 10 scale. Conclusion: The findings indicate that most patients experience moderate or mild pain after craniotomy, but patient satisfaction with pain treatment is high. Persistent pain after 3 and 6 months is rare and mild in nature.展开更多
Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divid...Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.展开更多
Introduction: Brain abscess represents 8% of intracranial masses in developing countries. Despite the advances in neuro-imaging, still, the diagnosis of brain abscess is difficult and may need a biopsy in most cases t...Introduction: Brain abscess represents 8% of intracranial masses in developing countries. Despite the advances in neuro-imaging, still, the diagnosis of brain abscess is difficult and may need a biopsy in most cases to verify the diagnosis because may even lead to death. CT scan with contrast is a good tool for diagnosing and localizing brain abscesses in late stages, however, it is difficult to diagnose them in the early stages. The development of MRI helps to more accurately diagnose brain abscess. Surgical management of brain abscesses is either medical or surgical through craniotomy or burr holes. Indications of each are still a point of debate among most neurosurgeons. Methodology: This is a descriptive longitudinal prospective study to compare the outcomes of two surgical procedures used in The National Centre for Neurological Sciences-Khartoum-Sudan (NCNS) from 2012 to 2015, craniotomy and excision of the abscess membrane versus burr hole and aspiration of brain abscess in terms of duration of hospitalization, length of antibiotic use, recurrence rate, number of images needed for follow-up, and the final postoperative early and late outcomes. The data was collected through a designed questionnaire and was then analyzed using SPSS version 20. No significant ethical approval was required for this study. Results: Fifty-four patients were operated on through craniotomy (29/54) and burr hole (25/54). Their ages ranged from 1 year to 53 years with an average presentation at 13 years of age. Most patients presented with fever (23.1%), convulsions (16%), vomiting (16.7%) and headache (15.4%). The mean of illness for both groups was almost 2 months. The majority of patients in this study were having no risk factors (38.9%) while the major risk factors seen were cardiac diseases (14.8%), neurosurgical procedures (13%) and otitis media (11.1%). As most patients presented late, the diagnosis of most was made using CT brain with contrast (83.3%). In most of the patients (85.2%) there were no organisms separated in the culture. 8/54 patients had positive cultures, 7/8 were bacterial and only one (1/8) was fungal. Most patients received antibiotics for 45 days postoperatively in both craniotomy and burr hole groups. When both groups were compared, those operated with craniotomy were found to have a relatively higher length of hospital stay, however, no significant difference was found between both groups. Also, it was found that those operated on with craniotomy had a high cure rate and less recurrence in comparison with burr hole group. Deterioration and death were significantly higher among craniotomy group. Only CT brain was used as the imaging modality of choice for follow-up in both groups for 4 months’ duration and it was noted that complete evacuation was significantly higher among craniotomy group while remnants were higher among burr hole group. Conclusion: Brain abscess is still a challenging condition for neurosurgeons in Sudan. The limited number of Sudanese neurosurgeons, neurosurgical centers and diagnostic facilities contributed to delay in diagnosing brain abscess in most patients. It is important to design a strict protocol and precautions for any neurosurgical operation or bedside procedure to prevent infection and subsequent brain abscess development. CT brain with contrast is a good imaging tool for assessing the size, site and stage of brain abscesses. No significant difference between craniotomy or burr hole for clearance from brain abscess in terms of antibiotic used or duration of hospital stay. However, burr hole aspiration is associated with higher rates of recurrences. On the other hand, craniotomy and excision have relatively higher neurologic morbidity postoperative with expectantly higher post-operative hospitalization but no differences in the final outcome. Therefore, the selection of surgical technique should be individualized in each case based on the abscess site size source patient fitness for surgery and neurosurgeon’s preference.展开更多
BACKGROUND The auditory brainstem implant(ABI)is a significant treatment to restore hearing sensations for neurofibromatosis type 2(NF2)patients.However,there is no ideal method in assisting the placement of ABIs.In t...BACKGROUND The auditory brainstem implant(ABI)is a significant treatment to restore hearing sensations for neurofibromatosis type 2(NF2)patients.However,there is no ideal method in assisting the placement of ABIs.In this case series,intraoperative cochlear nucleus mapping was performed in awake craniotomy to help guide the placement of the electrode array.CASE SUMMARY We applied the asleep-awake-asleep technique for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuroma resections and ABIs,using mechanical ventilation with a laryngeal mask during the asleep phases,utilizing a ropivacaine-based regional anesthesia,and sevoflurane combined with propofol/remifentanil as the sedative/analgesic agents in four NF2 patients.ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients.There was one uncooperative patient whose awake hearing test needed to be aborted.In all cases,tumor resection and ABI were performed safely.Satisfactory electrode effectiveness was achieved in awake ABI placement.CONCLUSION This case series suggests that awake craniotomy with an intraoperative hearing test for ABI placement is safe and well tolerated.Awake craniotomy is beneficial for improving the accuracy of ABI electrode placement and meanwhile reduces non-auditory side effects.展开更多
Background: Acute subdural hematoma (ASDH) is considered the most common traumatic brain mass lesion. Its prognosis is still grave despite the improvements in treatment modalities. Its mortality rate was reported to b...Background: Acute subdural hematoma (ASDH) is considered the most common traumatic brain mass lesion. Its prognosis is still grave despite the improvements in treatment modalities. Its mortality rate was reported to be around 60% until the 1990s. In the last decade, ASDH mortality rate was reduced to the level of 20% - 40%. Standard treatment to decrease intracranial tension via hematoma evacuation is associated with decompressive craniotomy and followed by ICU management. Objective: To evaluate the outcome and prognostic factors in patients of acute subdural hematoma treated by surgical evacuation and decompressive craniotomy. Also, outcome of cranioplasty by repositioning of patients own bone or by synthetic mesh methods is evaluated. Patients and Methods: It is one year retrospective study. It was conducted on 53 patients, in trauma unit, Assiut university hospitals. We report time lag between trauma and performed surgery, initial Glasgow coma scale (GCS), age, sex and presence of other intracranial pathologies. Outcome assessment is based on Glasgow outcome scale (GOS) and fol-low-up extended for 6 months. We include those patients with only (isolated) head trauma, shift of midline more than 5 mm in CT brain. We excluded pa-tients with GCS 3 and fixed dilated pupils as well as patients with GCS higher than 12. We did decompressive craniotomy and duraplasty in all patients. Bone flap of decompressive craniotomy is situated in the abdomen. All func-tionally recovered patients were submitted for cranioplasty with either re-placing patient own bone or by Titanium mesh. Results: We had 39 males and 14 females. Age ranged between 7 and 65 years old. 23 deaths, 10 persis-tent vegetative state, 10 severe disability, 8 moderate disability and 2 good recovery. The outcome analysis was based on 6 month follow-up. Conclu-sion: Acute subdural hematoma is a very serious condition. Mortality and morbidity is intimately related to GCS on admission. Presence of associated cerebral pathology increases mortality and morbidity of patients with post-traumatic acute subdural hematoma. Early evacuation of posttraumatic acute subdural hematoma with decompressive craniotomy is an important method to control raised intracranial tension, reduce shift of midline and very benefi-cial in decreasing mortality and morbidity. Regarding infection and avoiding bone flap resorption, Titanium mesh is better than patient own bone during cranioplasty after patient recovery.展开更多
BACKGROUND Eisenmenger syndrome(ES)is an uncorrected congenital cardiac defect with a left-to-right shunt,leading to pulmonary arterial hypertension.Patients with ES are susceptible to hemodynamic alterations during n...BACKGROUND Eisenmenger syndrome(ES)is an uncorrected congenital cardiac defect with a left-to-right shunt,leading to pulmonary arterial hypertension.Patients with ES are susceptible to hemodynamic alterations during noncardiac surgery with general anesthesia,which increases perioperative morbidity and mortality.Monitored anesthesia care(MAC)is often used during minor procedures in patients with cardiac disease.However,few reports on MAC in patients with ES exist.CASE SUMMARY A 49-year-old man was admitted for a severe headache lasting 30 d.He had been diagnosed with a large perimembranous ventricular septal defect(VSD)with bidirectional shunt flow and pulmonary arterial hypertension 10 years ago.A round mass in the right frontal lobe was revealed by Magnetic resonance imaging.Stereotactic aspiration using a neuronavigation system was performed under MAC.The patient was stayed in the hospital for 5 d,and discharged without complications.CONCLUSION MAC may be effective for craniotomy in patients with ES.展开更多
Background: Park-bench position is a commonly used position in patients operated with cerebellopontine tumor, microvascular decompression, or lesions of cerebellar hemisphere and vertebral artery. Several complication...Background: Park-bench position is a commonly used position in patients operated with cerebellopontine tumor, microvascular decompression, or lesions of cerebellar hemisphere and vertebral artery. Several complications associated with this positioning have been described. However, the delayed airway complication resulting from park-bench position has been rarely reported in the literatures. Herein, we report a rare case of delayed airway obstruction after a posterior-fossa craniotomy with park-bench position for acoustic neuroma. Case presentation: A 43-year-old woman, who has a right acoustic neuroma, was placed in the park-bench position for a posterior-fossa craniotomy. The anesthesia and operation were performed smoothly. However, progressive swelling in the left neck with extending to left face occurred two hours after endo-tracheal extubation. Computed tomographic scan of neck revealed diffuse swelling of the muscles and deep soft tissue in the left side. No obvious embolization of vascular system including jugular vein was found in the sonography. Because of obstruction in upper airway, orotracheal intubation and a head-up position were performed. The clinical symptoms improved gradually since the third post-operative day. She was discharged with obvious complications on the 23rd day after the operation. Conclusion: The possible mechanisms may originate from the kinking of the jugular vein due to hyper-flexed neck position during surgery. To prevent such complication, we must take great care of the anesthetized patients when placed in the forced neck position and always keep this rare but so critical complication in mind.展开更多
Background: The importance of monitoring cognition during awake craniotomy has been well described in previous studies. The relevance of being coached during such a procedure has received less attention and questions ...Background: The importance of monitoring cognition during awake craniotomy has been well described in previous studies. The relevance of being coached during such a procedure has received less attention and questions still remain unanswered about what factors are the most important herein. Objective: The aim of this study was to qualitatively analyze what factors were, according to our patients, important in being coaching during awake craniotomy. Methods: Twenty-six patients who underwent awake craniotomy received a questionnaire about their experiences during the procedure. The questions concerned different aspects of the pre-operative part, the operation itself and coaching aspects. Answers were qualitatively analyzed by two investigators and per question, different answer categories were made. Results: Two thirds of the 20 patients who responded to the questionnaire reported anxiety in the days before or during the operation, varying from general anxiety for being awake during surgery to anxiety for very specific aspects such as opening the skull. The constant presence of the neuropsychologist and a transparent communication during the procedure were most frequently (65% of all the answers) reported as helpful in staying calm. Conclusion: Results of this descriptive study show that patients experience different anxieties before and during an awake craniotomy and give more insight into what factors are important for patients in being coached during such an operation. This study gives directions for clinicians in improving their role as a coach.展开更多
Background: Traumatic subdural hematoma is one of the severe injuries to brain with high mortality rates. Dural opening is often associated with brain herniation against the dural edges due to associated edema that wo...Background: Traumatic subdural hematoma is one of the severe injuries to brain with high mortality rates. Dural opening is often associated with brain herniation against the dural edges due to associated edema that would lead to venous infarction. Aim: The objective of this study is to describe a technical note that would allow fast and effective closure of the dura after hematoma evacuation via duraplasty with analysis of the safety and competency of the technique. Subjects and Methods: The fast-track technique was implemented in 15 successive cases with acute subdural hematoma where the fascia lata flap was prepared and sutured to the planned dural incision before opening the dura, which allowed fast and effective closure of the dura before brain herniation. Subdural bridges were planned by using Gelfoam to prevent venous compression. Analysis of the technique effectiveness was performed by the operative detection of brain herniation, as well as clinical and radiological follow-up of patients. Results: All patients had a Glasgow coma score (GCS) below six before the operation. Mean time from trauma to surgery was five hours. The dura could be effectively closed with no brain herniation in all cases. Nine patients survived (60%), where five of them ended up in a vegetative state. Of these two recovered and three continued in a persistent vegetative state. The mortality rate was 40%. Post-operative infarction was detected in post-operative imaging of four patients. Conclusion: The fast-track duraplasty technique is fast and effective in prevention of brain herniation during surgery with favorable clinical outcome in comparison with the poor and severely deteriorated preoperative clinical presentation. More studies to evaluate the impact of the technique on the survival rate are warranted.展开更多
Background: Post-craniotomy CSF collection is a problem that may cause severe complications as meningitis, wound disruption, prolonged hospitalization, and additional surgeries. Objective: To evaluate our cases with r...Background: Post-craniotomy CSF collection is a problem that may cause severe complications as meningitis, wound disruption, prolonged hospitalization, and additional surgeries. Objective: To evaluate our cases with resistant post-operative subgaleal CSF collection, trying to identify causes and optimal management. Methods: Retrospective review of elective skull base cases during the period of January 2104 to January 2019 identification of cases with post-operative CSF subgaleal collection, which either managed conservatively or needed a second surgery. Results: 219 patients, 30 of them suffered subgaleal CSF collection, 22 patients improved with non-operative measures, eight patients needed second surgery with pericranial graft augmentation, and obliteration of subgaleal space resulted in resolution of CSF leak with no morbidities. Conclusion: Meticulous tensionless dural closure, obliteration of subgaleal space, tethering of dural grafts to bone edges are useful techniques in preventing post-operative CSF leak.展开更多
<strong>Background:</strong> Fixation of bone flap following craniotomy is usually achieved by synthetic materials. In rural and poor funding areas, innovation for cheap, safe and applicable material is ne...<strong>Background:</strong> Fixation of bone flap following craniotomy is usually achieved by synthetic materials. In rural and poor funding areas, innovation for cheap, safe and applicable material is needed. <strong>Purpose:</strong> The aim is to assess our new innovative technique in bone flap fixation against traditional techniques. <strong>Patients and Methods:</strong> The study was a prospective randomized controlled study enrolled at Al-Amal Hospital and Al-Ahly Bank Hospital from 2014-2019. Forty-eight patients were randomized in the study. Group A (24 patients) underwent titanium miniplate fixation while group B (24 patients) underwent our new technique. The new technique is double J tunnels performed by craniotome on either side of the bone (flap and skull sides), then a Prolene suture is passed through the shared stem of J’ holes and secured in the wrapped side of J’s holes and tying it tightly. Both techniques were examined against fixation time, rigidity, offset and final judgment postoperatively. <strong>Result:</strong> There was no statistically significant difference in using both techniques as regard fixation time. Our new technique was not inferior to the traditional one in achieving rigidity (p > 0.05). The final postoperative assessment was as equal as that seen in miniplate fixation. <strong>Conclusion: </strong>This technique is a simple, easy, cheap and effective method of fixing craniotomy bone flap.展开更多
Background:Spontaneous intracerebral hemorrhage(SICH)has high morbidity and mortality,with no clear standard of treatment available.Compared with the craniotomy approach,neuroendoscopy is a relatively minimally invasi...Background:Spontaneous intracerebral hemorrhage(SICH)has high morbidity and mortality,with no clear standard of treatment available.Compared with the craniotomy approach,neuroendoscopy is a relatively minimally invasive treatment method,and may be an efficient alternative.Therefore,this meta-analysis aimed to assess the clinical efficacy of neuroendoscopy and craniotomy in SICH patients.Methods:The electronic databases Web of Science,PubMed,EmBase,MEDLINE,and the Cochrane Library were systematically searched.According to the PRISMA template,we finally selected and analyzed 14 eligible studies that evaluated neuroendoscopy versus craniotomy.Primary outcomes included operation time,intraoperative blood loss volume,evacuation rate,residual hematoma,complications,hospital stay duration,clinical outcomes,and other parameters.Results:A total of 4 randomized controlled trials(RCTs)and 10 retrospective studies(non-RCTs)involving 1652 patients were included in the final analysis.In the neuroendoscopy(NE)group,operation time(p<0.00001),intraoperative blood loss volume(p<0.0001),hematoma evacuation rate(p=0.0002),complications(p<0.00001),hospitalization days(p=0.004),and mortality(p<0.0001)were significantly different from those of the craniotomy(C)group,with a higher rate of good recovery compared with the craniotomy group(P<0.00001).Conclusions:These findings suggest that patients with SICH and physicians may benefit more from neuroendoscopic surgery than craniotomy.展开更多
Background:In neurosurgery,the necessity of having a drainage tube is controversial.Subgaleal fluid collection(SFC)often occurs,especially in a craniotomy near the“parietal site”.This study aimed to reassess the ben...Background:In neurosurgery,the necessity of having a drainage tube is controversial.Subgaleal fluid collection(SFC)often occurs,especially in a craniotomy near the“parietal site”.This study aimed to reassess the benefit of using a prophylactic epidural drainage(ED)and non-watertight dura suture in a craniotomy near the parietal site.Methods:A retrospective review was conducted on 63 consecutive patients who underwent a craniotomy near the parietal site.The patients were divided into two groups according to different period.The deal group received ED and a non-watertight dura suture(drain group,DG),the control group that did not(non-drain group,NDG).Complications and patient recovery were evaluated and analysed.Results:Three patients(11.5%,26)in DG and 20 patients(54.1%,37)in NDG presented with SFC(p<0.05).One patient(3.8%)in DG and three patients(8.1%)in NDG presented with subdural tensile hydrops(STH)(p>0.05).Six developed an infection in NDG(four intracranial infections,one abscess,one pulmonary infection),while none in DG(p>0.05)developed infection.Three(11.5%)cases in DG and one(2.7%)case in NDG had muscle strength that improved postoperatively(p>0.05).Fifteen(57.7%)in DG and 14(37.8%)in NDG had epileptic seizures less frequently postoperatively(p<0.05).The average temperature(37.4°C vs 37.6°C,p>0.05),the maximum temperature(37.9°C vs 38.1°C,p>0.05)on 3 PODs,the postoperative hospital stay day(7.5 days vs 8.0 days,p>0.05),and the postoperative medicine fee(¥29762.0 vs¥28321.0,p>0.05)were analysed.Conclusion:In patients who undergo a craniotomy near the parietal site,the prophylactic use of ED and a nonwatertight dura suture helps reduce SFC,infection,and control epilepsy.展开更多
This study was designed to compare the approaches and efficacies of two different ways of neurosurgical management for spontaneous putaminal hemorrhage(SPH):computed tomographic-guided aspiration(CTGA)and the key-hole...This study was designed to compare the approaches and efficacies of two different ways of neurosurgical management for spontaneous putaminal hemorrhage(SPH):computed tomographic-guided aspiration(CTGA)and the key-hole approach(KHA).The indications of the two approaches are also explored.From September 2001 to 2003,a total of 1077 cases of SPH distributed in 135 hospitals all over the mainland of China were included for analysis.All cases had three-month follow-up data.The study was designed in a single-blinded manner to compare the efficacies of the different approaches.There were 563 cases in the CTGA group,165 in the KHA group,and 217 cases in the conventional open craniotomy(COC)group.In the CTGA and KHA groups,the mortalities at one month after operation(M1m)were 17.9% and 18.3%,respectively,while the mortalities at three months after operation(M3m)were 19.4% and 19.4%,respectively(P>0.05).The postoperative complications due to CTGA(23.7%)were not significantly different from those due to KHA(25.7%)(P=0.420).The M3m of patients with Glasgow coma scale(GCS)h8 was 3.45 and 4.0 times as much as those with GCS>8,respectively.The M3m of patients with complications was 3.92 times as much as those without complications.The M3m of patients with hemorrhage volume ≥70 mL was 2.67 times as much as those<70 mL.The CTGA is not better than KHA in the treatment of SPH in terms of a more favorable outcome or less mor tality and morbidity,but CTGA could be the first choice for those with bleeding volumes ≤50mL,while KHA is the first choice for those with bleeding volumes>50 mL.展开更多
Background:The treatment for spontaneous intracerebral hemorrhage(ICH)is still controversial,especially for hematomas in the basal ganglia.A retrospective case-control study with propensity score matching was performe...Background:The treatment for spontaneous intracerebral hemorrhage(ICH)is still controversial,especially for hematomas in the basal ganglia.A retrospective case-control study with propensity score matching was performed to compare the outcomes of conventional craniotomy and conservative treatment for patients with minor ICH in the basal ganglia.Methods:We retrospectively collected the data of consecutive patients with minor basal ganglia hemorrhage from January 2018 to August 2019.We compared clinical outcomes of two groups using propensity score matching.The extended Glasgow outcome scale obtained by phone interviews based on questionnaires at a 12-month follow-up was used as the primary outcome measure.According to a previous prognosis algorithm,patients were divided into good and poor prognosis groups to obtain a dichotomized(favorable or unfavorable)outcome as the primary outcome.Secondary outcomes included hospitalized complications,mortality,and modified Rankin score at 12 months.Results:A total of 54 patients were analyzed,and the baseline characteristics of patients in the surgery and conservative treatment groups were well matched.The primary favorable outcome at 12 months was significantly higher in the conservative treatment group than in the surgery group(81%vs 44%;OR 1.833,95%CI 1.159-2.900;P=0.005).The incidence of pneumonia in the surgery group was significantly higher than that in the conservative treatment group(P=0.005).Conclusions:It is not recommended to undertake conventional craniotomy for patients with a minor hematoma(25-40 ml)in the basal ganglia.An open craniotomy might induce worse long-term functional outcomes than the conservative treatment.展开更多
BACKGROUND Bacillus subtilis(B. subtilis) is considered a nonpathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have...BACKGROUND Bacillus subtilis(B. subtilis) is considered a nonpathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have been reported, mainly in the form of pyogenic meningitis,usually in cases of direct inoculation by trauma or iatrogenically.CASE SUMMARY A 51-year-old man, with a free previous medical history, presented to the Emergency Department of our hospital complaining of recurrent episodes of left upper limb weakness, during the last month, which had been worsened the last 48 h. During his presentation in Emergency Department he experienced a generalized tonic-clonic grand mal seizure. Brain magnetic resonance imaging(MRI) scan with intravenous Gadolinium revealed a 3.3 cm × 2.7 cm lesion at the right parietal lobe surrounded by mild vasogenic edema, which included the posterior central gyrus. The core of the lesion showed relatively homogenous restricted diffusion. Post Gadolinium T1 W1 image, revealed a ring-shaped enhancement. Due to the imaging findings, brain abscess was our primary consideration. Detailed examination for clinical signs of infectious foci revealed only poor oral hygiene with severe tooth decay and periodontal disease, but without detection of dental abscess. The patient underwent surgical treatment with right parietal craniotomy and total excision of the lesion. Pus and capsule tissue grew B. subtilis and according to antibiogram intravenous ceftriaxone 2 g bids was administered for 4 wk. The patient remained asymptomatic and follow-up MRI scan two months after operation showed complete removal of the abscess.CONCLUSION This case highlights the ultimate importance of appropriate oral hygiene and dental care to avoid potentially serious infectious complications and second, B. subtilis should not be considered merely as laboratory contaminant especially when cultivated by appropriate central nervous system specimen.展开更多
The reinforcing effect of transcutaneous acupoint electric stimulation(TAES)on enflurane anesthesia during craniotomy was studied.One hundred and ten neurosurgical patientswere randomly divided into three groups.Anest...The reinforcing effect of transcutaneous acupoint electric stimulation(TAES)on enflurane anesthesia during craniotomy was studied.One hundred and ten neurosurgical patientswere randomly divided into three groups.Anesthesia was maintained with enflurane in Group A(n=40).In Group B,enflurane anesthesia was supplemented by TAES with Han’s acupoint nerve stimu-lator(HANS)at Hegu(LI 4),Yuyao(EX-HN 4)and Fengchi(GB 20)points on the operated side(n=40).In Group C,enflurane anesthesia was supplemented by TAES and scalp infiltration with 0.5％procaine solution(n=30).The results showed that the minimum alveolar concentration(MAC)of enflurane in Group B and C decreased by 37.8-47.0％and 42.1-66.1％respectively than thatin Group A.The hemodynamics was more stable during operation,and the patients recovered after operation in group B and C.It was concluded that TAES with HANS significantly the anesthetic effect and decreased the side effects of enflurane during operation,and that the triplecombination of TAES,enflurane and scalp infiltration with procaine appeared to be a better anestheticmethod for craniotomy.展开更多
BACKGROUND Intradural osteoma is very rarely located in the subdural or subarachnoid space.Unfortunately,intradural osteoma lacks specificity in clinical manifestations and imaging features and there is currently no c...BACKGROUND Intradural osteoma is very rarely located in the subdural or subarachnoid space.Unfortunately,intradural osteoma lacks specificity in clinical manifestations and imaging features and there is currently no consensus on its diagnosis method or treatment strategy.Moreover,the pathogenesis of osteoma without skull structure involvement remains unclear.CASE SUMMARY We describe two cases of intradural osteomas located in the subdural and subarachnoid spaces,respectively.The first case involved a 47-year-old woman who presented with a 3-year history of intermittent headache and dizziness.Intraoperatively,a bony hard mass was found in the left frontal area,attached to the inner surface of the dura mater and compressing the underlying arachnoid membrane and brain.The second case involved a 56-year-old woman who had an intracranial high-density lesion isolated under the right greater wing of the sphenoid.Intraoperatively,an arachnoid-covered bony tumor was found in the sylvian fissure.The pathological diagnosis for both patients was osteoma.CONCLUSION Surgery and pathological examination are required for diagnosis of intradural osteomas,and craniotomy is a safe and effective treatment.展开更多
文摘Background: The eyebrow supraorbital keyhole approach could be considered a modified minimally invasive model for the classic pterional subfrontal approach in which an eyebrow incision and supraorbital mini craniotomy are performed for exposure of the anterior cranial fossa corridor. Methods: This study was retrospectively conducted on twenty four patients, age ranging from 20 to 65 years old, with anterior cranial fossa lesions who were meeting the eligibility criteria for eyebrow craniotomy in the period from August 2019 to January 2023. These patients were operated through eyebrow supraorbital approach in which microscopic endoscopic assisted technique were used. Extent of resection, clinical and cosmetic outcomes and complication incidence were assessed. Results: We included the twenty four patients who met inclusion criteria (17 females and 7 males) their ages ranged from 20 to 65 years. The most common pathology was meningioma in 19 patients. Two patients experienced supraorbital loss of sensation and only one patient experienced palsy of frontalis branch of facial nerve. Frontal sinus was breached in 3 patients with no patient experienced postoperative CSF leak. Total excision was accomplished for 23 patients. Four patients who had preoperative visual compromise, improvement of visual acuity and field defects was observed in 3 patients. No major intraoperative complications occurred. All patients filled cosmetic satisfaction questionnaire during their outpatient visits. For the eyebrow supraorbital approach, no incision related intolerable pain, no craniotomy defects or irregularities, no cosmetic complaints nor limitation of jaw opening were reported, and only minor symptoms in the form of limited eyebrow elevation, swelling and numbness in the forehead. Conclusions: The eyebrow craniotomy could be used safely as a more cosmetic and minimally invasive approach for a variety of anterior cranial fossa lesions. Endoscopic assistance has been found very useful for deeply seated lesions and hidden residuals with minimal brain retraction which couldn’t be accessed easily through microscopic field solely. Endoscopic assisted eyebrow supraorbital keyhole approach could be performed on a wider scale with great results but requires good selection of cases and more practice to expertise the needed skills.
文摘BACKGROUND Deep vein thrombosis(DVT)of the lower extremity is one of the most common postoperative complications,especially after craniocerebral surgery.DVT may lead to pulmonary embolism,which has a devastating impact on patient prognosis.This study aimed to investigate the incidence and risk factors of DVT in the lower limbs following craniocerebral surgery.AIM To identify independent risk factors for the development of postoperative DVT and to develop an effective risk prediction model.METHODS The demographic and clinical data of 283 patients who underwent craniocerebral surgery between December 2021 and December 2022 were retrospectively analyzed.The independent risk factors for lower extremity DVT were identified by univariate and multivariate analyses.A nomogram was created to predict the likelihood of lower extremity DVT in patients who had undergone craniocerebral surgery.The efficacy of the prediction model was determined by receiver operating characteristic curve using the probability of lower extremity DVT for each sample.RESULTS Among all patients included in the analysis,47.7%developed lower extremity DVT following craniocerebral surgery.The risk of postoperative DVT was higher in those with a longer operative time,and patients with intraoperative intermittent pneumatic compression were less likely to develop postoperative DVT.CONCLUSION The incidence of lower extremity DVT following craniocerebral surgery is significant,highlighting the importance of identifying independent risk factors.Interventions such as the use of intermittent pneumatic compression during surgery may prevent the formation of postoperative DVT.
文摘Introduction: The incidence of acute pain after craniotomy differs remarkably in previous studies, and the prevalence of persistent pain is not precisely known. We conducted 6-month follow-up surveys on the incidence and intensity of acute and persistent pain after elective craniotomy. Methods: We carried out a prospective cohort study via a series of structured questionnaires to record acute pain intensity preoperatively and postoperatively, and the incidence of persistent pain 3 and 6 months after a craniotomy in a tertiary care center. Patients scheduled for elective craniotomy were interviewed the day before surgery, postoperatively before discharge from the hospital, and 3 and 6 months after surgery. Pain was assessed on a numeric rating scale (0 - 10) at rest and movement, as well as expectations of pain before surgery, efficacy of pain therapy, and satisfaction with pain treatment. The incidence of adverse events, sleep time and interruptions caused by pain, different pain types, and drugs used for pain treatment were also recorded. Results: A total of 152 patients were enrolled in the study and completed the preoperative questionnaire;123 (81%) completed postoperative questionnaire and 108 (72%) completed the 3- and 6-month follow-ups. The average pain score at the time of the postoperative questionnaire was moderate, 4 at rest and 5 upon movement. The percentage of patients experiencing mild pain at rest and upon movement was 52% and 49%, and moderate pain was 15% and 16%, respectively. Severe postoperative pain was detected in 5% and 8% of patients at rest and upon movement, respectively. Three months after surgery, 6% of patients reported mild pain at rest, 3% moderate pain at rest, and 1% severe pain at rest. Persistent mild and moderate pain at rest after 6 months was reported by 3% and 1% of patients, respectively. The most common adverse events were postoperative nausea and vomiting (11%) and abdominal discomfort (8%). During postoperative pain treatment in the intensive care unit or post-anesthesia care unit, 92% of patients received acetaminophen, 88% fentanyl, and 24% oxycodone. During neurosurgical ward care, ibuprofen was used in 61% of patients. Satisfaction with analgesia was high throughout the study period with a median satisfaction score of 9 postoperatively and 10 at 3 and 6 months on the 0 - 10 scale. Conclusion: The findings indicate that most patients experience moderate or mild pain after craniotomy, but patient satisfaction with pain treatment is high. Persistent pain after 3 and 6 months is rare and mild in nature.
文摘Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.
文摘Introduction: Brain abscess represents 8% of intracranial masses in developing countries. Despite the advances in neuro-imaging, still, the diagnosis of brain abscess is difficult and may need a biopsy in most cases to verify the diagnosis because may even lead to death. CT scan with contrast is a good tool for diagnosing and localizing brain abscesses in late stages, however, it is difficult to diagnose them in the early stages. The development of MRI helps to more accurately diagnose brain abscess. Surgical management of brain abscesses is either medical or surgical through craniotomy or burr holes. Indications of each are still a point of debate among most neurosurgeons. Methodology: This is a descriptive longitudinal prospective study to compare the outcomes of two surgical procedures used in The National Centre for Neurological Sciences-Khartoum-Sudan (NCNS) from 2012 to 2015, craniotomy and excision of the abscess membrane versus burr hole and aspiration of brain abscess in terms of duration of hospitalization, length of antibiotic use, recurrence rate, number of images needed for follow-up, and the final postoperative early and late outcomes. The data was collected through a designed questionnaire and was then analyzed using SPSS version 20. No significant ethical approval was required for this study. Results: Fifty-four patients were operated on through craniotomy (29/54) and burr hole (25/54). Their ages ranged from 1 year to 53 years with an average presentation at 13 years of age. Most patients presented with fever (23.1%), convulsions (16%), vomiting (16.7%) and headache (15.4%). The mean of illness for both groups was almost 2 months. The majority of patients in this study were having no risk factors (38.9%) while the major risk factors seen were cardiac diseases (14.8%), neurosurgical procedures (13%) and otitis media (11.1%). As most patients presented late, the diagnosis of most was made using CT brain with contrast (83.3%). In most of the patients (85.2%) there were no organisms separated in the culture. 8/54 patients had positive cultures, 7/8 were bacterial and only one (1/8) was fungal. Most patients received antibiotics for 45 days postoperatively in both craniotomy and burr hole groups. When both groups were compared, those operated with craniotomy were found to have a relatively higher length of hospital stay, however, no significant difference was found between both groups. Also, it was found that those operated on with craniotomy had a high cure rate and less recurrence in comparison with burr hole group. Deterioration and death were significantly higher among craniotomy group. Only CT brain was used as the imaging modality of choice for follow-up in both groups for 4 months’ duration and it was noted that complete evacuation was significantly higher among craniotomy group while remnants were higher among burr hole group. Conclusion: Brain abscess is still a challenging condition for neurosurgeons in Sudan. The limited number of Sudanese neurosurgeons, neurosurgical centers and diagnostic facilities contributed to delay in diagnosing brain abscess in most patients. It is important to design a strict protocol and precautions for any neurosurgical operation or bedside procedure to prevent infection and subsequent brain abscess development. CT brain with contrast is a good imaging tool for assessing the size, site and stage of brain abscesses. No significant difference between craniotomy or burr hole for clearance from brain abscess in terms of antibiotic used or duration of hospital stay. However, burr hole aspiration is associated with higher rates of recurrences. On the other hand, craniotomy and excision have relatively higher neurologic morbidity postoperative with expectantly higher post-operative hospitalization but no differences in the final outcome. Therefore, the selection of surgical technique should be individualized in each case based on the abscess site size source patient fitness for surgery and neurosurgeon’s preference.
基金Beijing Municipal Administration of Hospitals Ascent Plan,No.DFL20180502.
文摘BACKGROUND The auditory brainstem implant(ABI)is a significant treatment to restore hearing sensations for neurofibromatosis type 2(NF2)patients.However,there is no ideal method in assisting the placement of ABIs.In this case series,intraoperative cochlear nucleus mapping was performed in awake craniotomy to help guide the placement of the electrode array.CASE SUMMARY We applied the asleep-awake-asleep technique for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuroma resections and ABIs,using mechanical ventilation with a laryngeal mask during the asleep phases,utilizing a ropivacaine-based regional anesthesia,and sevoflurane combined with propofol/remifentanil as the sedative/analgesic agents in four NF2 patients.ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients.There was one uncooperative patient whose awake hearing test needed to be aborted.In all cases,tumor resection and ABI were performed safely.Satisfactory electrode effectiveness was achieved in awake ABI placement.CONCLUSION This case series suggests that awake craniotomy with an intraoperative hearing test for ABI placement is safe and well tolerated.Awake craniotomy is beneficial for improving the accuracy of ABI electrode placement and meanwhile reduces non-auditory side effects.
文摘Background: Acute subdural hematoma (ASDH) is considered the most common traumatic brain mass lesion. Its prognosis is still grave despite the improvements in treatment modalities. Its mortality rate was reported to be around 60% until the 1990s. In the last decade, ASDH mortality rate was reduced to the level of 20% - 40%. Standard treatment to decrease intracranial tension via hematoma evacuation is associated with decompressive craniotomy and followed by ICU management. Objective: To evaluate the outcome and prognostic factors in patients of acute subdural hematoma treated by surgical evacuation and decompressive craniotomy. Also, outcome of cranioplasty by repositioning of patients own bone or by synthetic mesh methods is evaluated. Patients and Methods: It is one year retrospective study. It was conducted on 53 patients, in trauma unit, Assiut university hospitals. We report time lag between trauma and performed surgery, initial Glasgow coma scale (GCS), age, sex and presence of other intracranial pathologies. Outcome assessment is based on Glasgow outcome scale (GOS) and fol-low-up extended for 6 months. We include those patients with only (isolated) head trauma, shift of midline more than 5 mm in CT brain. We excluded pa-tients with GCS 3 and fixed dilated pupils as well as patients with GCS higher than 12. We did decompressive craniotomy and duraplasty in all patients. Bone flap of decompressive craniotomy is situated in the abdomen. All func-tionally recovered patients were submitted for cranioplasty with either re-placing patient own bone or by Titanium mesh. Results: We had 39 males and 14 females. Age ranged between 7 and 65 years old. 23 deaths, 10 persis-tent vegetative state, 10 severe disability, 8 moderate disability and 2 good recovery. The outcome analysis was based on 6 month follow-up. Conclu-sion: Acute subdural hematoma is a very serious condition. Mortality and morbidity is intimately related to GCS on admission. Presence of associated cerebral pathology increases mortality and morbidity of patients with post-traumatic acute subdural hematoma. Early evacuation of posttraumatic acute subdural hematoma with decompressive craniotomy is an important method to control raised intracranial tension, reduce shift of midline and very benefi-cial in decreasing mortality and morbidity. Regarding infection and avoiding bone flap resorption, Titanium mesh is better than patient own bone during cranioplasty after patient recovery.
文摘BACKGROUND Eisenmenger syndrome(ES)is an uncorrected congenital cardiac defect with a left-to-right shunt,leading to pulmonary arterial hypertension.Patients with ES are susceptible to hemodynamic alterations during noncardiac surgery with general anesthesia,which increases perioperative morbidity and mortality.Monitored anesthesia care(MAC)is often used during minor procedures in patients with cardiac disease.However,few reports on MAC in patients with ES exist.CASE SUMMARY A 49-year-old man was admitted for a severe headache lasting 30 d.He had been diagnosed with a large perimembranous ventricular septal defect(VSD)with bidirectional shunt flow and pulmonary arterial hypertension 10 years ago.A round mass in the right frontal lobe was revealed by Magnetic resonance imaging.Stereotactic aspiration using a neuronavigation system was performed under MAC.The patient was stayed in the hospital for 5 d,and discharged without complications.CONCLUSION MAC may be effective for craniotomy in patients with ES.
文摘Background: Park-bench position is a commonly used position in patients operated with cerebellopontine tumor, microvascular decompression, or lesions of cerebellar hemisphere and vertebral artery. Several complications associated with this positioning have been described. However, the delayed airway complication resulting from park-bench position has been rarely reported in the literatures. Herein, we report a rare case of delayed airway obstruction after a posterior-fossa craniotomy with park-bench position for acoustic neuroma. Case presentation: A 43-year-old woman, who has a right acoustic neuroma, was placed in the park-bench position for a posterior-fossa craniotomy. The anesthesia and operation were performed smoothly. However, progressive swelling in the left neck with extending to left face occurred two hours after endo-tracheal extubation. Computed tomographic scan of neck revealed diffuse swelling of the muscles and deep soft tissue in the left side. No obvious embolization of vascular system including jugular vein was found in the sonography. Because of obstruction in upper airway, orotracheal intubation and a head-up position were performed. The clinical symptoms improved gradually since the third post-operative day. She was discharged with obvious complications on the 23rd day after the operation. Conclusion: The possible mechanisms may originate from the kinking of the jugular vein due to hyper-flexed neck position during surgery. To prevent such complication, we must take great care of the anesthetized patients when placed in the forced neck position and always keep this rare but so critical complication in mind.
文摘Background: The importance of monitoring cognition during awake craniotomy has been well described in previous studies. The relevance of being coached during such a procedure has received less attention and questions still remain unanswered about what factors are the most important herein. Objective: The aim of this study was to qualitatively analyze what factors were, according to our patients, important in being coaching during awake craniotomy. Methods: Twenty-six patients who underwent awake craniotomy received a questionnaire about their experiences during the procedure. The questions concerned different aspects of the pre-operative part, the operation itself and coaching aspects. Answers were qualitatively analyzed by two investigators and per question, different answer categories were made. Results: Two thirds of the 20 patients who responded to the questionnaire reported anxiety in the days before or during the operation, varying from general anxiety for being awake during surgery to anxiety for very specific aspects such as opening the skull. The constant presence of the neuropsychologist and a transparent communication during the procedure were most frequently (65% of all the answers) reported as helpful in staying calm. Conclusion: Results of this descriptive study show that patients experience different anxieties before and during an awake craniotomy and give more insight into what factors are important for patients in being coached during such an operation. This study gives directions for clinicians in improving their role as a coach.
文摘Background: Traumatic subdural hematoma is one of the severe injuries to brain with high mortality rates. Dural opening is often associated with brain herniation against the dural edges due to associated edema that would lead to venous infarction. Aim: The objective of this study is to describe a technical note that would allow fast and effective closure of the dura after hematoma evacuation via duraplasty with analysis of the safety and competency of the technique. Subjects and Methods: The fast-track technique was implemented in 15 successive cases with acute subdural hematoma where the fascia lata flap was prepared and sutured to the planned dural incision before opening the dura, which allowed fast and effective closure of the dura before brain herniation. Subdural bridges were planned by using Gelfoam to prevent venous compression. Analysis of the technique effectiveness was performed by the operative detection of brain herniation, as well as clinical and radiological follow-up of patients. Results: All patients had a Glasgow coma score (GCS) below six before the operation. Mean time from trauma to surgery was five hours. The dura could be effectively closed with no brain herniation in all cases. Nine patients survived (60%), where five of them ended up in a vegetative state. Of these two recovered and three continued in a persistent vegetative state. The mortality rate was 40%. Post-operative infarction was detected in post-operative imaging of four patients. Conclusion: The fast-track duraplasty technique is fast and effective in prevention of brain herniation during surgery with favorable clinical outcome in comparison with the poor and severely deteriorated preoperative clinical presentation. More studies to evaluate the impact of the technique on the survival rate are warranted.
文摘Background: Post-craniotomy CSF collection is a problem that may cause severe complications as meningitis, wound disruption, prolonged hospitalization, and additional surgeries. Objective: To evaluate our cases with resistant post-operative subgaleal CSF collection, trying to identify causes and optimal management. Methods: Retrospective review of elective skull base cases during the period of January 2104 to January 2019 identification of cases with post-operative CSF subgaleal collection, which either managed conservatively or needed a second surgery. Results: 219 patients, 30 of them suffered subgaleal CSF collection, 22 patients improved with non-operative measures, eight patients needed second surgery with pericranial graft augmentation, and obliteration of subgaleal space resulted in resolution of CSF leak with no morbidities. Conclusion: Meticulous tensionless dural closure, obliteration of subgaleal space, tethering of dural grafts to bone edges are useful techniques in preventing post-operative CSF leak.
文摘<strong>Background:</strong> Fixation of bone flap following craniotomy is usually achieved by synthetic materials. In rural and poor funding areas, innovation for cheap, safe and applicable material is needed. <strong>Purpose:</strong> The aim is to assess our new innovative technique in bone flap fixation against traditional techniques. <strong>Patients and Methods:</strong> The study was a prospective randomized controlled study enrolled at Al-Amal Hospital and Al-Ahly Bank Hospital from 2014-2019. Forty-eight patients were randomized in the study. Group A (24 patients) underwent titanium miniplate fixation while group B (24 patients) underwent our new technique. The new technique is double J tunnels performed by craniotome on either side of the bone (flap and skull sides), then a Prolene suture is passed through the shared stem of J’ holes and secured in the wrapped side of J’s holes and tying it tightly. Both techniques were examined against fixation time, rigidity, offset and final judgment postoperatively. <strong>Result:</strong> There was no statistically significant difference in using both techniques as regard fixation time. Our new technique was not inferior to the traditional one in achieving rigidity (p > 0.05). The final postoperative assessment was as equal as that seen in miniplate fixation. <strong>Conclusion: </strong>This technique is a simple, easy, cheap and effective method of fixing craniotomy bone flap.
文摘Background:Spontaneous intracerebral hemorrhage(SICH)has high morbidity and mortality,with no clear standard of treatment available.Compared with the craniotomy approach,neuroendoscopy is a relatively minimally invasive treatment method,and may be an efficient alternative.Therefore,this meta-analysis aimed to assess the clinical efficacy of neuroendoscopy and craniotomy in SICH patients.Methods:The electronic databases Web of Science,PubMed,EmBase,MEDLINE,and the Cochrane Library were systematically searched.According to the PRISMA template,we finally selected and analyzed 14 eligible studies that evaluated neuroendoscopy versus craniotomy.Primary outcomes included operation time,intraoperative blood loss volume,evacuation rate,residual hematoma,complications,hospital stay duration,clinical outcomes,and other parameters.Results:A total of 4 randomized controlled trials(RCTs)and 10 retrospective studies(non-RCTs)involving 1652 patients were included in the final analysis.In the neuroendoscopy(NE)group,operation time(p<0.00001),intraoperative blood loss volume(p<0.0001),hematoma evacuation rate(p=0.0002),complications(p<0.00001),hospitalization days(p=0.004),and mortality(p<0.0001)were significantly different from those of the craniotomy(C)group,with a higher rate of good recovery compared with the craniotomy group(P<0.00001).Conclusions:These findings suggest that patients with SICH and physicians may benefit more from neuroendoscopic surgery than craniotomy.
文摘Background:In neurosurgery,the necessity of having a drainage tube is controversial.Subgaleal fluid collection(SFC)often occurs,especially in a craniotomy near the“parietal site”.This study aimed to reassess the benefit of using a prophylactic epidural drainage(ED)and non-watertight dura suture in a craniotomy near the parietal site.Methods:A retrospective review was conducted on 63 consecutive patients who underwent a craniotomy near the parietal site.The patients were divided into two groups according to different period.The deal group received ED and a non-watertight dura suture(drain group,DG),the control group that did not(non-drain group,NDG).Complications and patient recovery were evaluated and analysed.Results:Three patients(11.5%,26)in DG and 20 patients(54.1%,37)in NDG presented with SFC(p<0.05).One patient(3.8%)in DG and three patients(8.1%)in NDG presented with subdural tensile hydrops(STH)(p>0.05).Six developed an infection in NDG(four intracranial infections,one abscess,one pulmonary infection),while none in DG(p>0.05)developed infection.Three(11.5%)cases in DG and one(2.7%)case in NDG had muscle strength that improved postoperatively(p>0.05).Fifteen(57.7%)in DG and 14(37.8%)in NDG had epileptic seizures less frequently postoperatively(p<0.05).The average temperature(37.4°C vs 37.6°C,p>0.05),the maximum temperature(37.9°C vs 38.1°C,p>0.05)on 3 PODs,the postoperative hospital stay day(7.5 days vs 8.0 days,p>0.05),and the postoperative medicine fee(¥29762.0 vs¥28321.0,p>0.05)were analysed.Conclusion:In patients who undergo a craniotomy near the parietal site,the prophylactic use of ED and a nonwatertight dura suture helps reduce SFC,infection,and control epilepsy.
文摘This study was designed to compare the approaches and efficacies of two different ways of neurosurgical management for spontaneous putaminal hemorrhage(SPH):computed tomographic-guided aspiration(CTGA)and the key-hole approach(KHA).The indications of the two approaches are also explored.From September 2001 to 2003,a total of 1077 cases of SPH distributed in 135 hospitals all over the mainland of China were included for analysis.All cases had three-month follow-up data.The study was designed in a single-blinded manner to compare the efficacies of the different approaches.There were 563 cases in the CTGA group,165 in the KHA group,and 217 cases in the conventional open craniotomy(COC)group.In the CTGA and KHA groups,the mortalities at one month after operation(M1m)were 17.9% and 18.3%,respectively,while the mortalities at three months after operation(M3m)were 19.4% and 19.4%,respectively(P>0.05).The postoperative complications due to CTGA(23.7%)were not significantly different from those due to KHA(25.7%)(P=0.420).The M3m of patients with Glasgow coma scale(GCS)h8 was 3.45 and 4.0 times as much as those with GCS>8,respectively.The M3m of patients with complications was 3.92 times as much as those without complications.The M3m of patients with hemorrhage volume ≥70 mL was 2.67 times as much as those<70 mL.The CTGA is not better than KHA in the treatment of SPH in terms of a more favorable outcome or less mor tality and morbidity,but CTGA could be the first choice for those with bleeding volumes ≤50mL,while KHA is the first choice for those with bleeding volumes>50 mL.
基金the key research and development program of Zhejiang province(2017C03027)National Natural Science Foundation of China(No.81771262)+1 种基金Natural Science Foundation of Zhejiang Province(LQ20H090005)Wenzhou Municipal Science and Technology Bureau Project of China(Y20190568)
文摘Background:The treatment for spontaneous intracerebral hemorrhage(ICH)is still controversial,especially for hematomas in the basal ganglia.A retrospective case-control study with propensity score matching was performed to compare the outcomes of conventional craniotomy and conservative treatment for patients with minor ICH in the basal ganglia.Methods:We retrospectively collected the data of consecutive patients with minor basal ganglia hemorrhage from January 2018 to August 2019.We compared clinical outcomes of two groups using propensity score matching.The extended Glasgow outcome scale obtained by phone interviews based on questionnaires at a 12-month follow-up was used as the primary outcome measure.According to a previous prognosis algorithm,patients were divided into good and poor prognosis groups to obtain a dichotomized(favorable or unfavorable)outcome as the primary outcome.Secondary outcomes included hospitalized complications,mortality,and modified Rankin score at 12 months.Results:A total of 54 patients were analyzed,and the baseline characteristics of patients in the surgery and conservative treatment groups were well matched.The primary favorable outcome at 12 months was significantly higher in the conservative treatment group than in the surgery group(81%vs 44%;OR 1.833,95%CI 1.159-2.900;P=0.005).The incidence of pneumonia in the surgery group was significantly higher than that in the conservative treatment group(P=0.005).Conclusions:It is not recommended to undertake conventional craniotomy for patients with a minor hematoma(25-40 ml)in the basal ganglia.An open craniotomy might induce worse long-term functional outcomes than the conservative treatment.
文摘BACKGROUND Bacillus subtilis(B. subtilis) is considered a nonpathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have been reported, mainly in the form of pyogenic meningitis,usually in cases of direct inoculation by trauma or iatrogenically.CASE SUMMARY A 51-year-old man, with a free previous medical history, presented to the Emergency Department of our hospital complaining of recurrent episodes of left upper limb weakness, during the last month, which had been worsened the last 48 h. During his presentation in Emergency Department he experienced a generalized tonic-clonic grand mal seizure. Brain magnetic resonance imaging(MRI) scan with intravenous Gadolinium revealed a 3.3 cm × 2.7 cm lesion at the right parietal lobe surrounded by mild vasogenic edema, which included the posterior central gyrus. The core of the lesion showed relatively homogenous restricted diffusion. Post Gadolinium T1 W1 image, revealed a ring-shaped enhancement. Due to the imaging findings, brain abscess was our primary consideration. Detailed examination for clinical signs of infectious foci revealed only poor oral hygiene with severe tooth decay and periodontal disease, but without detection of dental abscess. The patient underwent surgical treatment with right parietal craniotomy and total excision of the lesion. Pus and capsule tissue grew B. subtilis and according to antibiogram intravenous ceftriaxone 2 g bids was administered for 4 wk. The patient remained asymptomatic and follow-up MRI scan two months after operation showed complete removal of the abscess.CONCLUSION This case highlights the ultimate importance of appropriate oral hygiene and dental care to avoid potentially serious infectious complications and second, B. subtilis should not be considered merely as laboratory contaminant especially when cultivated by appropriate central nervous system specimen.
文摘The reinforcing effect of transcutaneous acupoint electric stimulation(TAES)on enflurane anesthesia during craniotomy was studied.One hundred and ten neurosurgical patientswere randomly divided into three groups.Anesthesia was maintained with enflurane in Group A(n=40).In Group B,enflurane anesthesia was supplemented by TAES with Han’s acupoint nerve stimu-lator(HANS)at Hegu(LI 4),Yuyao(EX-HN 4)and Fengchi(GB 20)points on the operated side(n=40).In Group C,enflurane anesthesia was supplemented by TAES and scalp infiltration with 0.5％procaine solution(n=30).The results showed that the minimum alveolar concentration(MAC)of enflurane in Group B and C decreased by 37.8-47.0％and 42.1-66.1％respectively than thatin Group A.The hemodynamics was more stable during operation,and the patients recovered after operation in group B and C.It was concluded that TAES with HANS significantly the anesthetic effect and decreased the side effects of enflurane during operation,and that the triplecombination of TAES,enflurane and scalp infiltration with procaine appeared to be a better anestheticmethod for craniotomy.
基金Zhejiang Medicine and Health Science and Technology Project,No.2017KY072.
文摘BACKGROUND Intradural osteoma is very rarely located in the subdural or subarachnoid space.Unfortunately,intradural osteoma lacks specificity in clinical manifestations and imaging features and there is currently no consensus on its diagnosis method or treatment strategy.Moreover,the pathogenesis of osteoma without skull structure involvement remains unclear.CASE SUMMARY We describe two cases of intradural osteomas located in the subdural and subarachnoid spaces,respectively.The first case involved a 47-year-old woman who presented with a 3-year history of intermittent headache and dizziness.Intraoperatively,a bony hard mass was found in the left frontal area,attached to the inner surface of the dura mater and compressing the underlying arachnoid membrane and brain.The second case involved a 56-year-old woman who had an intracranial high-density lesion isolated under the right greater wing of the sphenoid.Intraoperatively,an arachnoid-covered bony tumor was found in the sylvian fissure.The pathological diagnosis for both patients was osteoma.CONCLUSION Surgery and pathological examination are required for diagnosis of intradural osteomas,and craniotomy is a safe and effective treatment.
