Craniotomy Surgery Research Articles

Postoperative wound care protocol prevents surgical site infection after craniotomy.

Postoperative wound care after craniotomy is not standardized. Evaluate the impact of a standardized post-craniotomy wound care protocol on surgical site infection (SSI). Prospective quasi-experimental single-center intervention cohort study involving adult patients undergoing craniotomy at a 461-bed academic medical center in Orange County, California from January 2019-March 2023 (intervention) compared to January 2017-December 2018 (baseline). A postoperative neurosurgical wound care protocol was developed involving chlorhexidine cloths to remove incisional clots and to clean the surgical incision and adjacent hair after craniotomy surgery. Protocol adherence was monitored by routine inpatient surveillance of wounds and photo-documentation for real-time feedback to surgeons and nursing staff. Impact of the intervention was assessed using multivariable regression models. There were 3560 craniotomy surgeries and 62 (1.7%) SSIs; 1251 surgeries and 30 (2.4%) SSIs during baseline, and 2309 surgeries and 32 (1.4%) SSIs during intervention. Process evaluation after implementation found significant decreases in incisional clots, erythema, drainage, and unclean hair. In multivariable analysis, the intervention was associated with fewer SSI (odds ratio (OR): 0.5 (0.3, 0.9), P = 0.02). A standardized post-craniotomy wound care protocol involving cleaning of the incision and adjacent hair, including removal of incisional clots with chlorhexidine cloths was effective in reducing the risk of SSI.

Experiences in Awake Craniotomy from Borneo: A Case Series from Sarawak General Hospital.

The indications for awake craniotomy now spans from resection of tumours at eloquent areas of the brain, deep brain stimulation and treatment of aneurysms to name a few. In the region of East Malaysia where patients have various ethnic backgrounds and native languages, planning and execution of these procedures can be somewhat challenging. This is a retrospective analysis of 11 awake surgeries conducted by the Department of Neurosurgery in Sarawak. The indications for awake craniotomy surgery in our sample population were intra-axial lesions in eloquent regions involving important cortical areas and subcortical tracts which were at risk of damage during tumour excision. Patients were assessed for intra-operative and post-operative neurological deficits. Eleven patients aged 20 years old-70 years old were included in this series. All patients were diagnosed with lesions in eloquent areas of the brain requiring surgical excision. Patients were of various ethnic backgrounds. The spoken language of these patients also varied based on their ethnicity. The histopathological diagnosis of nine patients were consistent with gliomas with three being of high grade. Three patients (27%) developed intra-operative deficits that were not present pre-operatively. This case series serve to demonstrate the feasibility of awake craniotomies even in centres without vast experiences in awake surgeries and ideal adjuncts which in comparison may be readily available in different centres. Although careful patient selection has been emphasised, it is a difficult feat in a region consisting of at least 30 different ethnic groups with distinct languages and cultures.

An efficacy of protection the organs at risks comparison between the intensitymodulated radiotherapy therapy (IMRT) and the three-dimensional conformal radiotherapy (3DCRT).

To compare the efficiency of three-dimensional conformal radiotherapy and intensity-modulated radiation therapy techniques. The cross-sectional study was conducted from February to August 2021 at Al-Amal National Hospital, Baghdad, Iraq, and comprised patients aged 19-45 years with cancerous head and neck tumours of size 2-7cm. All the patients underwent magnetic resonance imaging or computed tomography simulation scans. Treatment planning techniques used for each patient were three-dimensional conformal radiotherapy and intensitymodulated radiotherapy. After evaluating patterns, a better plan and treatment with an X-ray beam was chosen. Data was analysed using SPSS 24. The study involved thirty participants, with 17(57%) females and 13(43%) males, aged 19-45, and 28 patients having chemotherapy. Six out of thirty had craniotomy surgery. The intensity-modulated radiation therapy had a safer radiation dose than the three-dimensional conformal radiotherapy for spinal cord (p=0.3203), brain stem (p= 0.17924), right parotid gland (p=0.8556) and left parotid gland (p=0.2193). The three-dimensional conformal radiotherapy protected the organs better than intensity-modulated radiation therapy for left optic nerve (p=0.1227), right optic nerve (p=0.0032), left eye (p=0.3859), right eye (p=0.1189), left lens (p=0.0004), right lens (p=0.0001), optic chiasm (p=0.0320) and pituitary gland (p=0.9162). The intensity-modulated radiation therapy technique protected the spinal cord, brain stem, and right and left parotid glands. The three-dimensional conformal radiotherapy was safe for left and right optic nerves, left and right eyes, left and right lenses, optic chiasm and pituitary glands.

Efficacy of subcutaneous sumatriptan in postcraniotomy pain and opioid consumption.

Traditional pain management pathways following craniotomy are predicated on opioids. However, narcotics can confound critical neurological examination, contribute to respiratory depression, lower the seizure threshold, and lead to medication habituation, dependence, and/or abuse. Alternative medications to better address postoperative pain while mitigating opioid-related adverse effects remain insufficiently studied. Preliminary studies suggest sumatriptan, a 5-HT (1B/1D) receptor agonist known to regulate dural vasoactivity and inflammation, may moderate pain following trigeminal microvascular decompression and chronic postcraniotomy headache. In this study, the authors evaluated the efficacy of sumatriptan to modulate pain and opioid requirements following craniotomy surgery. This was a single academic center, retrospective cohort study of 300 consecutive adult patients who underwent elective craniotomy surgery between 2015 and 2022. Patients were equally divided between a control and a sumatriptan cohort contingent upon administration of 6 mg of subcutaneous sumatriptan within 1 hour of surgery completion and prior to opioid administration. Postoperative opioid consumption at 6, 12, and 24 hours, as well as admission total, inpatient length of stay, and 30-day global reevaluation, were assessed. Three hundred patients were included for analysis. Significant differences were seen in baseline hypertension (p < 0.01), hyperlipemia (p < 0.01), anxiety (p = 0.04), and operative time (p = 0.02). A significant reduction of mean postoperative pain scores at 12 (p = 0.03) and 24 (p < 0.01) hours and total opioid consumption (p = 0.04) was observed in the sumatriptan cohort. Subgroup analysis revealed significantly lower postoperative pain scores at 6 (p = 0.05), 12 (p < 0.01), and 24 (p < 0.01) hours in patients who underwent burr hole placement in the sumatriptan cohort as compared with controls; however, no significant difference in opioid consumption was noted. No adverse events related to sumatriptan administration were noted throughout the study. Postoperative single-dose subcutaneous sumatriptan following elective craniotomy may reduce pain scores and opioid requirements. Additional studies are needed to better understand nuanced differences in opioid modulation and optimal patient selection.

Comparison of the Effect of Scalp Block With Ropivacaine vs. Ropivacaine and Clonidine on Postoperative Pain in Patients Undergoing Craniotomy Surgery Under General Anesthesia.

Introduction Clonidine, an α2 agonist known for its hypotensive and analgesic effects, has proven beneficial in various routes of administration such as oral, intravenous, and local infiltration. Scalp blocks enhance hemodynamic stability during surgery and reduce intraoperative opioid requirements compared to controls in numerous studies. Additionally, they are effective in managing postoperative pain, resulting in reduced opioid consumption. Research has shown that clonidine can enhance and prolong the effects of intrathecal, epidural, and peripheral nerve blocks (e.g., brachial plexus, peribulbar). Here, we investigated the impact of adding clonidine at a dose of 1 μg/kg to scalp blocks performed with 0.5% ropivacaine for supra-tentorial craniotomy Material and methods This study was conducted on 60 patients under theAmerican Society of Anesthesiologists (ASA) grade I and II who were scheduled for elective supratentorial craniotomy. Patients were divided into two equal groups of 30 and received a scalp block following general anesthesia. Patients in Group A (n=30) received a scalp block of 0.5% ropivacaine plus 1 ml of normal saline (total 21 cc). Patients in Group B (n=30) received a scalp block of 0.5% ropivacaine and clonidine (1 μg/kg) combined with 0.5 ml of normal saline (total 21 cc). Blood pressure, heart rate, peripheral oxygen saturation (SpO2), visual analog score, Ramsay sedation score, duration of analgesia, and analgesia requirement in the first 24 hours were recorded from baseline and postoperatively. Results The duration of first rescue analgesia for Group A was 4.30 ± 1.5 hours and that of Group B was 9.10 ± 1.4 hours. Duration of analgesia was significantly prolonged in patients receiving ropivacaine with clonidine for scalp nerve block. The amount of tramadol given in the first 24 hours in Group A, 62.50 ± 25.00 mg, was highcompared to Group B, 57.14 ± 18.89 mg. The mean arterial blood pressure differed significantly in both groups at 30 minutes, 1 hour, 3 hours, and 12 hours after scalp block postoperatively and lower in Group B. Although changes in pulse rate, and SpO2 were not statistically significant in both groups, patients were hemodynamically stable and did not require any ionotropic support. Ramsay sedation score and visual analog score postoperatively were not significant. There were no significant adverse effects noted in any groups. Conclusion Our study concluded that administering clonidine at a dosage of 1 μg/kg, in combination with 0.5% ropivacaine for scalp nerve block procedures, significantly extends the duration of analgesia and enhances its quality, all while maintaining stable hemodynamic parameters.

“TIPS” and Technical Nuances for Digital Illustration in Neurointerventional Surgery

Medical illustrations represent a precious resource for learning surgical anatomy and surgical techniques, allowing preoperative and postoperative reviews. As traditional hand-drawn illustrations are difficult to use and expressing the area of neurointerventional surgery is time-consuming, we proposed methods for neurointerventional surgeons to create digital illustrations (DIs) for neurointerventional surgery using the iPad-exclusive Procreate application (Savage Interactive, Hobart, Australia). Dedicated "digital pens" were created and used for each endovascular device, creating straightforward representations of neurointerventional procedures and changes over time. DIs in neurointervention easily depict changes to highlighted surgical scenes for various devices with complex configurations and structures. DIs are also versatile, allowing easy intrainstitutional and interinstitutional sharing and discussion of technical tips on the manipulation of medical devices (coils, catheters, stents, etc.) among neurointerventional surgeons worldwide. DIs can be applied as educational tools not only in neurointerventional surgery, but also in craniotomy surgery and for surgical records from other specialties.

Dexmedetomidine Administration does not Affect Electrocorticography Reading during Epilepsy Focal Removal Surgery

Epilepsy prevalent across all ages and genders, making it one of the most widespread neurologic disorder. Worldwide, 20-40% of epilepsy patients are refractory or resistant to oral anti-epileptic drugs, requiring surgery to treat their seizures. The use of electrocorticography (ECoG) can help determine the focus of epilepsy and requires anaesthetic drugs that do not affect the electroencephalography (EEG) readings during surgery. The aim of this case was to study the effect of using dexmedetomidine (DEX) as additional to maintenance anesthesia in epileptic craniotomy surgery with ECoG. A 28-year-old man came to the hospital with complaints of recurrent seizures, generalized tonic-clonic type seizures that lasted 2-3 minutes, was unconscious during the seizure, fell asleep afterwards, and recurred 2-3 times a day. The patient had suffered from epilepsy since 4 years ago. Physical and supporting examinations were within normal limits. Head MSCT examination with contrast suspected oligodendroglioma. The patient was administered dexmetomidine while underwent epilepsy craniotomy surgery with ECoG to remove the tumor which was suspected to be the epileptic focus. The choice of anesthetic agent in epilepsy craniotomy, especially when involving ECoG modalities, requires special consideration to improve intraoperative quality and postoperative outcomes. Propofol is the most widely used induction agent. However, these agents have anticonvulsant effects and activate non-specific spike waves in large areas of the brain. This has the potential to interfere with spike wave monitoring with ECoG. The use of dexmedetomidine has been shown to produce a stable hemodynamic effect and does not affect the ECoG readings. The use of DEX as an adjuvant in anesthesia maintenance does not inhibit spike waves during surgery, so ECoG can be used effectively for anesthesia in craniotomy operations with ECoG.

Dexmedetomidine as Neuroanesthesia Management in Patient with Meningioma Craniotomy

Meningiomas are the type of tumour that grows from the protective membranes of the brain, which line both the brain and spinal cord. The incidence rate of meningioma between females and males is 2:1 and tt is a fairly common neurosurgical case at Margono Soekarjo General Hospital Purwokerto. Dexmedetomidine is the drug of choice used for sedation and analgesia. In various literature, it is said that the use of dexmedetomidine will reduce hemodynamic fluctuations during surgery. A 49-year-old man was hospitalized because of cephalgia and hemiparesis of his left extremity. Computed tomography scan revealed a solid tumour at parietooccipitalis region, lobulated, measuring 7,2 x 7,1 x 4,4 cm, and an increase in intracranial pressure. General anesthesia was administered, beginning with premedication using sufentanil for analgesia, followed by induction with thiopental, and rocuronium for muscle relaxation to facilitate intubation. Dexmedetomidine is an attractive option available for anesthesiologist for maintaining general anesthesia. In this surgical procedure to remove an intracranial tumor, appropriate induction and monitoring of the patient's condition during surgery is required to prevent the risk of increasing intracranial pressure. Dexmedetomidine reduces cerebral blood flow, decreases intracranial pressure, reduces the rate of cerebral oxygen metabolism, and maintains cerebral perfusion pressure. Good management of neuroanesthesia supports the maintenance of hemodynamic stability and leads to better outcomes in craniotomy surgery. Dexmedetomidine has benefits on maintenance of anaesthesia in neurosurgical procedures

Perioperative Craniotomy Excision of Dextra Subtemporal Tumor with Thiopental, Sufentanyl and Invasive Monitor

Intracranial masses can arise from a variety of aetiologies, including congenital, neoplastic, infectious, or vascular processes, each requiring distinct diagnostic and management considerations. Establishing the presence or absence of intracranial hypertension is a critical component of the preoperative evaluation for patients undergoing craniotomy for mass lesions. Hemodynamic is an examination of the physical aspects of blood circulation, cardiac function and physiological characteristics of peripheral vasculature. A 74 year old man was admitted to the hospital because of cephalgia, and left limb weakness. Previously, the patient often felt headaches that came and went since six months ago. Three days before being admitted, the patient felt weak in his left limb and experienced decreasing in consciousness. The patient was given thiopental because the onset of action of thiopental was very short. Administration of intravenous doses of thiopental can cause cerebral vasoconstriction. Sufentanil was administered as an analgesic, because sufentanil is an opioid that has a rapid onset and analgesic potential, compared to fentanyl, intravenous and sufentanil is 5–10 times stronger. This efficacy to maintain adequate cerebral perfusion pressure (CPP), reduce cerebral blood flow (CBF), maintain normal autoregulation, reduce cerebral metabolic rate for oxygen (CMRO2). Arterial cannulation with continuous transduction is considered the gold standard for blood pressure monitoring during anaesthetic procedures. Rapid fluctuations in blood pressure can occur due to patient positioning, surgical manipulation, and the effects of anaesthetics drugs, and close monitoring of these changes is crucial for maintaining hemodynamic stability. The impact of anaesthetic management on CBF is also an integral component of neuroanesthesia, as increases in CBF are associated with increases in cerebral blood volume (CBV). An effective neuro-anesthesia management program that incorporates both invasive blood pressure monitoring and optimization of cerebral perfusion that can help preserving hemodynamic stability and improving outcomes for patients undergoing craniotomy surgery

Topical dexamethason effectiveness combined with surgical intervention in patients suffering from chronic subdural hematoma

BackgroundA chronic subdural hematoma (CSDH) is one of the most common neurosurgery operations. This study aimed to evaluate the effect of topical corticosteroids combined with surgery in patients with CSDH. Materials and MethodsThe present study is a clinical trial study on patients referred to hospitals associated with Ahvaz University of Medical Sciences with chronic subdural hematoma in 2019. Patients requiring surgical drainage of chronic subdural hematoma who met the inclusion criteria underwent open craniotomy surgery on the side of the hematoma. A drain was placed in the open craniotomy site. On the third day after the operation, before removing the drain, 40 mg of methylprednisolone sodium succinate was injected through the drain into the subdural space, after which the drain was pulled entirely. Patients were evaluated with the Markwalder Grading Scale (MGS) on the third day, third month, and sixth month after surgery for improved or worsened neurological symptoms. Also, in the third and sixth months after surgery, the patients underwent Computerized Tomography Scan imaging and were checked for recurrence. Results32 patients with CSDH entered the study, including 28 men and four women, with a mean age of 71.62 ± 9.85 years. Moreover, 87.5 % had a unilateral chronic subdural hematoma (uCSDH), and 12.5 % had a bilateral chronic subdural hematoma (bCSDH). Left and right uCSDHs had the same frequency (43. 8 %). After surgery, 26 patients had no postoperative complications, and six patients experienced pneumocephalus. ConclusionTopical dexamethasone injection through the potential CSDH cavity can result in desirable outcomes.

Clinical Efficacy of Neuroendoscopy Combined with Intracranial Pressure Monitoring for the Treatment of Hypertensive Intracerebral Hemorrhage

ObjectiveTo compare the differences in postoperative complications and prognosis between patients treated with neuroendoscopy versus conventional craniotomy surgery for hypertensive intracerebral hemorrhage (HICH). MethodsIn this retrospective study, a total of 107 patients with HICH were included. Among them, 58 underwent neuroendoscopy (Group A), while 49 underwent conventional craniotomy under microscopic guidance (Group B). Intracranial pressure monitoring (ICPM) was applied in both groups. The clinical data, incidence of postoperative complications, preoperative and postoperative intracranial pressure values, and rate of favorable prognosis were compared between the two groups. ResultsNo significant difference in baseline clinical data upon admission was observed between the two groups (P > 0.05). The preoperative intracranial pressure did not differ between the two groups (P > 0.05), but the postoperative intracranial pressure in Group A was significantly lower than that in Group B (P < 0.05). After intervention with the different surgical approaches, Group A showed a significantly lower incidence of postoperative cerebral infarction and a significantly higher rate of favorable prognosis compared with Group B (P < 0.05). ConclusionNeuroendoscopy combined with ICPM is a safe and reliable approach for the treatment of HICH that reduces the incidence of postoperative cerebral infarction and improves the recovery of neurological function after surgery.

Analysis of Factors Related to the Efficacy of Consciousness-Regaining Therapy for Prolonged Disorder of Consciousness: A Retrospective Cohort Study

To analyse the factors related to the efficacy of consciousness-regaining therapy for prolonged disorder of consciousness. A retrospective analysis was conducted on the case data of 114 patients with pDOC admitted to the Department of Functional Neurosurgery of Tianjin Huanhu Hospital from January 2019 to January 2022 to explore the relevant factors that affect the efficacy of consciousness-regaining therapy (CRT) for prolonged disorder of consciousness (pDOC). Next, basic information on the cases, data on pDOC disease assessment, CRT methods, and efficacy evaluation were collected. These 114 patients were grouped, and a comparative analysis was done based on the efficacy at the end of treatment. Of these, 61 cases were allotted to the ineffective group and 53 cases to the effective group. There was a lack of statistical difference (P > 0.05) between the two groups based on gender, age, etiology, acute cerebral herniation, emergency craniotomy surgery, emergency decompressive craniectomy, time from onset to start of CRT, and CRT duration (P > 0.05). However, secondary hydrocephalus, CRT methods, CRS-R grading before treatment, and GOSE score at six months after treatment were found to be statistically different. The results of binary logistic regression analysis showed that the type of therapy (OR = 0.169, 95% CI: 0.057-0.508) affected the efficacy of CRT (P < 0.05). Personalized awakening therapy using various invasive CRT methods could improve the efficacy of therapy for pDOC compared with non-invasive therapy.

The Effect of Mannitol and Hypertonic Sodium Administration on Hemodynamic Parameters Under LiDCO Monitoring in Patients Undergoing Elective Craniotomy

In craniotomy surgery, it is important to maintain hemodynamics and prevent the increase of intracranial pressure. Using semi-invasive methods such as LiDCO monitoring is a good option in this situation. This study aimed to evaluate the effectiveness of mannitol and hypertonic sodium on hemodynamic parameters in patients undergoing elective craniotomy. This randomized clinical trial was done on 40 patients of both genders. Patients whose ages were between 18-65 years, who had American Society of Anesthesiologists (ASA) score I and II, and who underwent craniotomy surgery were eligible for this study. Participants were divided into two groups receiving hypertonic sodium and mannitol. Hemodynamic parameters were evaluated before surgery, 20 minutes, and 60 minutes after surgery in both groups, under Lithium dilution cardiac output (LiDCO) monitoring. The results showed that there was no difference between groups in terms of the average fluid intake, the duration of the operation, the amount of urinary output, and the primary hemodynamic characteristics. Significant differences were recorded in the evaluation of hemodynamic parameters. The results demonstrated a reduction in systolic, diastolic, and mean arterial blood pressure during 20 to 60 minutes after mannitol injection compared to hypertonic sodium injection. Additionally, the effectiveness of both therapies on maintaining cardiac function was similar, but the use of mannitol led to a greater decrease in arterial and peripheral vascular resistance. It can be concluded that mannitol may be more effective than hypertonic sodium during craniotomy procedures in terms of reducing blood pressure monitored with LiDCO.

Multimodal image fusion-assisted endoscopic evacuation of spontaneous intracerebral hemorrhage

PurposeAlthough traditional craniotomy (TC) surgery has failed to show benefits for the functional outcome of intracerebral hemorrhage (ICH). However, a minimally invasive hematoma removal plan to avoid white matter fiber damage may be a safer and more feasible surgical approach, which may improve the prognosis of ICH. We conducted a historical cohort study on the use of multimodal image fusion-assisted neuroendoscopic surgery (MINS) for the treatment of ICH, and compared its safety and effectiveness with traditional methods. MethodsThis is a historical cohort study involving 241 patients with cerebral hemorrhage. Divided into MINS group and TC group based on surgical methods. Multimodal images (CT skull, CT angiography, and white matter fiber of MRI diffusion-tensor imaging) were fused into 3 dimensional images for preoperative planning and intraoperative guidance of endoscopic hematoma removal in the MINS group. Clinical features, operative efficiency, perioperative complications, and prognoses between 2 groups were compared. Normally distributed data were analyzed using t-test of 2 independent samples, Non-normally distributed data were compared using the Kruskal-Wallis test. Meanwhile categorical data were analyzed via the Chi-square test or Fisher’s exact test. All statistical tests were two-sided, and p < 0.05 was considered statistically significant. ResultsA total of 42 patients with ICH were enrolled, who underwent TC surgery or MINS. Patients who underwent MINS had shorter operative time (p < 0.001), less blood loss (p < 0.001), better hematoma evacuation (p = 0.003), and a shorter stay in the intensive care unit (p = 0.002) than patients who underwent TC. Based on clinical characteristics and analysis of perioperative complications, there is no significant difference between the 2 surgical methods. Modified Rankin scale scores at 180 days were better in the MINS than in the TC group (p = 0.014). ConclusionsCompared with TC for the treatment of ICH, MINS is safer and more efficient in cleaning ICH, which improved the prognosis of the patients. In the future, a larger sample size clinical trial will be needed to evaluate its efficacy.

Neuroanesthesia Management in Cavernous Sinus Meningioma Craniotomy Patients

The most prevalent primary cavernous sinus (CS) lesion is cavernous sinus meningioma (CSM). Of all intracranial neoplasms, 1% are tumors in CS, and 41% are CSM. For contemporary neurosurgeons, orbital involvement in cavernous sinus meningiomas (CSMs) poses special difficulties. The condition is known as cavernous sinus meningioma (CSM) gradually impairs vision and may ultimately result in chiastic compression. Since January 2023, a male 55-year-old had been admitted to the hospital with cephalgia and mild diplopia in his right eye. Cavernous meningiomas were discovered using CT scans, and a craniotomy procedure was scheduled to remove the tumor. In order to facilitate intubation, the patient was given a premedication of sufentanyl for analgesia and was then given general anesthesia. Rocuronium was used to relax the muscles. Desflurane is an attractive option available to anesthesiologists to maintain general anaesthesia. This surgical procedure of removing intracranial tumours requires proper induction and monitoring of the patient's condition during surgery to prevent increased intracranial pressure. Intracranial elevation can cause systemic changes such as hypertension and changes in heart rhythm, as well as cerebral artery spasm, and lead to cerebral infarction and cerebral ischemia. An effective neuroanesthesia management program can help preserve hemodynamic stability and improve results during craniotomy surgery for the removal of meningiomas

Characteristics of Patients with Epidural Hemorrhage in Head Injury at a RSUP Prof. Dr. I.G.N.G Ngoerah in 2022

Introduction: Head injury is a condition of brain disorder that often occurs in Indonesia and 2 out of 100 head injury cases are epidural hematoma (EDH), which is intracranial hemorrhage where there is an accumulation of blood between the dura mater and internal tabula. Therefore, it is necessary to review the characteristics of epidural hemorrhage. This study aims to determine the characteristics of EDH patients in head injuries at RSUP Prof. Dr. I. G. N. G Ngoerah in 2022. Materials and Methods: This study used a retrospective descriptive method. The data were collected through medical records of epidural hemorrhage patients in 2022 at Prof. Dr. I. G. N. G Hospital, then analyzed descriptively using SPSS version 26. Results: From 88 cases obtained, most of them were male (79.5%), including the age group of adolescents and young adults with an age range of 15–24 years (35.2%). The most common case was mild head injury with a Glasgow Coma Scale of 14–15 (47.7%), bleeding volume in the interval 0–25 cc (60.2%), and found without midline shift (54.5%). Most patients had linear fractures (80.7%) and the majority of patients had bleeding in the temporal region (40.3%). Furthermore, more patients received conventional management (51.1%) than patients with craniotomy surgery (48.9%). Conclusion: In this study, adolescent male patients predominated. Mild head injury was the most common case with a bleeding volume of 0–25 cc without midline shift. Linear fracture and bleeding in the temporal region was the most characteristic result of epidural bleeding with nonoperative management found in most of the patients.

Enhanced recovery in cranial surgery (ERACraS) – A single-centre quality improvement study

BackgroundEnhanced Recovery After Surgery (ERAS) is a well-established, protocol-driven, evidence-based approach to peri-operative care. ERAS protocols have been used to improve patient morbidity and mortality outcomes in various surgical specialties. More recently, it has been introduced to neurosurgery. Our aim was to establish an Enhanced Recovery After Cranial Surgery (ERACraS) protocol for patients as part of a quality improvement project (QIP) with the intention of reducing hospital length of stay (HLOS). MethodsThis QIP was carried out in the Department of Neurosciences (DCN), Edinburgh, over two four-month periods. A total of 40 patients over 18 years of age undergoing elective craniotomy surgery under a sole neurosurgeon were invited to take part in this QIP. Subsequently, data was retrospectively collected through our institution’s online documentation system. Results19 patients received conventional perioperative care (pre-ERACraS group) during December 2021-March 2022, and 21 received care according to the novel ERACraS (ERACraS group) during June-September 2022. Regarding supra-tentorial surgery, there was a reduction of 73% in HLOS in the ERACraS group. No change was observed in infra-tentorial surgery. Overall, the ERACraS protocol reduced HLOS by 50% in cranial surgery. ConclusionThe QIP data from ERACraS in our unit has shown that implementing ERAS protocols is feasible. A reduction in HLOS has implications for patient morbidity, mortality, and quality of care. We endeavour to collect long-term data by collaborating with neurosurgical units across the UK and Ireland to validate its feasibility and sustainability as part of a major QIP in neurosurgical practice. This can be potentially adopted by neurosurgical centres across the globe in a safe and sustained manner.

Acute subdural hematoma in a footballer following a head-ball of the ball: a rare neurosurgical complication

Acute subdural hematoma is a frequent complication of high-energy head injuries. Herein, we report an unusual case of this condition that occurred in a young footballer after he head-balled a football. A 37-year-old footballer, during a match, jumped and gave a head shot on the ball. Upon landing, he felt severe headaches forcing him out of the stadium. About 4 h later, he lost consciousness and went into a coma. After resuscitation, he remained clouded, with cephalalgia and had left hemiparesis. The performed brain scan revealed an acute right fronto-parietal subdural hematoma and the patient benefited from craniotomy surgery in our department with simple postoperative suites. The authors, after a brief discussion of the biomechanics of this serious condition, ask all the actors of this very popular sport, to consider the possibility of occurrence of this condition in players.

Cost Effectiveness General Anesthesia Combined with Scalp Block Compared to General Anesthesia in Patients Undergoing Removal Tumor Craniotomyin Dr. Sardjito Hospital

Background. Providers of anesthesia services have many opportunities to reduce these costs, of course with the aim of maintaining balance between profit, security and costs. Craniotomy surgery removal of the scalp block tumor is an alternative option that can be combined with general anesthesia. The scalp block itself can blunt stress response in craniotomy and can maintain unwanted hemodynamic instability.&#x0D; Purpose. Find out the cost effectiveness of the scalp block in craniotomy patients removing tumors at Dr. SARDJITO Hospital.&#x0D; Method. Method. Twenty patients ranging in age from 18 - 65 years with intracranial tumors who underwent tumor binding craniotomy at RSUP Dr. SARDJITO is grouped into two treatment groups with general anesthesia and general anesthesia with a combination of scalp blocks, both techniques are calculated using drugs and consumables during the operation.&#x0D; Results. Total cost on the general anesthesia combined scalp block was Rp. 1,347,276 lower Rp. 377,833 compared to general anesthesia Rp. 1,725,109 with a significant difference (p = 0.005). Similarly, the hourly cost of the group in the combined general anesthesia scalp block was Rp. 286,351 Rp. 97,107 lower than general anesthesia Rp. 383,457 with a significant difference (p = 0.038).&#x0D; Conclusion. Combination of general anesthesia and scalp block using 0.5% levobupivacaine more cost effective than general anesthesia and scalp block with placebo in supratentorial tumor patients undergoing tumor removal craniotomy.

Preoperative hematocrit levels and postoperative mortality in patients undergoing craniotomy for brain tumors.

Abnormal hematocrit values, including anemia and polycythemia, are common in patients undergoing craniotomy, but the extent to which preoperative anemia or polycythemia independently increases the risk of mortality is unclear. This retrospective cohort study aimed to examine the association between preoperative anemia and polycythemia and postoperative mortality in patients who underwent craniotomy for brain tumor resection. We retrospectively analyzed data from 12,170 patients diagnosed with a brain tumor who underwent cranial surgery at West China Hospital between January 2011 and March 2021. The preoperative hematocrit value was defined as the last hematocrit value within 7 days before the operation, and patients were grouped according to the severity of their anemia or polycythemia. We assessed the primary outcome of 30-day postoperative mortality using logistic regression analysis adjusted for potential confounding factors. Multivariable logistic regression analysis reported that the 30-day mortality risk was raised with increasing severity of both anemia and polycythemia. Odds ratios for mild, moderate, and severe anemia were 1.12 (95% CI: 0.79-1.60), 1.66 (95% CI: 1.06-2.58), and 2.24 (95% CI: 0.99-5.06), respectively. Odds ratios for mild, moderate, and severe polycythemia were 1.40 (95% CI: 0.95-2.07), 2.81 (95% CI: 1.32-5.99), and 14.32 (95% CI: 3.84-53.44), respectively. This study demonstrated that moderate to severe anemia and polycythemia are independently associated with increased postoperative mortality in patients undergoing craniotomy for brain tumor resection. These findings underscore the importance of identifying and managing abnormal hematocrit values before craniotomy surgery.