Effect Of Craniotomy Research Articles

A prospective exploratory study to assess echocardiographic changes in patients with supratentorial tumors - Effect of craniotomy and tumor decompression.

Functional changes in the myocardium secondary to increased intracranial pressure (ICP) are studied sparingly. Direct echocardiographic changes in patients with supratentorial tumors have not been documented. The primary aim was to assess and compare the transthoracic echocardiography changes in patients with supratentorial tumors presenting with and without raised intracranial pressure for neurosurgery. Patients were divided into two groups based on preoperative radiological and clinical evidence of midline shift of <6 mm without features of raised ICP (Group 1) or greater than 6mm with features of raised ICP (Group 2). Hemodynamic, echocardiographic, and optic nerve sheath diameter (ONSD) parameters were obtained during the preoperative period and 48 h after the surgery. Ninety patients were assessed, 88 were included for analysis. Two were excluded based on a poor echocardiographic window (1) and change in the operative plan (1). Demographic variables were comparable. About 27% of the patients in Group 2 had ejection fraction <55% and 21.2% had diastolic dysfunction in Group 2 in the preoperative period. There was a decrease in the number of patients with a left ventricular (LV) function <55% from 27% before surgery to 19% in the postoperative period in group 2. About 5.8% patients with moderate LV dysfunction in the preoperative period had normal LV function postoperatively. We found a positive correlation between ONSD parameters and radiological findings of raised intracranial pressure. The study demonstrated that in patients with supratentorial tumors with ICP, cardiac dysfunction might be present in the preoperative period.

Importance of Control Groups for Evaluating Long-Term Behavioral and Cognitive Outcomes of Controlled Cortical Impact in Immature Rats.

Therapies are limited for pediatric traumatic brain injury (TBI), especially for the very young who can experience long-term consequences to learning, memory, and social behavior. Animal models of pediatric TBI have yielded mechanistic insights, but demonstration of clinically relevant long-term behavioral and/or cognitive deficits has been challenging. We characterized short- and long-term outcomes in a controlled cortical impact (CCI) model of pediatric TBI using a panel of tests between 2 weeks and ∼4 months after injury. Male rats with CCI at postnatal Day (PND) 10 were compared with three control groups: Naïve, Anesthesia, and Craniotomy. Motor testing (PND 25-33), novel object recognition (NOR; PND 40-50), and multiple tasks in water maze (WM; PND 65-100) were followed by social interaction tests (PND 120-140). Anesthesia rats performed the same as Naïve rats in all tasks. TBI rats, when compared with Naïve controls, had functional impairments across most tests studied. The most sensitive cognitive processes affected by TBI included those that required fast one-trial learning (NOR, WM), flexibility of acquired memory traces (reversals in WM), response strategies (WM), or recognition memory in the setting of reciprocal social interactions. Both TBI and Craniotomy groups demonstrated increased rates of decision making across several WM tasks, suggesting disinhibition of motor responses. When the TBI group was compared with the Craniotomy group, however, deficits were detected in a limited number of outcomes. The latter included learning speed (WM), cognitive flexibility (WM), and social recognition memory. Notably, effects of craniotomy, when compared with Naïve controls, spanned across multiple tasks, and in some tasks, could reach the effect sizes observed in TBI. These results highlight the importance of appropriate control groups in pediatric CCI models. In addition, the study demonstrates the high sensitivity of comprehensive cognitive testing to detect long-term effects of early-age craniotomy and TBI and provides a template for future testing of experimental therapies.

Effectiveness of craniotomy and long-term survival in 35 patients with gestational trophoblastic neoplasia with brain metastases: a clinical retrospective analysis.

ObjectiveTo investigate the clinical characteristics, treatments, and prognostic factors among patients with gestational trophoblastic neoplasia (GTN) exhibiting brain metastases who underwent craniotomy.MethodsThirty-five patients with GTN who had brain metastases and subsequently underwent craniotomies between January 1990 and December 2018 at Peking Union Medical College Hospital were identified using the GTN database. Their clinical manifestations, treatments, outcomes, and prognostic factors were retrospectively analyzed.ResultsAll 35 patients underwent decompressive craniotomy, hematoma removal, and metastatic tumor resection combined with multiagent chemotherapy. Eighty percent (28/35) achieved complete remission, 11.4% (4/35) achieved partial remission, and 8.6% (3/35) had progressive disease. Not counting 2 patients who were lost to follow-up, 81.8% of the patients (27/33) were alive after a median follow-up of 72 months. The 5-year overall survival rate was 80.4%. Univariate analysis revealed that a history of chemotherapy failure (p=0.020) and a >1-week interval between craniotomy and chemotherapy commencement (p=0.027) were adverse risk factors for survival. Multivariate analysis showed that previous chemotherapy failure remained an independent risk factor for poor survival (odds ratio=11.50; 95% confidence interval=1.55–85.15; p=0.017).ConclusionDecompressive craniotomy is a life-saving option if metastatic hemorrhage and intracranial hypertension produce a risk of cerebral hernia in patients with GTN who have brain metastases. Higher survival rates and improved prognoses can be achieved through perioperative multidisciplinary cooperation and timely standard postoperative chemotherapy.

Observation on the effect of craniotomy with large bone flaps on acute craniocerebral trauma and its influence on stress response of patients

Objective To investigate the effect of large bone flap craniotomy on acute craniocerebral trauma and its influence on stress response. Methods From January 2015 to December 2018, 80 patients with acute craniocerebral trauma were randomly divided into control group (40 cases) and observation group (40 cases) by random number table method.The patients in the control group were treated with conventional craniotomy and decompression, while the patients in the observation group were treated with craniotomy with large bone flaps.The changes of intracranial pressure, Glasgow coma index (GCS score), stress response index, prognosis and complications after 6 months were compared between the two groups before treatment and 2 weeks after treatment. Results Two weeks after treatment, the intracranial pressure in the observation group [(8.48±2.10)mmHg] was lower than that in the control group [(11.86±1.74) mmHg], while the GCS score[(10.35±1.87)points] was higher than that in the control group [(7.69±1.15)points](t=19.434, 7.663, all P<0.05). Two weeks after treatment, the serum levels of ACTH [(35.19±5.46)mg/L] and cortisol [(17.41±4.56)mg/L] in the observation group were lower than those in the control group [(48.91±4.95)mg/L and (28.93±7.48)mg/L] (t=11.774, 8.317, all P<0.05). Six months after treatment, the prognosis of the observation group(60.00%) was better than that of the control group (32.50%) (χ2=6.084, P<0.05). The incidence of complications of the observation group (5.00%) was lower than that of the control group (22.50%) (χ2=5.165, P<0.05). Conclusion Craniotomy with large bone flaps has good effect in the treatment of patients with acute craniocerebral trauma, and can reduce stress response and with fewer complications, which is worthy of clinical reference. Key words: Craniotomy; Decompression, surgical; Craniocerebral trauma; Intracranial pressure; Glasgow coma index; Stress response

Management of Spontaneous Superficial Intracerebral Hematomas

Background: Treatment of primary spontaneous superficial intracerebral hemorrhage (SSICH) is still controversial. The aim of this study is to investigate the effectiveness of craniotomy and early hematoma evacuation vs conservative (non operative) management in patients with SSICH. Methods: A prospective study of craniotomy and early hematoma removal vs. medical management was performed in 20 patients with cortical and subcortical (superficial) primary SSICH admitted to Assiut university hospital in one year period (March 2016-March 2017). Surgical or medical treatment was initiated immediately when patients admitted to hospital. We divided the patients into two groups according to type of treatment. Results: Age of the patients ranged from 2 months to 73 years (mean: 45.84 ± 23.28 years) among the 20 patients studied; 13 (65%) were males and 7 (35%) were females. Glasgow coma scale (GCS) at admission was less than 8 in 25%, between 8 - 12 in 45% and 15 in 30% of the patients. Arterial hypertension was the most common associated medical disease (65%). Eleven of patients (55%) had ventricular extension. GCS at admission was the strongest factor affecting outcomes and determined the type of treatment. All patients with a GCS ≤ 8 (5 cases (25%) were died regardless the type of treatment and there was no significant statistical difference in this group in relation to type of treatment p-value (0.606). We had 6 cases (30%) with a GCS 15; all of them were treated conservatively and all of them survived with significant p-value (0.003). Nine patients (45%) had GCS 8 - 12; two of them were treated conservatively and died while the remaining seven patients were treated surgically; five of them survived with significant p-value (0.025). No significant statistical difference was found in the outcome between the surgical and the conservative group regarding having associated intracranial hemorrhage. Conclusions: After analyzing the results, we found that when the GCS is “8 - 12”, surgical intervention is recommended and carried a better prognosis than waiting for the conservative treatment. When GCS is higher “>12”, conservative treatment can be the favorable option. Otherwise, we found no statistical difference between surgical and conservative treatment in the treatment of ICH.

Effect of craniotomy on oxidative stress and its effect on plasma L-carnitine levels.

to investigate the impact of craniotomy on oxidative stress and its effect on levels of plasma L-carnitine (LC). plasma levels of reactive oxygen species, superoxide dismutase (SOD), glutathion peroxidase (GSH-Px), catalase (CAT), total antioxidative capacity (T-AOC), and thiobarbituric acid reactive substances (TBARS) were measured in 34 patients (26 males and 8 females, mean age 47.7 ± 6.7 years) before and after craniotomy. Plasma levels of LC, acetyl-L-carnitine (ALC), and propionyl-L-carnitine (PLC) were also measured before and after the craniotomy. the plasma concentrations of SOD, GSH-Px, CAT, and T-AOC within the first 4 h after craniotomy were lower than their baseline values (P < 0.05). There were no statistically significant differences in the mean plasma levels of SOD, GSH-Px, CAT, or T-AOC between the baseline and 24 h post-operative values. The level of TBARS at 4 h after the craniotomy was lower than the pre-operative level (P < 0.05), but the 24 h post-operative value was similar to the baseline concentration (P > 0.05). Plasma levels of LC, ALC, and PLC were lower after the craniotomy (P < 0.05), but these levels returned to the baseline levels 24 h after the operation. craniotomy and the associated procedures for surgery/anesthesia temporarily reduce antioxidant activity and plasma levels of L-carnitine.

Surgical Trials in Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is crucially important neurological emergency with high societal impact of >1 million deaths worldwide each year.1–3 The pathophysiology of intracerebral hemorrhage can be considered to occur in ≤2 conceptual phases. In the first phase, there is immediate cellular injury in the hemorrhage core because of the acute bleed and early hemorrhagic expansion. The final hemorrhagic volume after the period of hemorrhagic expansion and the location are of hemorrhage are strong predictors of outcome.4,5 Prevention of hemorrhagic expansion can be achieved,6 but doing so does not improve outcome. The second conceptual phase of brain hemorrhage is the persistent hematoma phase characterized by progressive damage to perihematomal tissue caused by mass effect, excitotoxic edema, and progressive neurotoxicity resulting from iron, thrombin, blood breakdown products, free radical formation, protease activation and inflammation, and hyperglycolysis.7–12 The evolutionary damage to the perihematomal tissue is complex and involves multiple mechanisms that are presumed to be linked to the presence of the mass of collected blood and progressive edema. Animal models demonstrate that persistence of the hematoma in brain tissue results in progressive brain edema, metabolic distress, and potentially other mechanisms, which result in long-term disability. We hypothesize that in humans, early removal of the hemorrhage from the parenchyma will result in avoidance or mitigation of these secondary insults and result in substantially enhanced neurological recovery. The effectiveness of craniotomy in the treatment of ICH remains controversial, despite having been evaluated during the past 4 decades. To date, ≤7 randomized trials of surgical intervention have been completed and published in the English language (Table).13–19 Results of individual trials have generally failed to demonstrate improvement in outcome in surgically treated patients. View this table: Table. Randomized Surgical Trials for Intracerebral Hemorrhage Interestingly, the 1 positive trial used a minimally invasive surgical …

Effect of craniotomy on blood-brain barrier in rats

Objective To investigate whether the macromolecular materials could enter cerebrospinal fluid and brain tissues in craniotomy with incision or non-incision of dura and arachnoid. Methods Adult male SD rats were randomly divided into three groups according to the random number table. The dura and arachnoid of rats in group A were cut open during craniotomy after general anesthesia; epidural craniotomy was done in rats in group B after general anesthesia; rats in group C (control group) were only generally anesthetized. All the rats were injected with Evans blue, a tracer used to detect the results, half an hour before each time point (1,3, 6, 12, 24, 72 hours and 1 week) via vein. The rats were executed at each time point to obtain the specimens of brain. The content of Evans blue in brain tissue was measured by fluorescence spectrophotometer for statistical analysis. The water content in the brain tissue was measured in a part of rats selected in groups A and B preoperatively and at postoperative 3 and 27 hours. Results It was found that some regions of the brain tissue were stained light blue in group A at 1,3, 6 and 24 hours. The blue was much lighter in brain tissue obtained at 72 hours in group A, and no blue stained at 1 week in group A . The contents of Evans blue in the brain tissues of rats in group A at 1,3, 6, 12, 24, 72 hours and 1 week were (18.07±1.25) μg/ml, (36.21±0.78) μg/ml, (25.73±1.14) μg/ml, (16.53±0.84) μg/ml, (23.34±1.91) μg/ml, (43.34±2.25) μg/ml and (25.27±1.88)μg/ml respectively, which were significantly higher than (3.15±0.45)μg/ml, (3.36±0.33)μg/ml, (2.98±0.54)μg/ml, (3.47±0.55)μg/ml, (3.54±0.37) μg/ml, (2.88± 0.42) μg/ml and (2.85±0.22) μg/ml respectively in group B and (2.97±0.37)μg/ml in group C (P 0.05). Conclusion After craniotomy with incision of dura and arachnoid, some macromolecular materials can enter the subarachnoid space and the brain parenehyma through blood-brain barrier of the wound of the scalp if the dura is sutured loosely. Key words: Neurosurgical procedures; Blood-brain barrier; Evans blue; Craniotomy

Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury

IntroductionAcute post-traumatic brain swelling (BS) is one of the pathological forms that need emergent treatment following traumatic brain injury. There is controversy about the effects of craniotomy on acute post-traumatic BS. The aim of the present clinical study was to assess the efficacy of unilateral decompressive craniectomy (DC) or unilateral routine temporoparietal craniectomy on patients with unilateral acute post-traumatic BS.MethodsSeventy-four patients of unilateral acute post-traumatic BS with midline shifting more than 5 mm were divided randomly into two groups: unilateral DC group (n = 37) and unilateral routine temporoparietal craniectomy group (control group, n = 37). The vital signs, the intracranial pressure (ICP), the Glasgow outcome scale (GOS), the mortality rate and the complications were prospectively analysed.ResultsThe mean ICP values of patients in the unilateral DC group at hour 24, hour 48, hour 72 and hour 96 after injury were much lower than those of the control group (15.19 +/- 2.18 mmHg, 16.53 +/- 1.53 mmHg, 15.98 +/- 2.24 mmHg and 13.518 +/- 2.33 mmHg versus 19.95 +/- 2.24 mmHg, 18.32 +/- 1.77 mmHg, 21.05 +/- 2.23 mmHg and 17.68 +/- 1.40 mmHg, respectively). The mortality rates at 1 month after treatment were 27% in the unilateral DC group and 57% in the control group (p = 0.010). Good neurological outcome (GOS Score of 4 to 5) rates 1 year after injury for the groups were 56.8% and 32.4%, respectively (p = 0.035). The incidences of delayed intracranial hematoma and subdural effusion were 21.6% and 10.8% versus 5.4% and 0, respectively (p = 0.041 and 0.040).ConclusionsOur data suggest that unilateral DC has superiority in lowering ICP, reducing the mortality rate and improving neurological outcomes over unilateral routine temporoparietal craniectomy. However, it increases the incidence of delayed intracranial hematomas and subdural effusion, some of which need secondary surgical intervention. These results provide information important for further large and multicenter clinical trials on the effects of DC in patients with acute post-traumatic BS.Trial registrationISRCTN14110527

Cortical stimulation of language fields under local anesthesia: optimizing removal of brain lesions adjacent to speech areas

The main objective when resecting benign brain lesions is to minimize risk of postoperative neurological deficits. We have assessed the safety and effectiveness of craniotomy under local anesthesia and monitored conscious sedation for the resection of lesions involving eloquent language cortex. A retrospective review was performed on a consecutive series of 12 patients who underwent craniotomy under local anesthesia between 2001 and 2004. All patients had lesions close to the speech cortex. All resection was verified by post-operative imaging. Six subjects were male and 6 female, and were aged between 14 and 52 years. Lesions comprised 7 tumour lesions, 3 cavernomas and 1 dermoid cyst. Radiological gross total resection was achieved in 66% of patients while remaining cases had greater than 80% resection. Only one patient had a post-operative permanent deficit, whilst another had a transient post-operative deficit. All patients with uncontrollable epilepsy had good outcomes after surgery. None of our cases subsequently needed to be put under general anesthesia. Awake craniotomy with brain mapping is a safe technique and the "gold standard" for resection of lesions involving language areas.

Awake Craniotomy Under Local Anaesthesia and Monitored Conscious Sedation for Resection of Brain Tumours in Eloquent Cortex – Outcomes in 20 Patients

Resection or even biopsy of an intra-axial mass lesion in close relationship to eloquent cortex carries a major risk of neurological deficit. We review the safety and effectiveness of craniotomy under local anaesthesia and monitored conscious sedation for resection of mass lesions involving eloquent cortex. We performed a 3-year retrospective review of patients who underwent awake craniotomy under local anaesthesia at the National Neuroscience Institute, Singapore. All patients had tumours in close proximity to eloquent cortex, including speech areas in the dominant hemisphere as well as primary sensory and motor cortex in either hemisphere. Brain mapping was performed by direct cortical stimulation using the Ojemann stimulator to identify a safe corridor for surgical approach to the tumour. Intraoperative physiological monitoring was carried out by assessment of speech, motor and sensory functions during the process of surgical resection. All resections were evaluated and verified by postoperative imaging and reviewed by an independent assessor. Postoperative complications and neurological deficits, as well as extent of tumour resection, were evaluated. A total of 20 patients underwent stereotactic resection over a period of 3 years from July 2003 to August 2006. There were 7 male patients and 13 female patients, with a mean age of 39.8 years. The average length of stay was 5.5 days. There were no major anaesthetic complications and no perioperative deaths. Postoperative neurological deficits were seen in 6 patients (30%) and this was permanent in only 1 patient (5%). The degree of cytoreduction achieved was greater than 90% in 58% of patients and a further 21% had greater than 80% cytoreduction. Tumour surgery with conscious sedation in combination with frameless computer stereotactic guidance is a safe technique that allows maximal resection of lesions in close relationship to eloquent cortex and has a low risk of neurological deficit.

The effect of craniotomy on the intracranial hemodynamics and cerebrospinal fluid dynamics in humans

The goal of the research was to study the effect of the trephination of the human cranial cavity on the intracranial hemodynamics and cerebrospinal fluid (CSF) dynamics. The sample comprised 15 patients of a neurosurgical clinic in whom a trephine opening in the cranial bones was made for medical indications. In these patients, at rest and during an appropriate functional load, we recorded pulse changes in blood circulation (by transcranial Doppler sonography) and in the ratio between the pulse fluctuations in the blood and CSF volumes (by rheoencephalography) before and after surgery. Simultaneous recording of these parameters followed by computer pattern and phase analyses allowed evaluation of the complex biomedical compliance of the cranium during successive phases of the cardiac rhythm: the inflow of arterial blood, the redistribution of blood/CSF volumes, and the outflow of venous blood. Analysis of the results showed a beneficial influence of craniotomy on the intracranial hemodynamics and CSF dynamics. This was reflected in an increase in the cranial compliance, which increased the pulse increment in the volume of the arterial blood in the skull almost twofold. After craniotomy, the cross-flow of CSF between the cranial and spinal cavities decreased significantly, giving way to volumetric compensatory translocations of blood and CSF within the cranial cavity per se during the cardiac cycle, which increased the intracranial utilization of the energy of the cardiac output and contributed to the outflow of venous blood from the cranium. The results suggest a beneficial effect of craniotomy on the physiological mechanisms of the circulatory and metabolic maintenance of the brain activity.

Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex.

Resection or even biopsy of an intra-axial mass lesion in close relationship to eloquent cortex carries a major risk of neurological deficit. We have assessed the safety and effectiveness of craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex. We have performed a retrospective review of a consecutive series of 157 adult patients who underwent craniotomy under local anesthesia by one surgeon (P.M.B.) at Brigham and Women's Hospital in Boston. All patients had tumors in close proximity to eloquent cortex, including speech, motor, primary sensory, or visual cortex. In most cases the lesion was considered inoperable by the referring surgeon. All resection was verified by post-operative imaging approximately one month after surgery and all cases were reviewed by an independent neurosurgeon (A.D.). In 122 cases, brain mapping was performed to identify eloquent cortex and in the remainder neurological monitoring was maintained during the procedure. Radiological gross total resection was achieved in 57% of patients and greater than 80% resection was achieved in 23%. Thus 4 out of 5 of patients had major resection despite the close relationship of tumor to eloquent cortex. In 13%, less than 80% of tumor was removed because of danger of neurological deficit. In 7% of patients, only a biopsy could be done because of infiltration into eloquent cortex that could only be assessed at surgery. In 76 patients with pre-operative neurological deficits, there was complete resolution of these deficits in 33%, improvement in 32%, no change in 28%, and long-term worsening in 8%. Among 81 patients with no pre-operative neurological deficit, 1 patient suffered a major permanent neurological deficit, and 2 developed minor deficits. There was a transient post-operative deficit in one-third of cases, but this had resolved at one month in all but three patients. Monitored conscious sedation was performed without anesthetic complications using midazolam, sufentanyl and fentanyl with or without propofol. Only one case needed to be converted to general anesthesia. Patient satisfaction with the procedure has been good. Operating time and hospital stay were lower than the mean for brain tumor craniotomy at this hospital. Tumor surgery with conscious sedation is a safe technique that allows maximal resection of lesions in close anatomical relationship to eloquent cortex, with a low risk of new neurological deficit. Only 7% of intrinsic cortical tumors were ineligible for partial or complete resection with this technique.

Does the requirement of a craniotomy predict outcome?: a preliminary investigation

The literature has been replete with reports that persons who require craniotomy for the treatment of their traumatic brain injury have a far worse outcome. The majority of these reports have utilized the rather global Glasgow Outcome Scale as a determinant of outcome. This paper sought to evaluate the effect of craniotomy on outcome as measured by the DRS. Data was collected on 341 persons (mean age 37.7 years) with traumatic brain injury treated at the Level I trauma centre, who required inpatient rehabilitation. Surgical interventions were classified as 'no surgery', 'one cranial surgery', or 'two or more cranial surgeries'. Initial GCS scores revealed 44 persons at GCS 3-5, 102 persons at GCS 6-8, 83 persons at GCS 9-12 and 112 persons at GCS 13 15. The DRS was administered to each person at discharge from in patient rehabilitation. Mean DRS scores were 7.07 for GCS 3-5, 6.03 for GCS 6-8, 6.53 for GCS 9-12, 5.57 for GCS 13-15 groups. A factorial ANOVA revealed an interaction between initial GCS and surgical status. Univariate ANOVA's demonstrated significant differences in the GCS 3-5 and GCS 13-15 groups, suggesting a relationship between need for surgical intervention and less favourable outcome among persons who required in patient rehabilitation. However, no differences were demonstrated in the GCS 6-8 and GCS 9-12 groups. It appears that requiring surgical intervention is prognostic at only the extremes of the GCS categories and, thus, further investigation may reveal the limited role of need for surgical intervention injury in predicting outcome in persons with initial GCS 6-12.

Leakiness of rat brain microvessels to fluorescent probes following craniotomy.

The effects of craniotomy and/or histamine treatment upon brain microvascular permeability was studied in Wistar rats. Extravasation of circulating Na-fluorescein (MW 376) and of FITC-albumin (MW 69,000) was observed through a cranial window using intravital fluorescence microscopy. Simple exposure of the pial microvessels induced formation of discrete spots of fluorescent material around venules, but not around arterioles or capillaries. The average number of leaky spots to Na-fluorescein and to FITC-albumin was 4.3 and 1.8 per 10 mm2, respectively, 35 min after exposure. Pretreatment of the rats with either indomethacin (a cyclo-oxygenase inhibitor) or promethazine (a histamine H1-receptor blocker) did not reduce the number of leaky sites, whereas pretreatment with a combination of the two drugs had a significant protective effect. Administration of histamine (10(-4) M) to the exposed brain surface for 5 min increased the number of leaky sites to Na-fluorescein and FITC-albumin 3.2 and 3.6 times, respectively. It is concluded that exposure of the brain surface induces release of histamine and cyclo-oxygenase metabolites, and that these inflammatory mediators elicit formation of leaky sites in brain venules.

Solitary cerebral metastasis: the effect of craniotomy on the quality and the duration of survival.

The authors report 57 patients in whom craniotomies for solitary intracranial metastatic tumor were performed in Vancouver General Hospital between 1970 and 1980. The median survival after craniotomy varied between 3.5 and 10 months depending upon the types of primary tumors. Patients with metastatic central nervous system (CNS) tumor from breast, kidney, or an unknown primary site had longer periods of survival than those with bronchogenic carcinoma. The outcome for metastatic melanoma was poor. Eighty-two per cent of the patients were able to enjoy home life and were self-dependent at the time of discharge from the hospital. A long latent interval between the primary tumor diagnosis and secondary CNS metastasis favored longer survival for patients with bronchogenic carcinoma, but not for those with melanoma. The presence of systemic metastases was an adverse factor. There was no significant difference in the duration of survival between patients with right- or left-sided cerebral lesions, but those with right hemispheric involvement had a better quality of survival. The use of computed tomographic scanning improved both the duration and the quality of postoperative survival.

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

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

Indium (111In)-Labelled Bleomycin for the Detection of Intracranial Lesions

Brain scans with 99mTc pertechnetate were compared with scans made after administration of 111Indium bleomycin in 38 patients scanned on 41 occasions. They gave similar results in 34 pairs of examinations, including cases in which both failed to detect the tumour. In seven cases, the two agents differed. In two of these bleomycin distinguished residual tumour from the effects of craniotomy more clearly than did pertechnetate; in three bleomycin apparently detected tumour not seen with pertechnetate, and in two the differences may have been due to technical factors, or are unexplained.

The Effect of Craniotomy on the Brain Scan

The Effect of Craniotomy on the Brain Scan