Intracranial Tumor Resection Research Articles

Causes and Predictors of Unplanned Readmission in Patients Undergoing Intracranial Tumor Resection: A Multicenter Analysis of 31,776 Patients

Although unplanned readmission is a postoperative outcome metric associated with significant morbidity and financial burden, precise assessment tools for its prediction are yet to be developed. The Risk Analysis Index (RAI) could potentially be utilized to help improve prediction unplanned readmission in patients undergoing intracranial tumor resection (ITR). Here we evaluate the predictive accuracy of frailty on 30-day unplanned readmission following ITR using the RAI. Data were obtained from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database. Baseline characteristics, preoperative clinical status, and outcomes were compared between patients with and without unplanned readmission. Frailty was calculated using the RAI. Univariate and multivariate logistic regression analyses were performed to identify independent associations between unplanned readmissions and patient characteristics. The unplanned readmission rate of this cohort (N=31,776) was 10.8% (N= 3,420). Among the readmitted patients, 958 required unplanned reoperation. Multiple characteristics were significantly different between the readmitted and non-readmitted patients, including age, BMI, comorbidities, and RAI groups (p<0.05). Common causes of unplanned readmission included infection (9.4%), seizures (6%), and pulmonary embolism (4%). Patient characteristics identified as reliable predictors of unplanned readmission, included age, body mass index (BMI), functional status, diabetes, hypertension, hyponatremia, and their RAI score (p<0.05). Frail status, hyponatremia, leukocytosis, hypertension, and thrombocytosis were significant predictors of unplanned readmission. The RAI is a reliable pre-operative frailty index for predicting unplanned readmission following ITR. Utilizing the RAI may decrease unplanned readmission thorough identifying high risk patients, and enabling future implementation of appropriate management guidelines.

A comparative analysis of the Hospital Frailty Risk Score in predicting postoperative outcomes among intracranial tumor patients.

In recent years, frailty indices such as the 11- and 5-factor modified frailty indices (mFI-11 and mFI-5), American Society of Anesthesiologists (ASA) physical status classification, and Charlson Comorbidity Index (CCI) have been shown to be effective predictors of various postoperative outcomes in neurosurgical patients. The Hospital Frailty Risk Score (HFRS) is a well-validated tool for assessing frailty; however, its utility has not been evaluated in intracranial tumor surgery. In the present study, the authors investigated the accuracy of the HFRS in predicting outcomes following intracranial tumor resection and compared its utility to those of other validated frailty indices. A retrospective analysis was conducted using an intracranial tumor patient database at a single institution. Patients eligible for study inclusion were those who had undergone resection for an intracranial tumor between January 1, 2017, and December 31, 2019. ICD-10 codes were used to identify HFRS components and subsequently calculate risk scores. In addition to several postoperative variables, ASA class, CCI, and mFI-11 and mFI-5 scores were determined for each patient. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUROC), and the DeLong test was used to assess for significant differences between AUROCs. Multivariate models for continuous outcomes were constructed using linear regression, whereas logistic regression models were used for categorical outcomes. A total of 2518 intracranial tumor patients (mean age 55.3 ± 15.1 years, 53.4% female, 70.4% White) were included in this study. The HFRS had a statistically significant greater AUROC than ASA status, CCI, mFI-11, and mFI-5 for postoperative complications, high hospital charges, nonroutine discharge, and 90-day readmission. In the multivariate analysis, the HFRS was significantly and independently associated with postoperative complications (OR 1.14, p < 0.0001), hospital length of stay (coefficient = 0.50, p < 0.0001), high hospital charges (coefficient = 1917.49, p < 0.0001), nonroutine discharge (OR 1.14, p < 0.0001), and 90-day readmission (OR 1.06, p < 0.0001). The study findings suggest that the HFRS is an effective predictor of postoperative outcomes in intracranial tumor patients and more effectively predicts adverse outcomes than other frailty indices. The HFRS may serve as an important tool for reducing patient morbidity and mortality in intracranial tumor surgery.

Utility of Pre-operative Glasgow Coma Scale and SKALE Scoring System to Predict need for Post-operative Ventilator Support in Intracranial Tumour Patients

Objective: To evaluate the feasibility of GCS and SKALE in predicting post-operative requirement of ventilator support in intracranial tumour patients. Methods: Seventy patients undergoing intracranial tumour resection surgery were assessed pre-operatively using GCS and SKALE scoring systems to predict their post-operative requirement of ventilator support. The data was analysed using SPSS software and ShapiroWilk test and Chi-Square tests were apllied to compare the obtain data. Results: The study included 70 patients, of whom 88.6% had good GCS of 13-15 and 72.9% had good SKALE score of &gt;8. We found that all patients with poor GCS ≤8 required post -operative ventilator support, while only 4 out 62 patients with GCS 13-15 required ventilator support post-operatively (p value &lt;0.05). Patients with SKALE score ≤8 also had higher incidence of post-operative ventilator requirement (31.6%) as against those with SKALE score &gt;8 (11.8%). Conclusion: GCS is a good predictor of post-operative ventilator requirement. SKALE scoring system requires further studies to prove its utility.

474 Incidence and Risk Factors for Perioperative Stroke Following Resection of Intracranial Tumors: A Nationwide Analysis of 30,951 Cases

INTRODUCTION: Perioperative cerebrovascular accidents (CVA) in neurosurgical patients is a serious complication that may result in permanent neurological deficits. Establishment of associated risk factors allows for mitigation of CVA risk and sequelae. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for cranial tumor excision cases (2015-2019, N = 30,951). Univariate and multivariable analysis of demographic data and comorbidities was used to assess predictive strength of these factors on postoperative CVA. RESULTS: CVA occurred in 1.7% of cases (N = 532). Patients with CVA, on average, were older, frailer, with increased rates of diabetes mellitus, hypertension, and weight loss. In multivariable analysis, predictors of CVA included advanced age (≥75th percentile in cohort)(OR: 1.9, 95% CI: 1.4-2.5), diabetes mellitus (OR: 1.4, 95% CI: 1.1-1.8), hypertension (OR: 1.4, 95% CI: 1.1-1.7), and weight loss (OR: 1.9, 95% CI: 1.1-3.2). Increased proportions of CVA were found among patients with primary malignant brain tumors (46.1%) and meningiomas (32.9%) when compared to all other benign brain tumors (6.6%) and secondary metastatic brain tumors (14.5%)(all p &lt; .001). Elective surgery status was associated with decreased likelihood of CVA (OR: .74, 95% CI: .60-.91). In multivariable analysis, increasing frailty (as measured by mFI-5 and RAI-revised) was associated with increasing likelihood of CVA. CONCLUSIONS: The current study was the largest to identify preoperative risk factors for perioperative stroke after resection of intracranial tumors. Patients with advanced age, multiple comorbidities, and higher frailty scores were significantly more likely to suffer CVA. Frailty (as measured by mFI- and RAI-revised) is a valuable tool for preoperative risk stratification.

Implantation of hydrogel-liposome nanoplatform inhibits glioblastoma relapse by inducing ferroptosis

Glioblastoma is acknowledged as the most aggressive cerebral tumor in adults. However, the efficacy of current standard therapy is seriously undermined by drug resistance and suppressive immune microenvironment. Ferroptosis is a recently discovered form of iron-dependent cell death that may have excellent prospect as chemosensitizer. The utilization of ferropotosis inducer Erastin could significantly mediate chemotherapy sensitization of Temozolomide and exert anti-tumor effects in glioblastoma. In this study, a combination of hydrogel-liposome nanoplatform encapsulated with Temozolomide and ferroptosis inducer Erastin was constructed. The αvβ3 integrin-binding peptide cyclic RGD was utilized to modify codelivery system to achieve glioblastoma targeting strategy. As biocompatible drug reservoirs, cross-linked GelMA (gelatin methacrylamide) hydrogel and cRGD-coated liposome realized the sustained release of internal contents. In the modified intracranial tumor resection model, GelMA-liposome system achieved slow release of Temozolomide and Erastin in situ for more than 14 d. The results indicated that nanoplatform (T+E@LPs-cRGD+GelMA) improved glioblastoma sensitivity to chemotherapeutic temozolomide and exerted satisfactory anti-tumor effects. It was demonstrated that the induction of ferroptosis could be utilized as a therapeutic strategy to overcome drug resistance. Furthermore, transcriptome sequencing was conducted to reveal the underlying mechanism that the nanoplatform (T+E@LPs-cRGD+GelMA) implicated in. It is suggested that GelMA-liposome system participated in the immune response and immunomodulation of glioblastoma via interferon/PD-L1 pathway. Collectively, this study proposed a potential combinatory therapeutic strategy for glioblastoma treatment.

Neuro-oncological augmented reality planning for intracranial tumor resection.

Before starting surgery for the resection of an intracranial tumor, its outlines are typically marked on the skin of the patient. This allows for the planning of the optimal skin incision, craniotomy, and angle of approach. Conventionally, the surgeon determines tumor borders using neuronavigation with a tracked pointer. However, interpretation errors can lead to important deviations, especially for deep-seated tumors, potentially resulting in a suboptimal approach with incomplete exposure. Augmented reality (AR) allows displaying of the tumor and critical structures directly on the patient, which can simplify and improve surgical preparation. We developed an AR-based workflow for intracranial tumor resection planning deployed on the Microsoft HoloLens II, which exploits the built-in infrared-camera for tracking the patient. We initially performed a phantom study to assess the accuracy of the registration and tracking. Following this, we evaluated the AR-based planning step in a prospective clinical study for patients undergoing resection of a brain tumor. This planning step was performed by 12 surgeons and trainees with varying degrees of experience. After patient registration, tumor outlines were marked on the patient's skin by different investigators, consecutively using a conventional neuronavigation system and an AR-based system. Their performance in both registration and delineation was measured in terms of accuracy and duration and compared. During phantom testing, registration errors remained below 2.0 mm and 2.0° for both AR-based navigation and conventional neuronavigation, with no significant difference between both systems. In the prospective clinical trial, 20 patients underwent tumor resection planning. Registration accuracy was independent of user experience for both AR-based navigation and the commercial neuronavigation system. AR-guided tumor delineation was deemed superior in 65% of cases, equally good in 30% of cases, and inferior in 5% of cases when compared to the conventional navigation system. The overall planning time (AR = 119 ± 44 s, conventional = 187 ± 56 s) was significantly reduced through the adoption of the AR workflow (p < 0.001), with an average time reduction of 39%. By providing a more intuitive visualization of relevant data to the surgeon, AR navigation provides an accurate method for tumor resection planning that is quicker and more intuitive than conventional neuronavigation. Further research should focus on intraoperative implementations.

Endoscopic resection of intracranial dermoid and epidermoid tumors from a minimally invasive perspective

Endoscopic resection of intracranial dermoid and epidermoid tumors from a minimally invasive perspective

Patient assessment of cosmetic outcome after craniotomy for intracranial tumor surgery

BackgroundIntracranial tumors are commonly approached through a craniotomy, and the bone flap is later reattached with plates and screws. The gap created around the bone flap may cause the skin to submerge, potentially influencing the facial and head aesthetic appearance. The aim of this study was to examine patient satisfaction with cosmetic outcome after craniotomy for intracranial tumor resection. MethodsIn a prospective questionnaire-based study, patients were asked to report their degree of satisfaction with the scar and overall cosmetic appearance, and the extent of change to their facial appearance using 0–10 rating scales. The questionnaire was sent six months after surgery to patients undergoing first-time craniotomy for tumor resection at either of two neurosurgical departments. ResultsOf the 70 patients included in the study, 49 (70%) completed the questionnaire. Median scores were 9.3 for satisfaction with the scar and 9.0 for overall cosmetic satisfaction (a score of 10 reflected highest satisfaction). The median score was 1.7 for degree of change in facial appearance (a score of 0 reflected no change). However, 24.5% of patients reported major alterations to facial appearance. Satisfaction levels were similar by age, sex, and tumor type, but patients with occipital craniotomies were less satisfied with the overall cosmetic result than those with temporal craniotomies. ConclusionMost patients were satisfied with the cosmetic outcome of the craniotomy, but a considerable proportion reported major facial alterations. While the level of overall cosmetic satisfaction did not differ according to age, sex, or tumor type, the location of the craniotomy seemed to be a factor in satisfaction with the aesthetic outcome. Further studies are needed to investigate how the cosmetic result from craniotomy could be improved from the patient's perspective.

Risk factors of intraoperative blood transfusion in pediatric craniotomy for intracranial tumor resection: a 10-year analysis.

A pediatric craniotomy for intracranial tumor removal brings both high bleeding and blood transfusion risks. The aim of this study was to identify the risk factors for intraoperative blood transfusion in this procedure. The secondary outcome was to investigate postoperative complications and clinical outcomes related to blood transfusion. A retrospective analysis was performed among children who underwent a craniotomy for brain tumor resection at a tertiary hospital over a 10-year period. The pre- and intraoperative variables were examined and compared between the transfusion and nontransfusion groups. One hundred seventy-two patients (58%) received intraoperative blood transfusions among a total of 295 craniotomies in 284 children. Factors associated with blood transfusion were body weight ≤ 20 kg (adjusted odds ratio [AOR] 5.286, 95% confidence interval [CI] 2.892-9.661; p < 0.001), American Society of Anesthesiologists (ASA) physical status III-IV (AOR 6.860, 95% CI 1.434-32.811; p = 0.016), preoperative hemoglobin ≤ 11 g/dl (AOR 3.610, 95% CI 1.406-9.265; p = 0.008), tumor size ≥ 45 mm (AOR 2.117, 95% CI 1.214-3.693; p = 0.008), and duration of operation ≥ 6 hours (AOR 3.816, 95% CI 1.736-8.385; p = 0.001). Postoperative infection of other systems, other complications, duration of mechanical ventilation, and intensive care unit and hospital length of stay were found to be significantly higher in the transfusion group. Lower body weight, higher ASA physical status, preoperative anemia, large tumor size, and prolonged duration of surgery were found to be significant factors for predicting intraoperative blood transfusion in pediatric craniotomy. The identification and modification of risks from intraoperative blood transfusion can be beneficial in reducing the probability of transfusion and improving allocation efficiency of limited blood component resources.

Pineal parenchymal tumor of intermediate differentiation with late spinal dissemination 13 years after initial surgery: illustrative case.

Pineal parenchymal tumors of intermediate differentiation (PPTIDs) are rare in the pineal gland. A case of PPTID that disseminated to the lumbosacral spine 13 years after the total resection of a primary intracranial tumor has been reported. A 14-year-old female presented with headache and diplopia. Magnetic resonance imaging revealed a pineal tumor that induced obstructive hydrocephalus. A biopsy and endoscopic third ventriculostomy were performed. Histological diagnosis revealed a grade II PPTID. Two months later, the tumor was removed via craniotomy because the postoperative Gamma Knife surgery was ineffective. Histological diagnosis confirmed PPTID, although the grade was revised from II to III. Postoperative adjuvant therapy was not performed, because the lesion had been irradiated and gross total tumor removal was achieved. She has had no recurrence in 13 years. However, pain around the anus newly appeared. Magnetic resonance imaging of the spine revealed a solid lesion in the lumbosacral spine. The lesion was subtotally resected, and histological diagnosis revealed grade III PPTID. Postoperative radiotherapy was performed, and she had no recurrence 1 year after radiotherapy. Remote dissemination of PPTID can occur several years after the initial resection. Regular follow-up imaging, including the spinal region, should be encouraged.

Cottonoid Retention After Craniotomy: Causes and Ways to Avoid It.

Nonabsorbable surgical material left in an surgical wound may cause early postoperative infections and specific types of granulomas; thus, it represents a dangerous complication in neurosurgery. The authors have analyzed their experience and present four cases of cottonoid retention after intracranial tumor resection. During 5-year period (from 2013 until 2017), the incidence of such an undesirable event after craniotomy for various indications was 0.07%. It was not related to the professional experience of the operating neurosurgeon, but cases of deep-seated lesions, the presence of brain edema or excessive bleeding of neoplastic or peritumoral tissue, prolonged surgeries, use of cottonoids without marking thread, and inadequate counting of disposable surgical materials at the end of the procedure may increase the risk of this complication. In all of the presented cases, the retained cottonoids were clearly seen on postoperative computed tomography because of the presence of radiopaque identifiers. All of the patients underwent an urgent reoperation for removal of the foreign body within 24 h after completion of the primary surgery, and they subsequently experienced an uneventful postoperative course without any complications. Well-coordinated work of the surgical team-in particular, appropriate communication between the surgeon and the circulating nurse during counting of surgical materials at the end of the procedure-is absolutely necessary for prevention of cottonoid retention after brain surgery.

Resection of Recurrent Intracranial Tumors for Molecular Diagnostics in the Age of Precision Oncology: A Risk-Benefit Analysis

Resection of Recurrent Intracranial Tumors for Molecular Diagnostics in the Age of Precision Oncology: A Risk-Benefit Analysis

Complication Avoidance in Neurosurgery with Use of Intraoperative Ultrasonography.

Intraoperative ultrasonography is an extremely valuable tool for avoidance of complications during neurosurgical procedures, including resection of intracranial and spinal cord tumors, removal of spontaneous intracerebral hemorrhages and arteriovenous malformations, and ventricular access for shunt placements. Nevertheless, application of this highly useful technique may be accompanied by some challenges and difficulties, as well as human errors; thus, it requires specific knowledge and continuous training.

Gliosarcoma in a patient with triple-negative breast cancer: A case report

Abstract Gliosarcoma is a rare subtype of glioblastoma with the histological features of both glioblastoma and soft-tissue sarcoma. Triple-negative breast cancer (TNBC) is a special type of breast cancer that is different from other breast cancers. It is characterized by strong invasiveness, high recurrence rate, and poor prognosis. The concurrent occurrence of gliosarcoma and TNBC was rarely seen and reported. A 63-year-old woman with a history of TNBC was found to have an intracranial mass due to headache. Intracranial tumor resection surgery was undergone, and histopathological examination postoperation revealed gliosarcoma. After craniotomy, the patient underwent standard radiotherapy and chemotherapy. Postoperative follow-up observation showed no obvious recurrence of either tumor. In conclusion, gliosarcoma and TNBC are tumors with poor prognosis. It is rare to encounter two types of malignant tumors in the same patient. When we encounter intracranial space-occupying patients with a history of malignant tumors, we should first consider tumor metastasis. When excluding the possibility of cancer metastasis, the possibility of two primary tumors should be considered.

Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors.

Patients with intracranial tumors have a higher risk of thromboembolic events. This risk increases at the time of surgical intervention. We have noted an anecdotal increase in perioperative flap thrombosis in patients undergoing free tissue transfer for intracranial tumor resection. This study aims to formally evaluate this risk. A multi-institutional retrospective chart review was performed of patients who underwent free tissue transfer for scalp/cranial reconstruction. Perioperative thrombosis and free flap outcomes were evaluated. The 209 patients who underwent 246 free tissue transfers were included in the study. The 28 free flap scalp reconstructions were associated with intracranial tumors, 19 were performed following composite cranial resections with associated dural resection/reconstruction, and 199 were performed in the absence of intracranial tumors (control group). There was a significantly higher incidence of perioperative flap thrombosis in the intracranial tumor group (11/28, 39%) when compared to controls (38/199, 19%) (p= 0.0287). This was not seen when scalp tumors extended to the dura alone (4/19, 21%, p= 0.83). Therapeutic anticoagulation used for perioperative thrombosis (defined as intraoperative or in the immediate postoperative phase up to 5 days) was associated with a lower risk of flap failure, although this was not statistically significant (p= 0.148). Flap survival rates were equivalent between flaps performed for intracranial pathology (93.3%) and controls (95%). There is an increase in perioperative flap thrombosis in patients with intracranial tumors undergoing free tissue scalp reconstruction. Anticoagulation appears to mitigate this risk. This recommendation is based on level 3 evidence (retrospective case-control studies, systematic review of retrospective studies, and case reports) Laryngoscope, 133:1103-1109, 2023.

Patient and Service User Representation in Language Assessments on an Awake Craniotomy Pathway

Abstract AIMS Awake craniotomy (AC) with language mapping facilitates maximal safe intracranial tumour resection whilst preserving neurological function [1], and is associated with increased postoperative patient satisfaction and quality of life [2, 3]. We examine patients’ preoperative language assessment scores, alongside cultural and sociodemographic information to consider the impact on surgical planning and patient outcomes. METHOD A service evaluation of assessment tools was undertaken using clinical note audit and clinician reflections. Retrospective data collection from 48 patients assessed for AC with language mapping included language assessment scores, cultural and sociodemographic data, and surgical plan for awake or asleep tumour resection. RESULTS Analysis suggests language assessment scores may be influenced by a range of patient factors outside of the lesion location and its associated language deficits, including native language, age, ethnicity and religion. CONCLUSION Assessment scores influence a patient’s suitability for AC with language mapping and subsequent morbidity and mortality outcomes. Culture and sociodemographic background are integral to daily language use, and can therefore be expected to influence scores on language assessment tasks. This evaluation highlights the necessity for diversity of language use to be reflected in assessment tools used within an AC pathway. REFERENCES 1. Hervey-Jumper, S.L. and M.S. Berger, Maximizing safe resection of low- and high-grade glioma. JNO, 2016. 2. Wahab, S.S., P.L. Grundy, and C. Weidmann, Patient experience and satisfaction with awake craniotomy for brain tumours. BJNS, 2011. 3. Coello, A.F., et al., Selection of intraoperative tasks for awake mapping based on relationships between tumor location and functional networks: A review. JNS, 2013.

Combined Endoscopic and Exoscopic Resection of Intracranial Epidermoid Cysts

This article aims to introduce an endoscopic-exoscopic technique for the resection of epidermoid cysts. We retrospectively analyzed the intracranial epidermoid cysts patients who received whole-course combined endoscopic and exoscopic resection between 2017 and 2020 at our institution, to explore the benefit of combined endoscopic and exoscopic resection of intracranial epidermoid cysts, and evaluated the clinical utility of the endoscopic-exoscopic technique. A total of 17 patients were enrolled in the study. Of all patients, 6 patients (35.3%) underwent total resection, 10 patients (58.8%) underwent subtotal resection, and 1 patient (5.9%) underwent partial resection. Postoperative surgical complications were seen in 3 patients (17.6%), including intracranial infection in 2 patients (11.8%), and a delayed postoperative hematoma was observed in the seventh day after operation for 1 patient (5.9%), who was treated in a conservative manner and recovered smoothly from the hemorrhage. The median follow-up time was 33.3 months (range: 14.5-54.5 months). During the follow-up period, there was no recurrence of the tumors that received total resection. Two patients developed residual tumor regrowth but did not show any symptoms, therefore no further surgery was required. Endoscopic-exoscopic technique is safe and efficient in the resection of intracranial epidermoid cysts with panoramic views and superior maneuverability. With further development and accumulation of practical experiences, the endoscopic-exoscopic technique can also be applied in the resection of other intracranial tumors.

A Retrospective Analysis of the Postoperative Effect of Intraoperative Hypothermia on Deep Vein Thrombosis After Intracranial Tumor Resection

Deep venous thrombosis (DVT) is a common clinical vascular disease, and post-thrombotic syndrome is usually the complication of patients. This study was to explore the relationship between intraoperative hypothermia and DVT. Patients who were clinically diagnosed with intracranial tumors and underwent tumors resection from January 2019 to March 2021 were studied and divided into the DVT and non-DVT group. Prothrombin time, activated partial prothrombin time (ATPP), thrombin time, plasma fibrinogen, and venous flow velocity of both lower limbs were measured to observe DVT and the incidence of DVT. Univariate and multivariate logistic regression analyses were used to investigate the correlation between intraoperative hypothermia and DVT, and to analyze the DVT-related risk factors. A total of 462 patients were analyzed, of whom 231 patients were allocated to the DVT group and 231 were in the non-DVT group. Within the DVT group, 156 patients (33.8%) experienced intraoperative hypothermia. The risk factors that were significantly correlated with DVT were age, sex, operation time, ATPP value, and intraoperative hypothermia. The decreased ATPP value was found to be significantly associated with the increased incidence of DVT, and older ages (>45 years) were highly associated with DVT. Low body temperature before operation and intraoperative hypothermia were statistically significant as well. In addition, significant association was also displayed between the patient's operation time (>350 minutes) and DVT. Patients who underwent intracranial tumor resection experience a high incidence of DVT, and patients with intraoperative hypothermia are at greater risk of DVT.

Effect of low-dose lidocaine on MEPs in patients undergoing intracranial tumor resection with propofol anesthesia: A randomized controlled trial.

Objective:To investigate the effect of low-dose lidocaine on motor evoked potentials (MEPs) in patients undergoing intracranial tumor resection with propofol anesthesia.Methods:Forty patients who underwent intracranial tumor resection and required MEP monitoring were selected. They were randomly divided into the lidocaine group (group L, n = 20) and the control group (group C, n = 20) by computer-generated randomization. All patients were given propofol anesthesia under the guidance of the bispectral index. In group L, 1 mg/kg of lidocaine was injected intravenously during anesthesia induction. Then, lidocaine was continuously pumped at a speed of 1 mg/kg/h until the operation started. Group C was given an equal volume of normal saline. Heart rate (HR), mean artery pressure (MAP), and bispectral index were recorded before anesthesia induction (T0), 2 minutes after tracheal intubation (T1), and 35 minutes (T2), and 50 minutes (T3) after anesthesia induction. The amplitude and latency of MEP at T2 and T3, the total dosage of propofol after anesthesia induction, and adverse events before T3 were recorded.Results:Compared with those in group C, HR and MAP were significantly decreased at T1 in group L. No significant differences were observed in HR and MAP at T0, T2, and T3 between group L and group C. The total dosage of propofol and the incidence of adverse events were significantly lower in group L than in group C before T3. There were no significant differences in the amplitude and latency of MEP between the 2 groups at each time point.Conclusions:Low-dose lidocaine has no obvious effect on MEP in patients undergoing intracranial tumor resection. However, it increased hemodynamic stability, reduced propofol use, and decreased the incidence of adverse events.

Minimally invasive keyhole techniques for resection of giant intracranial tumors

BackgroundWhile keyhole neurosurgery is increasingly utilized in the operating room, there are few reports regarding the use of keyhole techniques to resect giant intracranial tumors. The feasibility and technique of that were discussed in this paper.MethodsWe retrospectively reviewed 95 consecutive patients who were admitted to our service between February 2012 and September 2017 with a maximum intracranial tumor diameter >5 cm. Keyhole approaches were used to resect these tumors in each case, including supraorbital, subtemporal, suboccipital, retromastoid, frontal, temporal, occipital, parietal, pterional, a combined temporo-parietal keyhole approach, and an approach via the longitudinal fissure.ResultsWe achieved gross total resection in 68/95 cases (71.6%) and subtotal resection in 27/95 cases (28.4%). No surgical death or severe disabilities such as coma and limb dyskinesia occurred following surgery. At the time of discharge, 8 patients had complications related to impaired cranial nerve function. In addition, 2 patients developed hydrocephalus requiring ventriculo-peritoneal shunt placement, and 4 patients developed a postoperative CSF leak requiring surgical intervention.ConclusionWith meticulous design and reasonable selection, resection of giant intracranial tumors utilizing minimally invasive keyhole approaches can be done safely with satisfactory surgical outcomes.