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Peri-operative medicine
Published in Henry J. Woodford, Essential Geriatrics, 2022
A variety of neurosurgical techniques have been used in the management of SDH. For chronic SDH, the liquefied nature of blood makes it amenable to craniostomy (i.e. burr hole formation and drain placement). This is a relatively quick and easy procedure that can be done under local anaesthesia. However, the congealed nature of blood with acute SDH makes it more challenging to remove. Craniotomy is typically used, which is the temporary removal of a region of skull bone, to allow decompression and clot extraction. This is a more complex and challenging procedure.
Neurosurgery: Supratentorial tumors
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Monica S. Tandon, Kashmiri Doley, Daljit Singh
Most of the patients undergo a craniotomy and tumor resection; the craniotomy may be performed through an open, minimally invasive, or a stereotactic technique. A biopsy is usually reserved for patients in whom resection is not expected to be beneficial (e.g., PCNSL, for obtaining a histopathological diagnosis), or if their resection is associated with an unacceptable morbidity, e.g. patients with multiple metastasis, highly malignant tumors, deep-seated tumors—patients with a poor functional status. The biopsy may be performed through a burr hole (frame-based or frameless stereotactic; needle biopsy) or via a mini-craniotomy (direct open biopsy). A stereotactic biopsy is usually preferred over an open biopsy if the lesion is not associated with mass effect. Though it is relatively safe, there is a small, albeit definite, risk of hemorrhage, especially in patients with PCNSL (increased vessel fragility), or multifocal HGGs. It can be performed under general anesthesia (GA) or conscious sedation.
A new synthesis: William Smellie
Published in Adrian Wilson, The Making of Man-Midwifery, 2018
As a country practitioner at Lanark in the 1720s, he tried to deliver such cases by turning to the feet, but found that this could not always be used and that even when it succeeded it often destroyed the child. The only alternative was craniotomy. The consequent “loss of children”, Smellie recalled, “gave me great uneasiness”.
A clinical report of intracranial granulocytic sarcoma and a literature review
Published in International Journal of Neuroscience, 2022
Hao Cheng, Guangfu Di, Wanan Gao, Zhao Chenhui, Xiaochun Jiang
This patient underwent craniotomy but did not receive radiation or chemotherapy. We did not do bone marrow examinations or cerebrospinal fluid examinations early on. Although the abnormalities of the eosinophil count and the eosinophil percentage were found in the retrospective analysis, we were still unable to determine whether the patient had isolated GS or leukemic GS. At present, there is still no standardized strategy for GS, and the selection of treatments should be individualized. However, both isolated and leukemic GS should be treated with chemotherapy, followed by surgery or local radiotherapy. Antic et al. showed that most surgically treated patients developed a recurrence or progressed to AML, and surgery treatment was preferred only in cases where the increased intracranial pressure was needed to be rapidly alleviated [11]. For example, some researchers have reported GS presenting as subdural or giant intracranial mass [12,13]. Besides, some studies showed that patients who received chemotherapy in a timely manner after diagnosis had a longer time to develop AML than patients who had not received chemotherapy [14,15]. Radiotherapy can be used as consolidation therapy after systemic chemotherapy [16], which mainly depends on the size, location, number of tumors, patient's expected survival time and the patient's tolerance. Only surgery or radiotherapy is not as effective as systemic chemotherapy.
Polymethylmethacrylate cranioplasty using low-cost customised 3D printed moulds for cranial defects – a single Centre experience: technical note
Published in British Journal of Neurosurgery, 2019
Krešimir Saša Đurić, Hrvoje Barić, Ivan Domazet, Petra Barl, Niko Njirić, Goran Mrak
Custom made cranioplasties were performed on 29 patients, of whom 25 underwent elective cranioplasties for large cranial defects and four were bone tumour resection and reconstruction cases. In the latter group, tumour resection margins were translated to the surgical site using a 3D template in three patients and using neuronavigation in one patient (illustrative case is summarised in Figure 1). Average age of patients was 43 ± 2 years and female to male ratio was approximately 1:3. Trauma was the predominant initial pathology and the frontal-temporal-parietal region was the most common location. Defects of the left side were more common than the right or bilateral. Average size of defects was 107.6 ± 52.9 cm2. In the elective cranioplasty group, the average time from initial craniotomy to cranioplasty was 22.6 ± 21.9 months, operation time 2.0 ± 0.7 hours, and length of hospital stay 4.1 ± 0.9 days. Four patients (13.8%) developed cranioplasty-related complications: two patients had to be re-operated because of screw loosening and migration; one patient developed subdural hygroma and was surgically treated one month later; one patient operated for a giant intraosseous frontal meningioma developed pseudomeningocoelae which required three revision surgeries. One patient was dissatisfied with the aesthetic outcome, and two patients were relatively satisfied. Patient data are summarised in Table 1.
Insights into the effect of a craniotomy on the impact resistance of the skull
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
A. Siegel, F. Sauter-Starace, S. Laporte
Craniotomy is a well-known procedure in neurosurgery, during which a bone flap is removed, and is mainly used to save patients with severe head trauma (Chaikoolvatana and Sripech 2007). They can also sometimes be performed for inserting implants, like a cochlear implant or the RNS system (NeuroPace, Inc) (Heck et al. 2014). The international standard EN 45502-2-3:2010 for cochlear implants requires a 2.5 J hammer test. It is intended to assess the implant’s mechanical resistance against everyday impact scenarios as falls or hits on the head. Human head resistance against impact is reported in the literature between 16 and 28 J in average (Yoganandan et al. 1995, Verschueren et al. 2007; Delye et al. 2007). However, to the authors’ knowledge, the influence of a craniotomy on the skull’s mechanical resistance to impact has never been addressed. Still, studies dealing with the design of cranial implants for skull reconstruction report a higher risk of skull fracture at the interface between the skull and the implant (Tsouknidas et al. 2011; Garcia-Gonzalez et al. 2017). This raises questions about the influence of a craniotomy on the mechanical resistance of the skull against impact loadings.