How to plan for specific scenarios
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad in Neurosurgery, 2014
Throughout the oral and clinical neurosurgical examination, will be provided with different scenarios for management. Must listen to the examiner and understand the question being asked. There are endless pitfalls. If there are no further details about the given scenario, then begin by mentioning the key factors that determine the management of a ruptured aneurysm. The key factors include Glasgow Coma Scale (GCS) rate of deterioration, age, size of haematoma and evidence of mass effect. In patients with low GCS who rapidly deteriorated and harbour a large intracranial haematoma, then the priority is to treat the increased intracranial pressure by medical optimization followed by craniotomy to evacuate the haematoma and clip the aneurysm. The key to this scenario is to focus on the management of the subarachnoid haemorrhage and consider the influence of the pregnancy on the recommended treatments. The management options depend on patient selection and the underlying aneurysm.
Intracranial haemorrhage
E Glucksman in MCQs in Neurology and Neurosurgery for Medical Students, 2022
This chapter provides that the themed presentation encourages quick, focused study and detailed answers aid comprehension and encourages familiarity with intracranial haemorrhage with essential diagrams, colour images and sample MRIs. An extradural haemorrhage is usually caused by rupture of the middle meningeal artery from direct trauma to the side of the skull. In this case however, the patient deteriorated over 3 days, whereas if it was an extradural haemorrhage, it would bleed much faster and cause more severe symptoms rapidly. Burr hole evacuation of the haematoma may be possible but in larger subacute haematomas craniotomy may be necessary, or it may be necessary for patients with re-accumulation of the blood following surgery.
Neuroanaesthesia
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
Anaesthesia for craniotomy is based on an understanding of techniques for controlling intra-cranial volume, and the effects of anaesthetic interventions. The brain is relatively non-compressible and this compensatory mechanism is soon exhausted. The airway may not be protected, and intubation maybe required prior to surgery. The neurological status is assessed and recorded immediately prior to anaesthesia. Postoperatively, a rapid return to being alert and able to co-operate with a further neurological examination is essential. Invasive haemodynamic monitoring is used for many neurosurgical procedures including craniotomy. Tracheal tube tapes and ties are placed with care to ensure obstruction of jugular venous return does not occur. Arterial blood pressure should be close to preoperative levels to balance the risks of bleeding, and ischaemia from vasospasm and hypoperfusion. Any neurological deterioration postoperatively should raise the suspicion of intracranial bleeding or swelling.
Oxford craniotomy infections database: A cost analysis of craniotomy infection
Published in British Journal of Neurosurgery, 2012
Andrew B. O'Keeffe, Timothy Lawrence, Stana Bojanic
We describe the process of establishing a large database for the investigation of craniotomy infection and the preliminary results of this database. The initial results have been used to generate a cost analysis for craniotomy infection. The craniotomy infections database prospectively registers craniotomy cases taking place in the John Radcliffe Hospital. In order to achieve this, each patient's details are registered at the time of operation and followed up to identify cases of infection. Infection was defined strictly according to Centre for Disease Control criteria and validated by at least two members of clinical staff. The first 10 months of data are presented here which identifies a total of 245 craniotomies and 20 verified craniotomy infections. An overall infection rate of 8% is identified, and the cost incurred by the neurosurgery department as a result of craniotomy infections is estimated at £1 85 660 for the 10-month period studied. This amounts to a cost per case of infection of £9283.
Fitness to fly post craniotomy – a survey of medical advice from long-haul airline carriers
Published in British Journal of Neurosurgery, 2009
R. Seth, S. Mir, J. S. Dhir, C. Cheeseman, J. Singh
Commercial airline passengers are subject to numerous medical risks while in transit. Seventeen long-haul airline companies were questioned concerning fitness to travel and the case of a patient wishing to travel post craniotomy. Three airline companies gave satisfactory medical information, while the remaining airlines felt it was the decision of the operating surgeon rather than the airline company. A literature review shows that post operative pneumocephalus and the risk of tension pneumocephalus is the major medical concern when transporting patients post craniotomy. Evidence is contradictory with respect to the importance of this potentially life threatening problem. Postoperative 100% oxygen may improve the rate of pneumocephalus absorption. Airline companies have an unstandardised approach to unique medical problems, resulting in increased responsibility for the attending surgeon who may be ill equipped to deal with poorly researched aviation medicine.
Benign ependymoma with extensive intracranial and spinal cerebrospinal fluid dissemination: case report and literature review
Published in British Journal of Neurosurgery, 2019
Fangmei Zhu, Jurong Ding, Yumei Li, Dewang Mao, Xianglei He, Wanyuan Chen, Lin Lou, Zhongxiang Ding
Myxopapillary ependymoma (MPE) is a rare variant of ependymoma that is most commonly located in the cauda equina and filum terminale. We present a case of 23-year-old man diagnosed with MPE in the fourth ventricle and sacral canal area with extensive disseminated lesions along the cerebrospinal ventricular system. Additionally, a molecular pathological diagnosis was performed. The patient underwent a craniotomy and a lumbar laminectomy. In the course of 18 months of follow-up, the patient have recovered very well.
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