Journal of neurosurgery
-
Hemicraniectomy is a commonly practiced neurosurgical intervention with a wide range of indications and clinical data supporting its use. The extensive use of this procedure directly results in more cranioplasties to repair skull defects. The complication rate for cranial repair after craniectomy seems to be higher than that of the typical elective craniotomy. This finding prompted the authors to review their experience with patients undergoing cranial repair. ⋯ The overall rate of complications related to cranioplasty after craniectomy is not negligible, and certain factors may be associated with increased risk. Therefore, when evaluating the need to perform a large decompressive craniectomy, the surgeon should also be aware that the patient is not only subject to the risks of the initial operation, but also the risks of subsequent cranioplasty.
-
Journal of neurosurgery · May 2010
A proposed classification system that projects outcomes based on preoperative variables for adult patients with glioblastoma multiforme.
Glioblastoma multiforme (GBM) is the most common and aggressive type of primary brain tumor in adults. Although the average survival is approximately 12 months, individual survival is heterogeneous. The ability to predict short- and long-term survivors is limited. Therefore, the aims of this study were to ascertain preoperative risk factors associated with survival, develop a preoperative prognostic grading system, and evaluate the utility of this grading system in predicting survival for patients undergoing resection of a primary intracranial GBM. ⋯ The present study found that older age, poor performance status, motor deficit, language deficit, and periventricular tumor location independently predicted poorer survival in patients undergoing GBM resection. A grading system based on these factors was able to identify 4 distinct groups of patients with different survival rates. This grading system, based only on preoperative variables, may provide patients and physicians with prognostic information that may guide medical and surgical therapy before any intervention is pursued.
-
Journal of neurosurgery · May 2010
A modified far-lateral approach for large or giant meningiomas of the posterior fossa.
Resecting large meningiomas along the posterior fossa convexity or cerebellopontine angle (CPA) through a suboccipital approach can be challenging. Limitations include a restricted angle of view, high venous pressures, and suboptimal brain relaxation. While a far-lateral craniotomy is a viable alternative, the risks associated with condylar resection are undesirable. ⋯ A modified far-lateral approach to the posterior fossa and CPA allows for safe, and often total, resection of large meningiomas with minimal morbidity. While avoiding the risks of condylar resection, this microsurgical strategy allows for greater field of view, minimal venous bleeding, and immediate access to the spinal subarachnoid space.
-
Journal of neurosurgery · May 2010
Patients' perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study.
Routine and nonselective use of awake and outpatient craniotomy for supratentorial tumors has been shown to be safe and effective from a medical standpoint. In this study the authors aim was to explore patients' perceptions about awake and outpatient craniotomy. ⋯ The results reflected positively on the patients' awake and outpatient surgery experience, but there were some areas that require improvement, specifically perioperative pain control and postoperative care. These insights on patients' perspectives can lead to better delivery of care, and ultimately, improved health outcomes.
-
Journal of neurosurgery · May 2010
Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus.
Spontaneous meningoencephaloceles of the lateral sphenoid sinus are rare lesions that are hypothesized to result from persistence of the lateral craniopharyngeal canal. Prior reports of the management of this lesion have been limited by its relative rarity. The objective of this paper is to report the theoretical etiology, surgical technique, and outcomes in patients undergoing endoscopic repair of spontaneous meningoencephalocele of the sphenoid sinus. ⋯ Endoscopic endonasal closure is an effective modality in the treatment of spontaneous meningoencephaloceles of the lateral sphenoid sinus. If the sphenoid sinus has extensive lateral pneumatization, adequate exposure may require a transpterygoid approach.