Neurosurgery
-
This is a prospective study of the methodology and clinical applications of motor evoked potentials (MEPs) during surgery for intramedullary spinal cord tumors. ⋯ MEP monitorability was a better predictor of functional outcome than the patient's preoperative motor status for the adult group. Significant predictors of MEP monitorability in the adult group were preoperative motor function (P < 0.01), history of no previous treatment (surgery or irradiation) (P < 0.01), and small tumor size (P < 0.05). Weak associations with monitorable MEPs existed for low-grade tumors (P = 0.09), the presence of baseline somatosensory evoked potentials (P = 0.10), and tumor pathological abnormalities (ependymoma) (P = 0.13). No associations were determined for sex (P > 0.4), associated syrinx (P > 0.3), or tumor location (P > 0.5). In the pediatric group, none of the examined factors were associated with MEP monitorability (P > 0.3). A decline of more than 50% in MEP amplitude during tumor removal should serve as a serious warning sign to the surgeon.
-
Infratentorial empyema is an uncommon form of intracranial suppuration that is usually secondary to neglected otogenic infection. The diagnosis is frequently delayed and often confused with that of meningitis. The associated mortality is distressingly high, yet it has, as a clinical entity, received scant attention in the literature. We present a 13-year experience of this condition. ⋯ Although rare, infratentorial empyema, especially when subdural, is a lethal disease. Cerebellopontine angle extension of pus was a particularly ominous sign in our experience. Early surgical drainage via wide posterior fossa craniectomy, aggressive treatment of associated hydrocephalus, eradication of the primary source of sepsis, and, finally, intravenous high dosage of appropriate antibiotics form the mainstay of treatment.
-
To examine outcomes and delayed complications after the surgical resection of intramedullary spinal cord (IMSC) cavernous malformations. The association of these lesions with cryptic intraparenchymal venous malformations at surgery also was analyzed. ⋯ The frequent coexistence of IMSC cavernous malformations with cryptic venous malformations in this series indicates a need for operative vigilance to preserve these venous anomalies. Delayed complications were the result of incomplete resection. The resultant hemorrhage required reexploration, which led to tethering of the spinal cord. Most patients who underwent resection, however, had improved neurologically at long-term follow-up.
-
This study used quantitative radiological imaging to determine the effect of surgical resection on postoperative survival of patients with malignant astrocytomas. Previous studies relied on the surgeons' impressions of the amount of tumor removed, which is a less reliable measure of the extent of resection. ⋯ We conclude that the most important prognostic factors affecting survival of patients with anaplastic astrocytomas and glioblastomas multiforme are tumor grade, age, preoperative performance status, and radiation therapy. Postoperative complications adversely affect survival. Aggressive surgical resection did not impart a significant increase in survival time. Surgical resection may improve survival, but its importance is less than that of other factors and may be demonstrable only by larger studies.
-
To determine the incidence and risk factors of surgical site infections (SSIs) after craniotomy and to test the risk index score proposed by the National Nosocomial Infections Surveillance (NNIS) system, which, to our knowledge, has not been validated in neurosurgery to date. ⋯ Independent risk factors for SSIs after craniotomy involve postoperative events. However, the NNIS risk index is effective in identifying at-risk patients.