Browsing by Subject "craniotomy"

Now showing 1 - 3 of 3
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    Is Placing Prophylactic Dural Tenting Sutures a Dogma?
    (Elsevier, 2021-09) Eroglu, Umit; Zaimoğlu, Murat; Sayacı, Emre Yağız; Ugur, Ugur; Attar, Ayhan; Kahilogullari, Gokmen; Bozkurt, Melih; Ünlü, Mustafa Ağahan; Özgüral, Onur; Doğan, İhsan; Seçinti, Kutsal Devrim; Abbasoğlu, Bilal; Erdoğan, Koral; Gökalp, Elif; Yakar, Fatih; Çağlar, Yusuf Şükrü; Cohen-Gadol, Aaron; Neurological Surgery, School of Medicine
    Objective In this study, we investigated if and when dural tenting sutures are necessary during craniotomy. Methods Results from 437 patients aged 18 to 91 years (average, 43.5 years) who underwent supratentorial craniotomy between 2014 and 2019 were evaluated. The patients were categorized into 1 of 3 groups, patients who had at least 3 prophylactic dural tenting sutures placed before opening of the dura (group 1), at least 3 dural tenting sutures placed after surgery was completed, during closure (group 2), or no dural tenting sutures (group 3 [control]). All such sutures in groups 1 and 2 were placed in the circumference of the craniotomy and dural junction. No central dural tenting sutures were placed in any of the patients. Results Among the 437 patients, 344 underwent surgery for the first time and 93 were undergoing a second surgery. Cranial computed tomography imaging was performed for each patient 1 hour, 3 days, and 1 month after surgery. In group 1, 3 patients had a cerebral cortex contusion and 2 patients had acute subdural hematoma after the sutures were placed. In groups 2 and 3, none of the patients had a cerebral cortex contusion or acute subdural hematoma. Fewer complications were observed when dural tenting sutures were placed during postsurgical closure. Conclusion Placing dural tenting sutures is an important technique for ensuring hemostasis. However, when not needed, they seem to cause inadvertent complications. As our results suggest, knowing when and where to use them is equally important.
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    Management of Intracranial Meningiomas Using Keyhole Techniques
    (Cureus, Inc., 2016-04-27) Burks, Joshua D.; Conner, Andrew K.; Bonney, Phillip A.; Archer, Jacob B.; Christensen, Blake; Smith, Jacqueline; Safavi-Abbasi, Sam; Sughrue, Michael; Department of Neurological Surgery, IU School of Medicine
    BACKGROUND: Keyhole craniotomies are increasingly being used for lesions of the skull base. Here we review our recent experience with these approaches for resection of intracranial meningiomas. METHODS: Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from January 2012 to June 2013. Thirty-one meningiomas were resected in 27 patients, including 9 supratentorial, 5 anterior fossa, 7 middle fossa, 6 posterior fossa, and 4 complex skull base tumors. Twenty-nine tumors were WHO Grade I, and 2 were Grade II. RESULTS: The mean operative time was 8 hours, 22 minutes (range, 2:55-16:14) for skull-base tumors, and 4 hours, 27 minutes (range, 1:45-7:13) for supratentorial tumors. Simpson Resection grades were as follows: Grade I = 8, II = 8, III = 1, IV = 15, V = 0. The median postoperative hospital stay was 4 days (range, 1-20 days). In the 9 patients presenting with some degree of visual loss, 7 saw improvement or complete resolution. In the 6 patients presenting with cranial nerve palsies, 4 experienced improvement or resolution of the deficit postoperatively. Four patients experienced new neurologic deficits, all of which were improved or resolved at the time of the last follow-up. Technical aspects and surgical nuances of these approaches for management of intracranial meningiomas are discussed. CONCLUSIONS: With careful preoperative evaluation, keyhole approaches can be utilized singly or in combination to manage meningiomas in a wide variety of locations with satisfactory results.
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    Post-Craniotomy Pain in the Brain Tumor Patient: An Integrative Review
    (Wiley, 2016-06) Guilkey, Rebecca Elizabeth Foust; Von Ah, Diane; Carpenter, Janet; Stone, Cynthia; Draucker, Claire B.; Department of Nursing, IU School of Nursing
    Aim To conduct an integrative review to examine evidence of pain and associated symptoms in adult (≥21 years of age), postcraniotomy, brain tumour patients hospitalized on intensive care units. Background Healthcare providers believe craniotomies are less painful than other surgical procedures. Understanding how postcraniotomy pain unfolds over time will help inform patient care and aid in future research and policy development. Design Systematic literature search to identify relevant literature. Information abstracted using the Theory of Unpleasant Symptoms’ concepts of influencing factors, symptom clusters and patient performance. Inclusion criteria were indexed, peer-reviewed, full-length, English-language articles. Keywords were ‘traumatic brain injury’, ‘pain, post-operative’, ‘brain injuries’, ‘postoperative pain’, ‘craniotomy’, ‘decompressive craniectomy’ and ‘trephining’. Data sources Medline, OVID, PubMed and CINAHL databases from 2000–2014. Review method Cooper's five-stage integrative review method was used to assess and synthesize literature. Results The search yielded 115 manuscripts, with 26 meeting inclusion criteria. Most studies were randomized, controlled trials conducted outside of the United States. All tested pharmacological pain interventions. Postcraniotomy brain tumour pain was well-documented and associated with nausea, vomiting and changes in blood pressure, and it impacted the patient's length of hospital stay, but there was no consensus for how best to treat such pain. Conclusion The Theory of Unpleasant Symptoms provided structure to the search. Postcraniotomy pain is experienced by patients, but associated symptoms and impact on patient performance remain poorly understood. Further research is needed to improve understanding and management of postcraniotomy pain in this population.