OBJECTIVE: To investigate the impact of postoperative serious cardiovascular adverse events (CAE) on outcomes of patients undergoing craniotomy for intracranial aneurysm clipping. METHODS: This retrospective cohort study was conducted among the patients undergoing craniotomy for intracranial aneurysm clipping during the period from December, 2016 to December, 2017, who were divided into CAE group and non-CAE group according to the occurrence of Clavien-Dindo grade ≥II CAEs after the surgery. The perioperative clinical characteristics of the patients, complications and neurological functions during hospitalization, and mortality and neurological functions at 1 year postoperatively were evaluated. The primary outcome was mortality within 1 year after the surgery. The secondary outcomes were Glasgow outcome scale (GOS) score at 1 year, lengths of postoperative hospital and intensive care unit (ICU) stay, and Glasgow coma scale (GCS) score at discharge. RESULTS: A total of 361 patients were enrolled in the final analysis, including 20 (5.5%) patients in CAE group and 341 in the non-CAE group. No significant differences were found in the patients' demographic characteristics, clinical history, or other postoperative adverse events between the two groups. The 1-year mortality was significantly higher in CAE group than in the non-CAE group (20.0% vs 5.6%, P=0.01). Logistics regression analysis showed that when adjusted for age, gender, emergency hospitalization, subarachnoid hemorrhage, volume of bleeding, duration of operation, aneurysm location, and preoperative history of cardiovascular disease, postoperative CAEs of Clavien-Dindo grade≥II was independently correlated with 1-year mortality rate of the patients with an adjusted odds ratio of 3.670 (95% CI: 1.037-12.992, P=0.04). The patients with CEA also had a lower GOS score at 1 year after surgery than those without CEA (P=0.002). No significant differences were found in the occurrence of other adverse events, postoperative hospital stay, ICU stay, or GCS scores at discharge between the two groups (P > 0.05). CONCLUSION Postoperative CAEs may be a risk factor for increased 1-year mortality and disability in patients undergoing craniotomy for intracranial aneurysms.
Craniotomy/adverse effects* ; Humans ; Intracranial Aneurysm/surgery* ; Postoperative Period ; Retrospective Studies ; Subarachnoid Hemorrhage/surgery* ; Treatment Outcome

OBJECTIVES: To analyze the risk factors for postoperative deep vein thrombosis (DVT) in neurosurgical patients to provide the basis for the prevention of postoperative DVT. METHODS: A total of 141 patients underwent neurosurgery were enrolled. Thrombelastography (TEG) test was performed before and at the end of surgery. According to whether there was DVT formation after operation, the patients were divided into a thrombosis group and a non-thrombosis group. -test and rank sum test were used to compare the general clinical characteristics of the 2 groups, such as age, gender, intraoperative blood loss, -dimer, intraoperative crystal input, colloid input, blood product transfusion, operation duration, length of postoperative hospitalization. The application of chi-square test and rank-sum test were used to compared TEG main test indicators such as R and K values between the 2 groups. Logistic regression was used to analyze the possible risk factors for postoperative DVT in neurosurgical patients. RESULTS: There were significant differences in postoperative TEG index R, clotting factor function, intraoperative blood loss, hypertension or not, length of postoperative hospital stay, and postoperative absolute bed time (all <0.05). Logistic regression analysis showed hypercoagulability, more intraoperative blood loss and longer postoperative absolute bed time were risk factors for DVT formation after craniotomy. CONCLUSIONS Hypercoagulability in postoperative TEG test of patients is an important risk factor for the formation of postoperative DVT after neurosurgery, which can predict the occurrence of postoperative DVT to some extent.
Craniotomy ; adverse effects ; Humans ; Postoperative Complications ; epidemiology ; Postoperative Period ; Risk Factors ; Thrombophilia ; Venous Thrombosis ; epidemiology ; etiology

OBJECTIVETo find out the optimal approach to decompress externally the severe injured brain and to avoid possible complications caused by external decompression.

METHODS68 patients who underwent external decompression after traumatic brain injury were admitted into Tianjin Medical University General Hospital for cranioplasty from 1995 to 2001. Complications were retrospectively investigated and analyzed in all patients. The findings were compared between the patients who accepted the decompressive craniectomy in our hospital and in local hospitals. chi(2)-test was employed for statistical analysis and complication evaluation.

RESULTSLarge craniectomy definitely caused some side effects to patients. Among various complications, several of them showed significantly high incidence (P<0.05) in patients who underwent the decompressive operation in local hospitals such as shunt-dependent hydrocephalous, subdural fluid collection, and CSF leakage from scalp incision. The rest of the complications had no remarkable difference (P<0.05) between the two groups including dilation or/and migration of lateral ventricle underlying the cranial defect, skin flap concavity, encephalomalacia of the decompressive area, seizure and infection.

CONCLUSIONSTo reduce the incidence of iatrogenic side effects, surgical craniectomy should be performed according to the strict indication and standard and any abuse should be avoided.

Adolescent ; Adult ; Chi-Square Distribution ; Craniocerebral Trauma ; surgery ; Craniotomy ; adverse effects ; standards ; Decompression, Surgical ; adverse effects ; standards ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Treatment Outcome

OBJECTIVETo investigate the role of large decompressive craniectomy (LDC) in the management of severe and very severe traumatic brain injury (TBI) and compare it with routine decompressive craniectomy (RDC).

METHODSThe clinical data of 263 patients with severe TBI (GCS < or = 8) treated by either LDC or RDC in our department were studied retrospectively in this article. One hundred and thirty-five patients with severe TBI, including 54 patients with very severe TBI (GCS < or = 5), underwent LDC (LDC group). The other 128 patients with severe TBI, including 49 patients with very severe TBI, underwent RDC (RDC group). The treatment outcome and postoperative complications of the two treatment methods were compared and analyzed in a 6-month follow-up period.

RESULTSNinety-six patients (71.7 %) obtained satisfactory treatment outcome in the LDC group, while only 75 cases (58.6 %) obtained satisfactory outcome in the RDC group (P < 0.05). Moreover, the efficacy of LDC in treating very severe TBI was higher than that of RDC (63.0 % vs. 36.7 %, P < 0.01). The chance of reoperation due to refractory intracranial pressure (ICP) in the LDC group was significantly lower than that of the RDC group (P < 0.05), while the incidences of delayed intracranial hematoma and subdural effusion were significantly higher than those of the RDC group ( P < 0.05).

CONCLUSIONSLDC is superior to RDC in improving the treatment outcome of severe TBI, especially the very severe ones. LDC can also efficiently reduce the chances of reoperation due to refractory ICP. However, it increases the incidences of delayed intracranial hematoma and contralateral subdural effusion.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries ; surgery ; Child ; Child, Preschool ; Craniotomy ; adverse effects ; Decompression, Surgical ; adverse effects ; Female ; Humans ; Infant ; Intracranial Pressure ; Male ; Middle Aged

OBJECTIVETo explore the causes, clinical manifestation and therapy of frontal sinusitis after transfrontal craniotomy.

METHODSThirty-three patients with frontal sinusitis after transfrontal craniotomy were included in the study. Among them, 7 cases had frontal sinus abscess and 4 cases had frontal sinus fistula. Twenty-three patients were treated with traditional frontal sinus surgery with facial incision. The nasofrontal dilatation tube was positioned for more than 3 months. Nine patients were treated with endoscopic frontal sinus surgery, and 1 patient was treated with combined endoscopic and traditional frontal sinus surgery, with nasofrontal dilatation tube positioned for less then 1 month. In the revision surgery, the bone wax and phlogistic acestoma were cleaned out in both operational methods. The causes of frontal sinusitis after transfrontal craniotomy were discussed by studying the frontal sinus CT image, and prior surgical data.

RESULTSAll patients were followed up for more than 6 months after the nasofrontal dilatational tube was removed. Among 33 patients, two cases with traditional frontal sinus surgery were operated twice due to nasofrontal dilatation tube fall off in 1 month. In all 33 patients, 30 cases cured and 3 cases got better. There were no curative difference between two operational methods.

CONCLUSIONSThe causes of frontal sinusitis after transfrontal craniotomy were inadequate sinus management in craniotomy and bone wax tamping in frontal sinus. There was more frontal sinus abscess and fistula occurring in frontal sinusitis after transfrontal craniotomy than that in ordinary frontal sinusitis. The therapy included cleaning out bone wax and phlogistic acestoma, and expanding the frontal sinus ostium. The satisfying curative effect was obtained in both operational methods, but endoscopic frontal sinus surgery was better because it is minimally invasive, no facial incision and quick recovery with less nasofrontal dilatational tube posting time.

Adult ; Craniotomy ; adverse effects ; Female ; Forehead ; surgery ; Frontal Sinusitis ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy

OBJECTIVETo study the effect of transcutaneous acupoint electrical stimulation (TAES) on stress who received propofol target controlled infusion (TCI) general anesthesia in brain surgery.

METHODSTotally 40 neurosurgical patients of I-II grade (ASA grading) in our hospital were randomly divided into the TAES group (T group) and the control group (C group), 20 in each group. All patients received intravenous anesthesia by propofol TCI. The TAES intervention was adopted in those of C group. Electrodes were only applied to corresponding acupoints without electric stimulation. The arterial blood was withdrawn before TAES (T0), before anesthesia (T1), before cutting (T2), at 60 min after encephalic incision (T3), immediately after incisions suture (T4), at about 10 min after removing tracheal catheters (T5) to detect beta-endorphin (beta-EP), cortisol (COR), adrenalin (E), blood sugar (Glu). The heart rate (HR) and mean arterial pressure (MAP) were recorded. The total time of surgery, anesthesia, total infusion amount, blood lost amount, and urine amount were recorded.

RESULTSIn both groups, HR, MAP, COR, and E at T2 were lower than at T0 significantly (P < 0.05). beta-EP in group C at T2 was lower than at T0 significantly (P < 0.05). HR, MAP, COR in group C at T3 were higher than at T0 significantly (P < 0.05). HR, MAP, E, and Glu in group C at T4 and T5 were higher than at T0 significantly (P < 0.05). beta-EP in group T at T1 and T3 were higher than at T0 significantly (P < 0.05). HR, COR, E, Glu, and beta-EP in group T at T4 and T5 were higher than at T0 significantly (P < 0.05). Between groups, comparing with the time point T0, the amplitude of variation of MAP, COR, and E at T2 in group C were significantly less (P < 0.05); the amplitude of variation of HR, MAP, and COR at T3 in group C were less significantly, when compared with the time point T0 (P < 0.05); the amplitude of variation of HR, MAP, COR, E, and Glu at T4 and T5 in group C were less significantly, when compared with the time point T0 (P < 0.05). When comparing the two groups, the amplitude of variation of beta-EP at time points of T1, T3, T4, and T5 in group T were larger than at T0 in group C (P < 0.05).

CONCLUSIONTAES could reduce stress and stabilize the internal environment when used in brain surgery with propofol TCI general anesthesia.

Acupuncture Points ; Adult ; Aged ; Craniotomy ; adverse effects ; Female ; Humans ; Intraoperative Period ; Male ; Middle Aged ; Propofol ; administration & dosage ; Stress Disorders, Post-Traumatic ; Transcutaneous Electric Nerve Stimulation

OBJECTIVETo observe the therapeutic effect of Huoxue Jieyu decoction (HJD) on patients with depression after craniotomy.

METHODSNinety patients were randomly divided into 2 groups according to the sequence of their consultation. The 45 patients in the treated group were treated with conventional symptomatic treatment plus oral administration of HJD, and the 38 patients in the control group were treated in the same way but with chlorimipramine (anafranil) instead of HJD. Hamilton depression (HAMD) scores before and after treatment, occurrence of adverse effects and long-term therapeutic effect of treatment were observed.

RESULTSThe score of HAMD was insignificantly different in 2 groups before and after treatment (P >0.05), but the occurrence of adverse effects between them was significantly different (P < 0.01).

CONCLUSIONThe therapeutic effect of HJD on depression was similar to that of anafranil, but HJD has less adverse effect and more stabilized long-term effect.

Adolescent ; Adult ; Craniotomy ; adverse effects ; Depressive Disorder ; drug therapy ; etiology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Postoperative Complications ; drug therapy

Hyponatremia and increased urine output after calvarial remodeling have been noted in pediatric patients with craniosynostosis. If not treated properly, patients develop hypoosmotic conditions that can lead to cerebral edema, increased intracranial pressure, and collapsed circulation. Postoperative hyponatremia after central nervous system surgery is considered as the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Recently, however, cerebral salt wasting syndrome (CSWS) instead of SIADH has been reported frequently. CSWS is associated with a decreased serum sodium level, increased urinary sodium level, increased urine output, decreased ECF volume, increased atrial natriuretic peptide (ANP) level, and increased brain natriuretic peptide (BNP) level. We experienced nine patients with craniosynostosis who underwent calvarial remodeling. By postoperative day 1, the ANP and BNP levels increased by 3-6 folds compared with the preoperative levels. They returned to the normal levels by postoperative day 5. The ADH level was within the normal range even after operation. The urinary sodium level increased in all patients by postoperative day 1 and 3. But the serum sodium level, and serum and urine osmolarity were normal due to appropriate replacement of sodium and fluid. After calvarial remodeling, the potential development of CSWS should be considered and distinguished from SIADH. The patients with CSWS require normal saline resuscitation and should prophylactically receive normal saline.
Child ; Child, Preschool ; Craniosynostoses/complications/*surgery ; Craniotomy/*adverse effects ; Diagnosis, Differential ; Female ; Humans ; Hyponatremia/*diagnosis/*etiology ; Inappropriate ADH Syndrome/*diagnosis/*etiology ; Infant ; Male ; Reconstructive Surgical Procedures/adverse effects ; Research Support, Non-U.S. Gov't ; Skull/*surgery

BACKGROUNDNasopharygeal fibroangioma (NPF) can be approached through lateral rhinotomy, the middle skull fossa approach and the transcranial-facial combined approach. It is complicated and thus results in more insults, and when adopted, the total resection rate of tumor is still low. The nasal endoscope is minimally invasive, the dead angles of a craniotomy, such as sphenoid sinus, maxillary sinus, and nasopharynx are easily approached by an endoscope. Lateral rhinotomy have to make facial incision and affects maxillary bone development. We combined the craniotomy and endoscopic approach intending to take advantages of the two approaches.

METHODSTwelve NPF patients who underwent craniotomy with endoscopic assistance from March 2002 to July 2008 at the Beijing Tongren Hospital were selected. All patients were male. Their ages ranged from 11 to 33 years. The main symptoms were visual deterioration, exophthalmos, nasal obstruction, epistaxis and pharynx nasalis neoplasm. The diagnosis was based on CT, MRI and digital subtraction angiography (DSA). All patients had intracranial encroachment and all underwent DSA and embolism treatment were taken before surgery. Seven patients had a pterional craniotomy, five had a frontal-temporal-orbital-zygomatic craniotomy. Most of the tumor was resected piecemeal, then removed through the sphenoidal sinus. Finally, using an endoscope in the nasal cavity, tumor in nasal cavity was resected and removed through the sphenoidal sinus, observing the dead angle of the craniotomy and confirming that sinus drainage was unobstructed.

RESULTSThe tumor was removed completely in 11 patients and partially resected in one patient because of hemorrhage. One patient had an infection after the operation and one patient had cerebrospinal rhinorrhea 3 years after surgery that was remediated by endoscopic repair.

CONCLUSIONCraniotomy with endoscopic assistance in the treatment of NPF was minimally invasive, safe and efficient, and avoided facial incision.

Adolescent ; Adult ; Child ; Child, Preschool ; Craniotomy ; adverse effects ; methods ; Endoscopy ; adverse effects ; methods ; Fibroma ; diagnostic imaging ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Nasopharyngeal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Radiography ; Young Adult

OBJECTIVETo investigate the treatment of chronic subdural hematoma (CSDH) with burr-hole craniotomy in our hospital.

METHODSFrom January 2004 to December 2009, 398 patients with CSDH, 338 males and 60 females (male/female equal to 5.63/1), received burr-hole craniotomy in our hospital. The median age was 60 years with the mean age of (58.1 ± 18.1) years, (65.0 ± 14.5) years for females and (57.0 ± 18.2) years for males. Trauma history was determined in 275 patients (69.1%). Burr-hole craniotomy was performed under local anesthesia in 368 patients and general anesthesia in 30 patients. CSDH was classified into 3 groups according to the density on CT scan. Clinical data concerning etiologies, symptoms and signs, concomitant diseases, diagnosis, therapies and outcomes were investigated retrospectively. Patients'neurological status on admission and at discharge was also classified to judge the outcomes.

RESULTSGenerally, trauma history showed few differences between those over 60 years old and under 60 years old, but showed obvious differences when gender was taken into account. Totally 123 male patients (60.0% of 204 cases) suffering from head injuries were under 60 years, whereas 35 female patients (85.4% of 41 cases) with trauma histories were over 60 years. The duration from trauma to appearance of clinical symptoms was (84.0 ± 61.7) days (range, 0-1493 days). Traumatic accident was the leading etiology, other accompanying diseases such as cerebral vascular disease, hypertension, etc, were also predisposing factors. Commonly, the elderly presented with hemiplegia/hemidysesthesia/hemiataxia and the young with headache. Most CSDH patients (95.6%) treated with burr-hole craniotomy successfully recovered. However, postoperative complications occurred in 17 cases, including recurrence of CSDH in 15 cases, subdural abscess in 1 case and pneumonia in 3 cases.

CONCLUSIONBurr-hole craniotomy is an easy, efficient and reliable way to treat CSDH.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Craniotomy ; adverse effects ; methods ; Female ; Hematoma, Subdural, Chronic ; surgery ; Humans ; Infant ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Risk Factors ; Tomography, X-Ray Computed