No abstract

C ranioplasty, the placement of a bone flap or prosthesis to repair a defect in the skull, is a surgical procedure usually performed in patients who have undergone decompressive craniectomy (DC) due to poor control of elevated intracranial pressure following traumatic brain injury (TBI) or stroke. Though it is a relatively simple procedure, many complications, such as hemorrhage, infection, and bone necrosis, have been reported. 11,14,22,27 In addition, seizures are common after cranioplasty and are associated with poor outcomes; however, the risk factors for, and the incidence of, such seizures have not been well described. Moreover, there are few reports about the effect of antiepileptic drugs (AEDs) for seizure prophylaxis. 15 Our aim was to evaluate the risk factors that predispose patients to postcranioplasty seizures and to examine the role of seizure prophylaxis in cranioplasty. Methods Study DesignThe records of patients who had undergone cranioplasty at a single medical center during the period from January 2009 to December 2014 and who had at least 2 years of follow-up were retrospectively reviewed. The study included all patients who had initially undergone DC for brain swelling due to TBI, hemorrhagic or ischemic stroke, or brain tumor or abscess. To standardize the baseline risks and pathological entities, the study excluded patients ABBREVIATIONS AED = antiepileptic drug; DC = decompressive craniectomy; PMMA = polymethylmethacrylate; TBI = traumatic brain injury.OBJECTIVE Cranioplasty is a relatively simple and less invasive intervention, but it is associated with a high incidence of postoperative seizures. The incidence of, and the risk factors for, such seizures and the effect of prophylactic antiepileptic drugs (AEDs) have not been well studied. The authors' aim was to evaluate the risk factors that predispose patients to postcranioplasty seizures and to examine the role of seizure prophylaxis in cranioplasty. METHODS The records of patients who had undergone cranioplasty at the authors' medical center between 2009 and 2014 with at last 2 years of follow-up were retrospectively reviewed. Demographic and clinical characteristics, the occurrence of postoperative seizures, and postoperative complications were analyzed. RESULTS Among the 583 patients eligible for inclusion in the study, 247 had preexisting seizures or used AEDs before the cranioplasty and 336 had no seizures prior to cranioplasty. Of these 336 patients, 89 (26.5%) had new-onset seizures following cranioplasty. Prophylactic AEDs were administered to 56 patients for 1 week after cranioplasty. No early seizures occurred in these patients, and this finding was statistically significant (p = 0.012). Liver cirrhosis, intraoperative blood loss, and shunt-dependent hydrocephalus were risk factors for postcranioplasty seizures in the multivariable analysis. CONCLUSIONS Cranioplasty is associated with a high incidence of postoperative seizures. The prophylactic use of AEDs can reduce the occurrence of early seizures. https://thejns.org/doi/abs...

Background: Cerebral vasospasm still results in high morbidity and mortality rates in patients after aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to establish a protocol for the management of vasospasm and demonstrate our experience of angioplasty using the Scepter XC balloon catheter. Methods: In this retrospective study, a computed tomography angiography and perfusion image was arranged if early symptoms occurred or on the 7th day following aneurysmal SAH. In patients with clear consciousness, balloon angioplasties were performed for symptomatic vasospasms, which were not improved within 6-12 h after maximal medical treatments. In unconscious patients, balloon angioplasties were performed for all patients with angiographic vasospasms. Results: Fifty patients underwent Scepter XC balloon angioplasty among 396 consecutive patients who accepted endovascular or surgical treatments for ruptured aneurysms. All angioplasty procedures were successful without complications. 100% angiographic improvement and 94% clinical improvement were reached immediately after the angioplasties. A favorable functional outcome (modified Rankin Score of ≤2) could be achieved in 82% of patients. Even in patients with poor clinical grading (Hunt-Hess grade 4-5), a clinical improvement rate of 87.5% and favorable outcome rate was 70.8% could be achieved. Conclusion: Balloon angioplasty with Scepter XC balloon catheter is safe and effective for post-SAH vasospasm. This device's extra-compliant characteristics could considerably improve the quality of angioplasty procedures. For all patients, even those with poor neurological status, early treatment with combined protocol of nimodipine and angioplasty can have good clinical outcomes.

Pituicytoma revealed a negative endocrine secretory function through IHC staining. Additionally, pituicytoma is associated with hypersecretion of the pituitary gland both clinically and pathologically. Diagnosing pituicytoma before pathological confirmation is difficult because the tumour may present with hormone dysfunction. Therefore, IHC staining of specimens is useful to exclude the possibility of coexisting pituicytoma and pituitary adenoma.