Anesthetic and surgical predictors of treatment outcome in re-do craniotomy

Abstract

Introduction:Craniotomy is a neurosurgical operation done to remove brain tumor, repair vascular lesion, and relieve intracranial pressure. Complications can arise which may necessitate re-do craniotomy. The study is planned to find out the relationship between variables such as age, American Society of Anaesthesiologist (ASA), Glasgow coma score (GCS), frequency of re-do craniotomy, and surgical outcome of re-do craniotomy.Materials and Methods:This is a retrospective study of all the patients who had re-do craniotomy over a 4-year period. The data that were collected included age, sex, ASA classification, indication for re-do craniotomy, GCS, frequency of re-do craniotomy, postoperative complications, and outcome.Results:Twenty-five patients had indication for re-do craniotomy within the study period. Forty percent were male and 60% were female, and their mean age was 38.56 ± 17.38 years. The indications for re-do craniotomy were removal of residual tumor, evacuation of clot, and cerebrospinal fluid leakage. Seventy-six percent had good outcome, while 24% had poor outcome. Outcome was good for patients who had re-do craniotomy done once, while poor outcome was for patients with second and third craniotomies. Ninety percent of patients with ASA 2 had good outcome, while 9.1% had poor outcome; but 64.3% had good outcome with ASA 3, while 37.7% had poor outcome with a P-value of 0.18. Seventy-five percent had poor outcome in patients with GCS of less than 9, while 25% had good outcome; but 14.3% had poor outcome in patients with GCS above 9, while 85.7% had good outcome with a P-value of 0.031.Conclusions:Increasing frequency of re-do craniotomy and lower GCS were major factors affecting outcome in re-do craniotomy in our center. The outcome of these patients is valuable in the management of other patients with re-do craniotomy in future.

Anesthesia Management of Patients with Redo Craniotomy: Cases of Supratentorial Recidive Tumors

“…The awareness status measured in the GCS score of less than 9 has poor results, while a GCS between 9 and 15 leads to 85.7% good results and the difference between the two is statistically significant. This suggests that patients with a GCS of less than 8 are 19.6 times less likely to survive (Adigun et al, 2011). Both patients in this case report had a GCS score of 15.…”

“…Studies show that ASA 2 has good results, and ASA 2 has a figure 5.6 times less likely to survive compared to ASA 3 after a re-craniotomy, and ASA 3 patients are 0.2 times less likely to survive where patients have ASA 3. The first patient has ASA physical status 2, while the second patient has ASA physical status 2 (Adigun et al, 2011). The awareness status measured in the GCS score of less than 9 has poor results, while a GCS between 9 and 15 leads to 85.7% good results and the difference between the two is statistically significant.…”

“…Intraoperative parameters are measured by blood pressure and heart rate, since intraoperative hypotension is a common intraoperative side effect and has been reported to be associated with adverse perioperative outcomes. Better management of intraoperative anesthesia may have a greater effect on long-term outcomes (Adigun et al, 2011).…”

Profil Pasien Pasca Kraniotomi di ICU RSUP Prof. Dr. R. D. Kandou Manado Periode Juli 2016 - Juni 2017

“…Buang dan Haspani 4 mendapatkan bahwa operasi neurosurgical terbanyak pada tipe operasi emergency yaitu sebesar 63,1%. Adigun et al 13 menyatakan bahwa skor ASA pasien yang dilakukan kraniotomi terbanyak pada ASA III yaitu sebanyak 56%.…”

Commentary: Combined Orbitozygomatic Pretemporal Transcavernous and Endonasal Transmaxillary Approach for Resection of a Giant Trigeminal Schwannoma

“…A frontotemporal approach, even with the extension to the orbitozygomatic bones, 7 is the first-choice surgical route to reach the MF tumor portion and to guarantee an adequate control of the neurovascular structures; the association of the endonasal transmaxillary approach, through the Caldwell-Luc approach, [8][9][10] in a multiportal single-stage resection allows an easy access to the lesion increasing the chances of gross total resection. Moreover, a single surgical intervention reduces anesthesiologic risks 11 while, from a surgical point of view, a single-stage resection allows to work in an inviolate field without the effects of previous manipulations of delicate anatomic structures which cause both scar tissue and adhesions. 12 Skull base neurosurgery is a challenging field 13 : cranial nerves deficit and/or major vessels damage can severely harm the patient.…”