Diamond-Shaped Mini-Craniotomy: A New Concept in Neurosurgery

Umana, Giuseppe Emmanuele; Scalia, Gianluca; Fricia, Marco; Nicoletti, Giovanni Federico; Iacopino, Domenico Gerardo; Maugeri, Rosario; Tomasi, Santino Ottavio; Cicero, Salvatore; Alberio, Nicola

doi:10.1055/s-0041-1730942

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…However, it is important to note that there could be other causes of hematomas distant from the surgical site after a craniotomy. For example, the use of anticoagulant or antiplatelet medications can increase the risk of bleeding 15,16 . Additionally, manipulation of the brain during surgery can cause vessel injury irrespective of the presence of amyloid angiopathy.…”

Section: Discussionmentioning

confidence: 99%

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Remote intracerebral hemorrhage following craniotomy for an intracerebral hematoma: A case report

Scalia,

Silven,

Costanzo

et al. 2023

Clinical Case Reports

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Key Clinical MessageRemote intracerebral hemorrhage (RICH) is a rare yet highly consequential complication that can occur after a craniotomy performed for the evacuation of an intracerebral hemorrhage (ICH). In this case report, we present the clinical details of a 74‐year‐old female patient who underwent a supratentorial craniotomy to address an ICH, and subsequently developed RICH. A 74‐year‐old woman was admitted to our department with a severe headache, onset of dysarthria, and left‐sided brachio‐crural hemiparesis. The patient had a history of arterial hypertension and a previous cerebral ischemia incident 2 years prior, potentially due to cerebral amyloid angiopathy. Despite the immediate surgical intervention and intensive care, she succumbed to respiratory distress after developing a contralateral ICH. RICH following craniotomy for an intracerebral hematoma is a rare but potentially devastating complication. Close monitoring, prompt recognition of neurological deterioration, and timely intervention are imperative to optimize patient outcomes. Further research is needed to better understand the underlying mechanisms and risk factors associated with this complication, allowing for improved prevention and management strategies in the future.

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Section: Discussionmentioning

confidence: 99%

“…For example, the use of anticoagulant or antiplatelet medications can increase the risk of bleeding. 15 , 16 Additionally, manipulation of the brain during surgery can cause vessel injury irrespective of the presence of amyloid angiopathy.…”

Section: Discussionmentioning

confidence: 99%

Remote intracerebral hemorrhage following craniotomy for an intracerebral hematoma: A case report

Scalia,

Silven,

Costanzo

et al. 2023

Clinical Case Reports

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“…The most commonly used being craniotomy (bone is repositioned after hematoma evacuation) and craniectomy (a decompressive procedure where the dura is expanded and bone is not re-placed at the end of surgery, needing a subsequent cranioplasty surgery), with no clear superiority of any of the two in terms of post-operative outcome [ 18 , 19 ]. However, recently, other techniques aimed to minimize surgical trauma have been proposed such as endoscopic/endoscope-assisted evacuation [ 20 ] and minicraniotomy in elderly patients [ 21 , 22 , 23 , 24 ]. Altogether, regardless of the surgical technique, the results largely depend on the clinical/radiological features and there is not a standardized indication to select those patients who will maximally benefit from a specific technique.…”

Section: Discussionmentioning

confidence: 99%

Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?

Trevisi

Scerrati

Rustemi

et al. 2022

JPM

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Background: The incidence of traumatic acute subdural hematomas (ASDH) in the elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays no clear role as a predictor. We investigated whether the timing of surgery had a major role in influencing the outcome in these patients. Methods: We retrospectively retrieved clinical and radiological data of all patients ≥70 years operated on for post-traumatic ASDH in a 3 year period in five Italian hospitals. Patients were divided into three surgical timing groups from hospital arrival: ultra-early (within 6 h); early (6–24 h); and delayed (after 24 h). Outcome was measured at discharge using two endpoints: survival (alive/dead) and functional outcome at the Glasgow Outcome Scale (GOS). Univariate and multivariate predictor models were constructed. Results: We included 136 patients. About 33% died as a result of the consequences of ASDH and among the survivors, only 24% were in good functional outcome at discharge. Surgical timing groups appeared different according to presenting the Glasgow Outcome Scale (GCS), which was on average lower in the ultra-early surgery group, and radiological findings, which appeared worse in the same group. Delayed surgery was more frequent in patients with subacute clinical deterioration. Surgical timing appeared to be neither associated with survival nor with functional outcome, also after stratification for preoperative GCS. Preoperative midline shift was the strongest outcome predictor. Conclusions: An earlier surgery was offered to patients with worse clinical-radiological findings. Additionally, after stratification for GCS, it was not associated with better outcome. Among the radiological markers, preoperative midline shift was the strongest outcome predictor.

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“…Craniotomy is a surgical procedure in which a flap of the skull bone is removed in order to expose the dura and access the brain [ 1 ]. It is an integral part of all neurosurgical procedures and involves the usage of high-speed drills and other specialized instruments [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Craniotomy Simulator with Force Myography and Machine Learning-Based Skills Assessment

et al. 2023

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Craniotomy is a fundamental component of neurosurgery that involves the removal of the skull bone flap. Simulation-based training of craniotomy is an efficient method to develop competent skills outside the operating room. Traditionally, an expert surgeon evaluates the surgical skills using rating scales, but this method is subjective, time-consuming, and tedious. Accordingly, the objective of the present study was to develop an anatomically accurate craniotomy simulator with realistic haptic feedback and objective evaluation of surgical skills. A CT scan segmentation-based craniotomy simulator with two bone flaps for drilling task was developed using 3D printed bone matrix material. Force myography (FMG) and machine learning were used to automatically evaluate the surgical skills. Twenty-two neurosurgeons participated in this study, including novices (n = 8), intermediates (n = 8), and experts (n = 6), and they performed the defined drilling experiments. They provided feedback on the effectiveness of the simulator using a Likert scale questionnaire on a scale ranging from 1 to 10. The data acquired from the FMG band was used to classify the surgical expertise into novice, intermediate and expert categories. The study employed naïve Bayes, linear discriminant (LDA), support vector machine (SVM), and decision tree (DT) classifiers with leave one out cross-validation. The neurosurgeons’ feedback indicates that the developed simulator was found to be an effective tool to hone drilling skills. In addition, the bone matrix material provided good value in terms of haptic feedback (average score 7.1). For FMG-data-based skills evaluation, we achieved maximum accuracy using the naïve Bayes classifier (90.0 ± 14.8%). DT had a classification accuracy of 86.22 ± 20.8%, LDA had an accuracy of 81.9 ± 23.6%, and SVM had an accuracy of 76.7 ± 32.9%. The findings of this study indicate that materials with comparable biomechanical properties to those of real tissues are more effective for surgical simulation. In addition, force myography and machine learning provide objective and automated assessment of surgical drilling skills.

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Diamond-Shaped Mini-Craniotomy: A New Concept in Neurosurgery

Cited by 4 publications

References 21 publications

Remote intracerebral hemorrhage following craniotomy for an intracerebral hematoma: A case report

Remote intracerebral hemorrhage following craniotomy for an intracerebral hematoma: A case report

Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?

Craniotomy Simulator with Force Myography and Machine Learning-Based Skills Assessment

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