Minicraniotomy Under Local Anesthesia and Monitored Sedation for the Operative Treatment of Uncomplicated Traumatic Acute Extradural Hematoma

Adeleye, Amos Olufemi; Idowu, Olusola; Ghadirpour, Reza; Iaccarino, Corrado

doi:10.1016/j.wneu.2020.04.219

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…Articles were included if they met the following criteria: (1) original peer-reviewed articles with a digital objective identifier, (2) English only, (3) AC used as a neurosurgical procedure in Africa, (4) provided sufficient quantitative data and were accessible on databases used, and (5) articles involving human subjects only. The exclusion criteria were (1) articles that aggregated AC data on African and non-African countries without differentiating the Africa sources, (2) sufficient extractable data were not provided, and (3) studies that investigated neurosurgical interventions other than AC (eg, minicraniotomy 21 ). Case-reports and letters to editors were excluded unless sufficient data were provided.…”

Section: Methodsmentioning

confidence: 99%

Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges

et al. 2023

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BACKGROUND: Awake craniotomy (AC) is a common neurosurgical procedure for the resection of lesions in eloquent brain areas, which has the advantage of avoiding general anesthesia to reduce associated complications and costs. A significant resource limitation in low- and middle-income countries constrains the usage of AC. OBJECTIVE: To review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa. METHODS: We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review guidelines across 3 databases (PubMed, Scopus, and Web of Science). English articles investigating AC in Africa were included. RESULTS: Nineteen studies consisting of 396 patients were included. Egypt was the most represented country with 8 studies (42.1%), followed by Nigeria with 6 records (31.6%). Glioma was the most common lesion type, corresponding to 120 of 396 patients (30.3%), followed by epilepsy in 71 patients (17.9%). Awake-awake-awake was the most common protocol used in 7 studies (36.8%). Sixteen studies (84.2%) contained adult patients. The youngest reported AC patient was 11 years old, whereas the oldest one was 92. Nine studies (47.4%) reported infrastructure limitations for performing AC, including the lack of funding, intraoperative monitoring equipment, imaging, medications, and limited human resources. CONCLUSION: Despite many constraints, AC is being safely performed in low-resource settings. International collaborations among centers are a move forward, but adequate resources and management are essential to make AC an accessible procedure in many more African neurosurgical centers.

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Section: Methodsmentioning

confidence: 99%

Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges

et al. 2023

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“…We have recently indicated that general anesthesia costs up to 10 times that of local anesthesia for neurosurgical operative procedures in our practice. 32…”

Section: Discussionmentioning

confidence: 99%

Single Frontal Burr-Hole Craniostomy Under Local Anesthesia for Treating Chronic Subdural Hematoma in the Septuagenarians and Older Adults: Surgical Technique and Results

Adeleye

Ulasi

2023

Indian Journal of Neurotrauma

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Background Chronic subdural hematoma (CSDH) is not a totally benign disease in the elderly patients, especially those aged 70 years and above. Hence, the surgical treatment of CSDH in aged patients needs to be as minimally disruptive as possible. Methods An annotated description of the surgical technique of single frontal burr-hole craniostomy performed under local anesthesia and without closed tube drainage for evacuating CSDH in the septuagenarians and older adults is given. We also review the outcome of the procedure on a prospective consecutive cohort of patients in our service Results Thirty patients, 25 males, aged 70 years and above successfully underwent this surgical procedure. Their mean age was 76.5 years (standard deviation, 4.3). The CSDH was bilateral in 30% (9/30), and more left sided in the rest, the unilateral cases, and was of mixed density radiologically, in most cases (73%, 22/30). Clinical presentation was mainly gait impairment, cognitive decline, and headache, and 57% (17/30) presented with coma or stupor as assessed by the Markwalder grading scale.The surgery was successfully executed in all, median duration 45.0 minutes (interquartile range 37.3–60.0), and solely under local anesthesia in 77% (23/30) or with momentary short-acting sedation in the rest. The outcome was very good in 90.0% (27/30) using the modified Rankin Scale (mRS) including two-third (20/30) completely asymptomatic (mRS 0) and 7/30 with only slight symptoms/disability, mRS ≤ 2. Three patients died perioperatively, all presenting in coma. Conclusion This surgical technique appears very effectual for CSDH, is executed at a comparatively low cost, and, being much less disruptive than other traditional methods, may be a more homeostatic operative treatment in geriatric patients at least.

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“…We have recently indicated that general anaesthesia costs up to 10 times that of local anaesthesia for neurosurgical operative procedures in our practice. 26…”

Section: Discussionmentioning

confidence: 99%

Single Frontal Burr-hole Craniostomy Under Local Anaesthesia for Treating Chronic Subdural Haematoma in the Septuagenarians and Older Adults: Surgical Technique and Results

Adeleye¹,

Ulasi²

2020

Preprint

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Introduction. Chronic subdural haematoma is not a totally benign disease in the elderly patients, especially those aged 70 years and above. Hence, the surgical treatment of CSDH in those aged patients needs to be as minimally disruptive as possibleMaterials and Methods. An annotated description of the surgical technique of single frontal burr-hole craniostomy performed under local anaesthesia and without closed tube drainage for evacuating CSDH in the septuagenarians and older adults is described. We also review the outcome of the procedure on a prospective consecutive cohort of patients in our serviceResults. Thirty patients, 25 males, aged 70 years and above successfully underwent this surgical procedure. Their mean age was 76.5 years (standard deviation, SD, 4.3). The CSDH was bilateral in 30% (9/30); more left-sided in the rest, the unilateral cases, and was of mixed density radiologically, in most cases (73%, 22/30). Clinical presentation was mainly gait impairment, cognitive decline, and headache; and 57% (17/30) presented in coma or stupor as assessed by the Markwalder grading scale. The surgery was successfully executed in all, median duration 45.0 minutes (IQR 37.3-60.0), and solely under local anaesthesia in 77% (23/30) or with momentary short-acting sedation in the rest. Outcome was very good in 83.3% (25/30) using the modified Rankin Scale (mRS) including two-third (20/30) completely asymptomatic (mRS 0), and 5/30 with only slight symptoms and no disability, mRS 1. Three patients died perioperatively.Conclusion. This surgical technique appears very effectual for CSDH, is executed at a comparatively low-cost, and, being much less disruptive than other traditional methods, may be a more homeostatic operative treatment in geriatric patients at least.

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Minicraniotomy Under Local Anesthesia and Monitored Sedation for the Operative Treatment of Uncomplicated Traumatic Acute Extradural Hematoma

Cited by 5 publications

References 20 publications

Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges

Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges

Single Frontal Burr-Hole Craniostomy Under Local Anesthesia for Treating Chronic Subdural Hematoma in the Septuagenarians and Older Adults: Surgical Technique and Results

Single Frontal Burr-hole Craniostomy Under Local Anaesthesia for Treating Chronic Subdural Haematoma in the Septuagenarians and Older Adults: Surgical Technique and Results

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