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Singh M, Ahamed TPW, Maurya VP, Gupta P, Bhaisora KS, Srivastava AK, Verma PK, Das KK, Kumar A, Dikshit P, Mehrotra A, Jaiswal AK, Behari S, Kumar R. Stereotactic biopsy for brain lesions: Doing more with less. J Neurosci Rural Pract 2024; 15:95-102. [PMID: 38476427 PMCID: PMC10927046 DOI: 10.25259/jnrp_258_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/17/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives Stereotactic biopsy (STB) is a potential diagnostic tool considering its minimal invasiveness, high diagnostic yield, and minimal associated complications. Over the years, various frame-based instrument systems and frameless stereotactic biopsy systems have emerged to be employed in clinical use. With this study, we intend to get more by doing less in the form of STB for the patients of doubtful intracranial lesions treated over the past 5 years. We also want to highlight the technique of performing the procedure under scalp block, which can be used as a versatile tool in many clinical scenarios. Stereotactic biopsies may be planned even in rural district-level health facilities. One-time investment to procure instruments and avail existing imaging can lead to establishing definitive diagnoses in many doubtful cases. This will result in lesser cost and early establishment of treatment. Independent risk factors determining the outcome, such as deep-seated lesions, associated edema, and intraoperative hypertension, were studied. Establishing the diagnosis helped in prognosticating the disease, explaining the natural progression of symptoms, and starting adjuvant therapy. This tissue biopsy would also help secure samples for research and molecular analysis. Materials and Methods Twenty patients underwent STBs at our institution between January 2018 and December 2022. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including the diagnostic value and surgery-related complications. These patients were followed up, and their progression-free and overall survival were analyzed. The need for adjuvant treatment was noted and analyzed. All procedures were performed using Cosman Roberts Wells® stereotactic frame. Pre-procedure magnetic resonance scans were performed at the time of admission. Contrast-enhanced computerized tomography (CT) scan after frame application was performed to identify targets and calculate the coordinates. A post-procedure CT scan was done to confirm the accessibility of the targeted lesion. Results The most common location of the tumor was a deep-seated thalamic lesion. A definitive diagnosis was established in 19 patients (95%) at the first STB. The diagnoses were glioma in 55% of cases, primary central nervous system lymphoma, tuberculosis, and demyelinating disorders in 10% of each, and a metastatic brain tumor in 1 (5%). The post-operative complications were all transient except in one patient with deterioration of motor weakness. The follow-up was noted, and modes of adjuvant treatment needed in these patients were recorded. Conclusion Stereotactic biopsy is a useful and effective method for achieving a definitive diagnosis and aiding in treating multifocal or small deep-seated lesions in or around eloquent regions.
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Affiliation(s)
- Mayank Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - T. P. Waseem Ahamed
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pragya Gupta
- Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pawan Kumar Verma
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyadarshi Dikshit
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Chrysoula S, Zoi S, Eleni K, Freideriki S, Stella B, Stavros C. Dexmedetomidine as an adjuvant to scalp block in patients undergoing elective craniotomy: A prospective randomized controlled trial. Clin Neurol Neurosurg 2023; 227:107669. [PMID: 36924695 DOI: 10.1016/j.clineuro.2023.107669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE Regional techniques minimize anesthetic requirements and their effects may be beneficial. There is a lack of consensus and evidence concerning alternative analgesia strategies for cranial neurosurgery. This study was designed to evaluate the effect of scalp block with or without dexmedetomidine combined with general anesthesia on hemodynamic stability, opioid consumption and postoperative pain in patients undergoing elective craniotomy. METHODS One hundred five patients undergoing elective craniotomy for tumor dissection were randomly divided into three groups to receive scalp block as an adjuvant to general anesthesia: with either 40 ml ropivacaine 0.5 % (Group R), 40 ml ropivacaine 0.5 % plus dexmedetomidine 1 μg/kg (Group RD) or 40 ml saline as a placebo (Group C). After a standard induction sequence using propofol, fentanyl and a single dose of rocuronium, patients were intubated. Bilateral scalp block was given immediately after induction. Anesthesia was maintained with propofol and remifentanil infusion. Five minutes before head pinning scalp block was performed by blocking the supraorbital, supratrochlear, auriculotemporal, occipital, and postauricular branches of the greater auricular nerves. All patients were monitored with electrocardiogram, invasive blood pressure, pulse oximetry and BIS monitoring. Primary outcomes measures were overall hemodynamic variables during surgery and intravenous fentanyl and remifentanil consumption. Mean arterial pressure (MAP) and heart rate (HR) were recorded at seven time-points: scalp block (T1-baseline), pin fixation (T2), skin incision (T3), drilling (T4), dura matter incision (T5), dura matter closure (T6) and skin closure (T7). For all time points it was recorded the mean value after 3 consecutive measures with 5 min interval. Secondary outcome was postoperative pain intensity using visual analog scale 24 and 48 h after surgery. VAS scores, fentanyl and remifentanil were evaluated using Kruskal-Wallis test. MAP and HR were compared by One-Way repeated measures Anova (GLMM) using time as random efect and by One-Way Anova using time as fxed efect. RESULTS Mean arterial pressure was significant lower at skin closure compared to baseline in group R (p < 0,001) and in group RD (p < 0,001). Patients in group RD showed significant lower heart rate at dura matter incision, dura matter closure and skin closure compared to baseline, pin fixation and skin incision time points (p < 0,001) and reported significantly less heart rate than group C (p < 0,001) and group R (p < 0,001) during dura matter incision, dura matter closure and skin closure time points. Patients in group RD receive significant lower fentanyl than group R (p < 0,01). The intraoperative consumption of remifentanil was significant higher in control group compared to group R (p < 0,01) and to group RD (p < 0,001). Additionally, remifentanil consumption was significant lower in group RD as compared to group R (p < 0,001). Postoperative pain had no statistically differences between the three groups at 24 h and 48 h after craniotomy (Preop VAS: p = 0,915, VAS 24: p = 0,284, VAS 48, p = 0,385). No adverse effects were noted. CONCLUSION Our study indicated that addition of dexmedetomidine to scalp block with ropivacaine 0.5% provided significantly better perioperative hemodynamic stability during elective craniotomy. Moreover, scalp block with or without dexmedetomidine reduced fentanyl and remifentanil consumption, but it didn't significantly prolonged analgesia in patients undergoing elective craniotomy.
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Aspide R, Migliorino E, Pirina A, Berselli B, Manet R, Goutagny S, Castioni CA, Palandri G. Ventriculoatrial Shunt Under Locoregional Anesthesia: A Technical Note. World Neurosurg 2022; 166:135-40. [PMID: 35870783 DOI: 10.1016/j.wneu.2022.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ventriculoatrial shunt is routinely performed under general anesthesia and is used to treat various kinds of hydrocephalus. Idiopathic normal pressure hydrocephalus patients are generally elderly and can have high comorbidities; in such patients, avoiding general anesthesia and limiting opioid administration could be beneficial. We started to perform ventriculoatrial shunt under locoregional anesthesia, in order to make this procedure more truly "minimally invasive". METHODS Demographic data, American Society of Anesthesiologists (ASA) score and vital signs, Ramsay sedation scale, and procedural duration were collected. All procedures were performed combining sedation with cervical plexus and scalp block. After internal jugular vein cannulation, a catheter was inserted and connected with a programmable valve and then with the ventricular catheter. Outcome was assessed by the Idiopathic Normal Pressure Hydrocephalus Grading Scale and complications were recorded at 3-month follow-up. RESULTS Ten consecutive patients were enrolled; the mean age was 74 years, 8 were male, ASA score median value was 3. Opioids were administered only in 4 patients, in 6 patients the value of Ramsay scale was 5. The average duration of surgery was 59.5 minutes. No procedure was converted to general anesthesia. CONCLUSIONS Our preliminary experience with ventriculoatrial shunt under locoregional anesthesia demonstrates that this technique is feasible, is not associated with an increase in operating times or complications, can avoid general anesthesia, and helps to limit opioid administration in the elderly. It can therefore represent a valid option in order to improve treatment quality in these complex patients.
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Patel KS, Sun MZ, Willis SL, Alemnew M, De Jong R, Evans AS, Duong C, Gopen Q, Yang I. Selective scalp block decreases short term post-operative pain scores and opioid use after craniotomy: A case series. J Clin Neurosci 2021; 93:183-187. [PMID: 34656245 DOI: 10.1016/j.jocn.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/12/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
There is no consensus on the management of post-craniotomy pain. Several randomized controlled trials have examined the use of a regional scalp block for post-craniotomy pain. We aim to investigate whether scalp block affected short or long-term pain levels and opioid use after craniotomy. This study prospectively administered selective scalp blocks (lesser occipital, preauricular nerve block + pin site block) in 20 consecutive patients undergoing craniotomy for semicircular canal dehiscence. Anesthesia, pain, and opioid outcomes in these patients were compared to 40 consecutive historic controls. There was no significant difference in patient demographics between the two groups and no complications related to selective scalp block. The time between the end of procedure and end of anesthesia decreased in the scalp block group (16 vs 21 min, P = 0.047). Pain scores were significantly less in the scalp block group for the first 4 h, after which there was no statistically significant difference. Time to opioid rescue was longer in the scalp block group (3.6 vs 1.8 h, HR 0.487, P = 0.0361) and opioid use in the first 7 h was significantly less in the scalp block group. Total opioid use, outpatient opioid use, and length of stay did not differ. Selective scalp block is a safe and effective tool for short-term management of postoperative pain after craniotomy and decreases the medication requirement during emergence and recovery. Selective scalp block can speed up OR turnover but is not efficacious in the treatment of postoperative pain beyond this point.
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Affiliation(s)
- Kunal S Patel
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Matthew Z Sun
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Shelby L Willis
- Department of Head & Neck Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Mahlet Alemnew
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Russell De Jong
- Department of Head & Neck Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Audree S Evans
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Courtney Duong
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Quinton Gopen
- Department of Head & Neck Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States; Department of Head & Neck Surgery, University of California Los Angeles, Los Angeles, CA, United States; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, United States; Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, United States; Department of Surgery, Harbor-UCLA Los Angeles, Los Angeles, CA, United States; Los Angeles Biomedical Research Center, Harbor-UCLA Los Angeles, Los Angeles, CA, United States.
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Abdelhameed E, Abdelghany MS, Abdelkhalek H, Elatrozy HIS. Awake surgery for lesions near eloquent brain under scalp block and clinical monitoring: experience of single center with limited resources. Egypt J Neurol Psychiatr Neurosurg 2021; 57:78. [PMID: 34149281 PMCID: PMC8205193 DOI: 10.1186/s41983-021-00333-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 06/07/2021] [Indexed: 01/12/2023] Open
Abstract
Background Surgery of the brain tumors near eloquent areas carries the risk of either disabling neurological deficit or inadequate resection with bad prognosis in both situations. Awake surgery is the gold standard procedure for such lesions. However, it requires certain anesthetic drugs, advanced techniques, and trained teams that are not available in every neurosurgical institute. This work aims to evaluate safety, feasibility, and outcome of operating on patients with space occupying lesions near eloquent areas under scalp block being continuously examined by a neurologist through retrospective study of 20 cases with supratentorial lesions related to language or sensorimotor cortex. Results There were 12 males and 8 females with mean age 36.8 years. Forty percent of patients were presented by motor weakness. Tumors were related to motor cortex in 11 patients and to language areas in 9 patients. Mean operative time was 210 min. Gross or near total resection was achieved in 15cases, four cases had subtotal resection and biopsy only was done in 1 case. Two patients suffered from intraoperative seizures and conversion to general anesthesia was required in one patient. Conclusion Operating on tumors near eloquent brain areas under scalp block and continuous neurological examination during tumor resection proved to be effective in early detection and prevention of permanent major deficits especially in the developing countries with limited resources.
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Affiliation(s)
- Esam Abdelhameed
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Shebl Abdelghany
- Department of Anaethesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hazem Abdelkhalek
- Department of Neuropsychiatry, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hytham Ibrahim Shokry Elatrozy
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt.,Neurosurgery Department, Tanta University Hospital, Elgeish Street, Tanta, 31257 Egypt
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Bojaxhi E, Louie C, ReFaey K, Gruenbaum SE, Leone BJ, Bechtel P, Barbosa MP, Chaichana KL, Quinones-Hinojosa A. Reduced Pain and Opioid Use in the Early Postoperative Period in Patients Undergoing a Frontotemporal Craniotomy under Regional vs General Anesthesia. World Neurosurg 2021; 150:e31-e37. [PMID: 33684585 DOI: 10.1016/j.wneu.2021.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study compares the postsurgical course of frontotemporal craniotomies conducted "awake" under regional anesthesia (RA) versus "asleep" under general anesthesia (GA) to investigate postoperative recovery, pain, opioid use, and anesthesia-related side effects. METHODS We retrospectively reviewed craniotomies for supratentorial, intra-axial tumors with frontotemporal exposure. Chronic opioid use and emergent cases were excluded. Primary outcomes included pain scores on a 0-10 numerical rating scale, opioid use as oral morphine milligram equivalence, first time to opioid use, nausea, and sedation on the Richmond Agitation and Sedation Scale (RASS). Secondary outcomes included postoperative seizures, Karnofsky Performance Scale (KPS) status, and hospital length of stay (LOS). RESULTS A total of 91 patients met inclusion criteria: 56 underwent a craniotomy under RA versus 35 under GA. Demographics and operative characteristics were similar between cohorts. A significant reduction in both postoperative pain and opioid use was observed among RA versus GA (first postoperative pain score 2 vs. 5, P < 0.01; postoperative day [POD] 0 median pain score 2.5 vs. 4, P < 0.01; POD 0 mean opioid in mg 14.49 vs. 24.43, P < 0.01). The time until patients requested opioids for pain after surgery was prolonged for RA versus GA [mean 7.23 vs. 3.42 hours, P < 0.01). Somnolence (RASS < 0) on POD 0 was significantly reduced among RA versus GA, with 23% versus 43%. Both cohorts had equivocal postsurgical outcomes such as seizures, KPS, and hospital LOS. CONCLUSIONS Frontotemporal craniotomy under RA during awake craniotomies provides better pain control, a reduction in opioid use, and less somnolence in the early postoperative period.
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Affiliation(s)
- Elird Bojaxhi
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA.
| | - Christopher Louie
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Surgery, University of California, San Diego, California, USA
| | - Karim ReFaey
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Shaun E Gruenbaum
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bruce J Leone
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Perry Bechtel
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Maria P Barbosa
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
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Festa R, Tosi F, Pusateri A, Mensi S, Garra R, Mancino A, Frassanito P, Rossi M. The scalp block for postoperative pain control in craniosynostosis surgery: a case control study. Childs Nerv Syst 2020; 36:3063-3070. [PMID: 32418049 DOI: 10.1007/s00381-020-04661-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Postoperative analgesia after corrective surgery of pediatric craniosynostosis is crucial in terms of short- and long-term outcomes. The objective of this observational study was to evaluate the effectiveness of an analgesic technique based on the scalp block versus traditional pharmacological approach. METHODS Thirteen patients, aged between 3 months and 2 years, undergoing surgical correction of craniosynostosis, received scalp nerve block before awakening (scalp block group). This group of patients was compared to a second group of 13 patients, retrieved from our database, treated with the traditional pharmacological approach (control group). Pain scores, need of rescue therapy, resumption of oral nutrition, degree of parent satisfaction at discharge, and length of stay in the Pediatric Intensive Care Unit (PICU) and in the hospital were compared between the two groups. RESULTS Objective Pain Score values were significantly lower in patients treated with scalp block at 30 min and at 8 h after extubation. The number of pharmacological interventions for the treatment of pain in PICU was significantly higher in Control group. Children in Scalp block group started earlier oral feeding than in Control group, both for clear fluids and milk. Length of stay in PICU was longer in Scalp block group than in Control group, though the difference between the mean data in the two groups is about 3 . This difference does not seem significant from a clinical standpoint, since it seems more related to logistic issues (e.g., availability of bed in the Pediatric Neurosurgery Unit, presence of a parent), rather than clinical problems contraindicating the discharge from PICU. Indeed, the overall hospital length of stay was similar between the two groups. CONCLUSION Scalp nerve block was effective for immediate postoperative pain control in patients younger than 2 years who underwent cranioplasty for craniosynostosis. The best pain control compared to conventional therapy allowed to limit the need for rescue analgesics in PICU and an earlier recovery time. ClinicalTrials.gov Identification: NCT04133467.
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Affiliation(s)
- Rossano Festa
- Anesthesia and Intensive care, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Federica Tosi
- Anesthesia and Intensive care, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Angela Pusateri
- Anesthesia and Intensive care, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Sonia Mensi
- Anesthesia and Intensive care, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Rossella Garra
- Anesthesia and Intensive care, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Aldo Mancino
- Anesthesia and Intensive care, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Paolo Frassanito
- Pediatric Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Largo Agostino Gemelli, 8, 00168, Roma, Italy.
| | - Marco Rossi
- Anesthesia and Intensive care, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy.,Dipartimento di Scienze dell'emergenza, anestesiologiche e della rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
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Adeleye AO, Idowu OK, Ghadirpour R, Iaccarino C. Minicraniotomy Under Local Anesthesia and Monitored Sedation for the Operative Treatment of Uncomplicated Traumatic Acute Extradural Hematoma. World Neurosurg 2020; 142:513-519. [PMID: 32389868 DOI: 10.1016/j.wneu.2020.04.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Major craniotomy is currently the de facto operative treatment for traumatic acute extradural hematoma (AEDH). This craniotomy, involving extensive scalp dissection (the trauma flap) and major cranial bone opening, can be impracticable in the remote regions of some Western countries, and even more so in the low-resource health systems of most developing countries. METHODS We describe the surgical technique of minicraniotomy under local anesthesia plus monitored sedation as a much less invasive operative treatment for AEDH. The results of its use in a preliminary patient group are also presented. RESULTS The procedure has been carried out in 10 consecutive patients (7 men), including an infant 4 months of age. The age range was 4 months to 56 years. The patients suffered varying severity of head injury, with a median Glasgow Coma Scale (GCS) score of 11 out of 15 (range, 4-15). The median trauma to surgery time was 25 hours (range, 13-192 hours). The surgery was successfully completed, with hematoma evacuated and hemostasis achieved. The median duration of surgery was 90 minutes. The in-hospital outcome was Glasgow Outcome Scale score of normal status in 6 patients, moderate deficit in 2 patients, and vegetative state in the patient whose preoperative GCS score was 4. One other patient, admitted with a GCS score of 11, died 5 days postoperatively from extracranial causes. The surviving patients have been followed-up for a median time of 15 months with no new deficits. CONCLUSIONS Compared with full craniotomy under general anesthesia, minicraniotomy under local anesthesia plus sedation may be a more pragmatic, less invasive, and low-cost surgical treatment option for uncomplicated traumatic acute extradural hematoma.
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Affiliation(s)
- Amos O Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.
| | - Olusola K Idowu
- Department of Anaesthesia, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
| | - Reza Ghadirpour
- Emergency Neurosurgery Unit, AUSL RE IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Corrado Iaccarino
- Emergency Neurosurgery Unit, AUSL RE IRCCS of Reggio Emilia, Reggio Emilia, Italy; Department of Neurosurgery, University Hospital of Parma, Parma, Italy
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Mohamed AA, Radwan TA, Mohamed MM, Mohamed HA, Mohamed Elemady MF, Osman SH, Safan TF, Khair TM, Ali NA, Fahmy RS, Belita MI, Abdalla SR, Seleem AA, Atta EM, Zaid OI, Ragab AS, Salem AE, AlKholy BM. Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study. BMC Anesthesiol 2018; 18:129. [PMID: 30219027 PMCID: PMC6138934 DOI: 10.1186/s12871-018-0590-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations. METHODS 64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase. RESULTS Patients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile. CONCLUSION Our data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase. TRIAL REGISTRATION Clinical Trial registry on ClinicalTrials.gov , NCT 03411330 , 25-1-2018.
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Affiliation(s)
- Ahmed Abdalla Mohamed
- Anaesthesia, Faculty of Medicine, Cairo University, 139 H,Kafra Gate,Hadayk AL Ahram, Giza, Egypt.
| | - Tarek Ahmed Radwan
- Anaesthesia, Faculty of Medicine, Cairo University, 52 Elthawra street, Heliopolis, Cairo, Egypt
| | - Mohamed Mahmoud Mohamed
- Anaesthesia, Faculty of Medicine, Cairo University, 10 Abdlhameed Kotb Street, Kozzika, Maadi, Cairo, Egypt
| | - Hatem Abdellatif Mohamed
- Anaesthesia, Faculty of Medicine, Cairo University, 6 Ahmed Angad Street, Faisal-Alharam-Giza, Egypt
| | | | - Safinaz Hassan Osman
- Anaesthesia, Faculty of Medicine, Cairo University, 4 Hussein El Ezaby Street, Misr Alexandria Road, Cairo, Egypt
| | - Tamer Fayez Safan
- Anaesthesia, Faculty of Medicine, Cairo University, 1 Alsaraya Street, Almanyal, 11559, Cairo, Egypt
| | - Tamer Mohamed Khair
- Anaesthesia, Faculty of Medicine, Cairo University, 290 Teraat el gabal Street, El Zayton, Cairo, Egypt
| | - Norhan Abdelaleem Ali
- Anaesthesia, Faculty of Medicine, Cairo University, 29 Mansoura street, Agouza, Giza, Egypt
| | - Rania Samir Fahmy
- Anaesthesia, Faculty of Medicine, Cairo University, 1 Alsaraya Street, Almanyal, 11559, Cairo, Egypt
| | - Mohamed Ibrahim Belita
- Anaesthesia, Faculty of Medicine, Cairo University, 1 Alsaraya Street, Almanyal, 11559, Cairo, Egypt
| | - Shady Rady Abdalla
- Anaesthesia, Faculty of Medicine, Cairo University, 1 Alsaraya Street, Almanyal, 11559, Cairo, Egypt
| | - Ahmed Abdelaziz Seleem
- Anaesthesia, Faculty of Medicine, Cairo University, 15 B, Misr Construction Buldings,Zahraa el Maadi, Cairo, Egypt
| | - Ehab Mohi Atta
- Anaesthesia, Faculty of Medicine, Cairo University, 1 Alsaraya Street, Almanyal, 11559, Cairo, Egypt
| | - Osama Ismail Zaid
- Anaesthesia, Faculty of Medicine, Cairo University, 1 Alsaraya Street, Almanyal, 11559, Cairo, Egypt
| | - Ahmed Shaker Ragab
- Anaesthesia, National Cancer Institute, Anaesthesiology Department, Cairo University, Kasr Alainy Street, Cairo, Egypt
| | - Ahmed Essam Salem
- Anaesthesia, Faculty of Medicine, Tanta University, 92 Ahmed Orabi Street, El Mohandsen, Cairo, Egypt
| | - Badawy Mohamed AlKholy
- Chemical Patholpgy, Faculty of Medicine, Cairo University, 10 B Youssef Algendy Street, Bab Allouk, Cairo, Egypt
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Sargın M, Samancıoğlu H, Uluer MS. Transient Facial Nerve Palsy After the Scalp Block for Burr Hole Evacuation of Subdural Hematoma. Turk J Anaesthesiol Reanim 2017; 46:238-240. [PMID: 30140522 DOI: 10.5152/tjar.2018.58219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 02/06/2018] [Indexed: 11/22/2022] Open
Abstract
Scalp block has become a frequently used technique with an increasing number of indications today. Despite the many advantages of the scalp block, certain rare complications have been identified. It should be remembered that although it is a relatively safe procedure, it may lead to the development of facial nerve palsy. In this article, we present a case of transient facial nerve palsy developed after the scalp block that was used to drain the subdural hematoma with a burr hole.
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Affiliation(s)
- Mehmet Sargın
- Department of Anaesthesiology and Reanimation, Isparta City Hospital, Isparta, Turkey
| | | | - Mehmet Selçuk Uluer
- Department of Anaesthesiology and Reanimation, Health Sciences University Konya Training and Research Hospital, Konya, Turkey
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Akcil EF, Dilmen OK, Vehid H, Ibısoglu LS, Tunali Y. Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration. Clin Neurol Neurosurg 2017; 154:98-103. [PMID: 28183036 DOI: 10.1016/j.clineuro.2017.01.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The most painful stages of craniotomy are the placement of the pin head holder and the skin incision. The primary aim of the present study is to compare the effects of the scalp block and the local anesthetic infiltration with bupivacaine 0.5% on the hemodynamic response during the pin head holder application and the skin incision in infratentorial craniotomies. The secondary aims are the effects on pain scores and morphine consumption during the postoperative 24h. METHODS This prospective, randomized and placebo controlled study included forty seven patients (ASA I, II and III). The scalp block was performed in the Group S, the local anesthetic infiltration was performed in the Group I and the control group (Group C) only received remifentanil as an analgesic during the intraoperative period. The hemodynamic response to the pin head holder application and the skin incision, as well as postoperative pain intensity, cumulative morphine consumption and opioid related side effects were compared. RESULTS The scalp block reduced the hemodynamic response to the pin head holder application and the skin incision in infratentorial craniotomies. The local anesthetic infiltration reduced the hemodynamic response to the skin incision. As well as both scalp block and local anesthetic infiltration reduced the cumulative morphine consumption in postoperative 24h. Moreover, the pain intensity was lower after scalp block in the early postoperative period. CONCLUSION The scalp block may provide better analgesia in infratentorial craniotomies than local anesthetic infiltration.
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Sethi S, Kapil S. Scalp block for brain abscess drainage in a patient with uncorrected tetralogy of Fallot. World J Clin Cases 2014; 2:934-937. [PMID: 25516875 PMCID: PMC4266848 DOI: 10.12998/wjcc.v2.i12.934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/29/2014] [Accepted: 10/16/2014] [Indexed: 02/05/2023] Open
Abstract
We report a case of an 11-year-old boy with diagnosed but uncorrected tetralogy of Fallot presented to us for brain abscess drainage. The child was managed successfully with scalp block with sedation.
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