Appendix 1: Horsley’s Procedure for Cranial Surgery

ObjectiveThe dural sealant patch (DSP) is designed for watertight dural closure after cranial surgery. The goal of this study is to assess, for the first time, safety and performance of the DSP as a means of reducing cerebrospinal fluid (CSF) leakage in patients undergoing elective cranial intradural surgery with a dural closure procedure.DesignFirst in human, open-label, single-arm, multicentre study with 360-day (12 months) follow-up.SettingThree large tertiary reference neurosurgical centres, two in the Netherlands and one in Switzerland.ParticipantsForty patients undergoing elective cranial neurosurgical procedures, stratified into 34 supratentorial and six infratentorial trepanations.InterventionEach patient received one DSP after cranial surgery and closure of the dura mater with sutures.Outcome measuresPrimary composite endpoint was occurrence of one of the following events: postoperative percutaneous CSF leakage, intraoperative leakage at 20 cm H2O positive end-expiratory pressure or postoperative wound infection. Overall success was defined as achieving the primary endpoint in no more than two patients. Secondary endpoints were device-related serious adverse events or adverse events (AEs), pseudomeningocele and thickness of dura+DSP. Additional endpoints were reoperation in 30 days and user satisfaction.ResultsNo patients met the primary endpoint. No device-related (serious) AEs were observed. There were two incidences of self-limiting pseudomeningocele as confirmed on MRI. Thickness of dura and DSP were (mean±SD) 3.5 mm±2.0 at day 7 and 2.1 mm±1.2 at day 90. No patients were reoperated within 30 days. Users reported a satisfactory design and intuitive application.ConclusionsDSP, later officially named Liqoseal, is a safe and potentially efficacious device for reducing CSF leakage after intracranial surgery, with favourable clinical handling characteristics. A randomised controlled trial is needed to assess Liqoseal efficacy against the best current practice for reducing postoperative CSF leakage.Trial registration numberNCT03566602.

Download Full-text

Cerebrospinal fluid leakage after cranial surgery in the pediatric population—a systematic review and meta-analysis

Child s Nervous System ◽

10.1007/s00381-021-05036-8 ◽

2021 ◽

Author(s):

Emma M. H. Slot ◽

Kirsten M. van Baarsen ◽

Eelco W. Hoving ◽

Nicolaas P. A. Zuithoff ◽

Tristan P. C van Doormaal

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cerebrospinal Fluid ◽

Pediatric Population ◽

Meta Analysis ◽

Leakage Rate ◽

Csf Leak ◽

Cerebrospinal Fluid Leakage ◽

Cranial Surgery ◽

Csf Leakage

Abstract Background Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors. Methods The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model. Results Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9). Conclusion The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as “leakage of CSF through the skin,” as an unambiguous definition is fundamental for future research.

Download Full-text

Survival after trepanation—Early cranial surgery from Late Iron Age Switzerland

International Journal of Paleopathology ◽

10.1016/j.ijpp.2015.08.002 ◽

2015 ◽

Vol 11 ◽

pp. 56-65 ◽

Cited By ~ 13

Author(s):

Negahnaz Moghaddam ◽

Simone Mailler-Burch ◽

Levent Kara ◽

Fabian Kanz ◽

Christian Jackowski ◽

...

Keyword(s):

Iron Age ◽

Cranial Surgery ◽

Late Iron Age

Download Full-text

Blood supply to the corticospinal tract: A pictorial review with application to cranial surgery and stroke

Clinical Anatomy ◽

10.1002/ca.23782 ◽

2021 ◽

Author(s):

Maximilano Nuñez ◽

Andrew Guillotte ◽

Amir H. Faraji ◽

Hansen Deng ◽

Ezequiel Goldschmidt

Keyword(s):

Blood Supply ◽

Corticospinal Tract ◽

Cranial Surgery ◽

Pictorial Review

Download Full-text

Economic Analysis Of Evicel® Compared With Standard Of Care For Dural Closure In Elective Cranial Surgery: A United Kingdom Hospital Perspective

Value in Health ◽

10.1016/j.jval.2015.09.742 ◽

2015 ◽

Vol 18 (7) ◽

pp. A369 ◽

Cited By ~ 1

Author(s):

S Lim ◽

N Ferko ◽

B Tibensky ◽

WI Danker ◽

N Jamous ◽

...

Keyword(s):

United Kingdom ◽

Economic Analysis ◽

Standard Of Care ◽

Hospital Perspective ◽

Cranial Surgery ◽

Dural Closure

Download Full-text

BRMP-01. Awake cranial surgery with intraoperative language mapping for brain tumors. A single-center experience

Neuro-Oncology ◽

10.1093/neuonc/noab196.894 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi223-vi223

Author(s):

Andrés Cervio ◽

Sebastían Giovannini ◽

Sonia Hasdeu ◽

Lucía Pertierra ◽

Blanca Diez

Keyword(s):

Brain Tumors ◽

Functional Mri ◽

Tumor Resection ◽

Awake Surgery ◽

Anesthetic Technique ◽

Low Grade ◽

Safe Procedure ◽

Language Mapping ◽

Cranial Surgery

Abstract BACKGROUND Maximal safe resection of brain tumors affecting language areas has been a matter of increasing interest worldwide in the last decades. Functional MRI, tractography, and awake cranial surgery are standard procedures in our department since 2006. The aim of this study was to describe our experience in a series of 58 patients who underwent awake cranial surgery with intraoperative language mapping. METHODS Retrospective study of 58 adult patients who underwent awake surgery for brain tumors between January 2006 and January 2021. Preoperative neuropsychological assessment served as inclusion criteria. Language was evaluated according to the BDAE (Boston diagnostic aphasia examination) and WAB (Western aphasia battery) and strength according to the MRC (Medical Research Council) motor scale in the preoperative, immediate postoperative, and 3-months follow up. Functional MRI and tractography depicting white-matter tracts, neuronavigation, cortical and subcortical stimulation were performed in all cases. Conscious sedation was the anesthetic technique (propofol, fentanyl, and NSAIDs). Minimum follow-up was 6 months. FINDINGS The average age was 35 years (16–74). The anatomopathological findings were: low-grade glioma in 75,8% (n = 44), high-grade glioma in 15,6% (n = 9) and others in 8,6% (n = 5). No complications were registered during postoperative course. At the immediate postoperative evaluation 65% of patients presented with speech disturbances but at the 3-months follow up speech recovery was observed in all cases. Only 1 patient remained with moderate aphasia. mRS score at 3- months follow up was ≤ 1 in 96% of patients. Two patients had a persistent moderate hemiparesis. CONCLUSION Tumor resection in awake patients showed to be a safe procedure, and well tolerated by the patients. Preoperative planning of anatomical and functional aspects and intraoperative neurophysiological assessment are the cornerstones for pursuing maximal safe resection.

Download Full-text

Abstract WP131: Effects Of EDAS Surgery On The Circulating Angiogenic Factors Of Patients With Moyamoya And Intracranial Atherosclerosis.

Stroke ◽

10.1161/str.47.suppl_1.wp131 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Nestor R Gonzalez ◽

Juan F Toscano ◽

Raymond Liou ◽

Neal Rao ◽

Jason D Hinman ◽

...

Keyword(s):

Mixed Models ◽

Angiogenic Factors ◽

Intracranial Atherosclerosis ◽

Control Groups ◽

Prospective Longitudinal Study ◽

Cranial Surgery ◽

Tumor Pathology ◽

Vessel Maturation ◽

And Control ◽

Prospective Longitudinal

Objective: To evaluate the levels of circulating angiogenic factors in patients with moyamoya disease (MMD), intracranial atherosclerosis (ICAS), and controls, and the effects of EDAS in their levels. Methods: Prospective longitudinal study of angiogenic factors in 22 patients with MMD, ICAS, and controls. Patients with MMD and ICAS underwent EDAS surgery. Control cases had cranial surgery for non-vascular or tumor pathology. Angiogenic factors were measured at baseline and 7 days after surgery. Log-corrected levels were compared between groups. Multivariate analysis of variance (MANOVA) was used to examine differences within pairs and between groups. Regression mixed models were built to account for intrasubject correlation and evaluate the association of angiogenic levels with group and treatment. Results: Mean age was 41 ± 11 in MMD, 65 ± 16 in ICAS, and 51 ± 19 in controls. There were 83% females in the MMD group, 44% in ICAS, and 43% in controls. Patients with MMD had significantly higher levels of PDGFAA (568.8 pg/ml), vs ICAS (165.9pg/mL), and controls (38.4 pg/mL) p=0.007; PDGFBB (1449.7 pg/mL), vs. ICAS (141.2 pg/mL), and controls (65.2 pg/mL) p=0.03; TGFB1 (24.5 ng/mL), vs. ICAS (13.8 ng/mL), and controls (6.2 ng/mL) p=0.006; TSP1 (128.5 ng/mL), vs. ICAS (91.7 ng/mL), and controls (9 ng/mL) p=0.0007. After surgery (EDAS for MMD and ICAS vs. cranial surgery for controls) levels of PDGFAA, PDGFBB, and TGFB1 increased on the ICAS and control groups eliminating the baseline differences. EDAS, independently from etiology, affected the levels of pro-angiogenic TGFB2 (EDAS: 290 pg/mL, controls: 161 pg/mL), and BMP2 (EDAS: 153 pg/mL, controls: 109 pg/mL) p<0.02. EDAS also increased the levels of the anti-angiogenic TSP2 (EDAS: 54.5 ng/mL, controls: 29 ng/mL) p=0.02. Conclusion: Patients with MMD have baseline higher levels of pro-angiogenic factors PDGFAA, PDGFBB, and TGFB1, involved in vessel maturation. EDAS, independent from etiology, affected the levels of TGFB2, BMP2 and TSP2, cytokines involved in vessel maturation, increased vascular permeability, and modulation of cell migration, respectively.

Download Full-text