Comparison of 1.0 g/kg of 20% mannitol initiated at different time points and effects on brain relaxation in patients with midline shift undergoing supratentorial tumor resection: a randomized controlled trial

2021 ◽  
pp. 1-8
Author(s):  
Jun-Jie Zhang ◽  
Yi-Heng Liu ◽  
Meng-Yun Tu ◽  
Kai Wei ◽  
Ying-Wei Wang ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Skin Incision ◽  
Serum Osmolality ◽  
Hemodynamic Parameters ◽  
Midline Shift ◽  
Early Administration ◽  
Supratentorial Tumor ◽  
Routine Administration ◽  
Brain Relaxation ◽  
Dural Opening

OBJECTIVE Previous studies have suggested the use of 1.0 g/kg of 20% mannitol at the time of skin incision during neurosurgery in order to improve brain relaxation. However, the incidence of brain swelling upon dural opening is still high with this dose. In the present study, the authors sought to determine a better timing for mannitol infusion. METHODS One hundred patients with midline shift who were undergoing elective supratentorial tumor resection were randomly assigned to receive early (immediately after anesthesia induction) or routine (at the time of skin incision) administration of 1.0 g/kg body weight of 20% mannitol. The primary outcome was the 4-point brain relaxation score (BRS) immediately after dural opening (1, perfectly relaxed; 2, satisfactorily relaxed; 3, firm brain; and 4, bulging brain). The secondary outcomes included subdural intracranial pressure (ICP) measured immediately before dural opening; serum osmolality and osmole gap (OG) measured immediately before mannitol infusion (T0) and at the time of dural opening (TD); changes in serum electrolytes, lactate, and hemodynamic parameters at T0 and 30, 60, 90, and 120 minutes thereafter; and fluid balance at TD. RESULTS The time from the start of mannitol administration to dural opening was significantly longer in the early administration group than in the routine administration group (median 66 [IQR 55–75] vs 40 [IQR 38–45] minutes, p < 0.001). The BRS (score 1/2/3/4, n = 14/26/9/1 vs 3/25/18/4, p = 0.001) was better and the subdural ICP (median 5 [IQR 3–6] vs 7 [IQR 5–10] mm Hg, p < 0.001) was significantly lower in the early administration group than in the routine administration group. Serum osmolality and OG increased significantly at TD compared to levels at T0 in both groups (all p < 0.001). Intergroup comparison showed that serum osmolality and OG at TD were significantly higher in the routine administration group (p < 0.001 and = 0.002, respectively). Patients who had received early administration of mannitol had more urine output (p = 0.001) and less positive fluid balance (p < 0.001) at TD. Hemodynamic parameters, serum lactate concentrations, and incidences of electrolyte disturbances were comparable between the two groups. CONCLUSIONS Prolonging the time interval between the start of mannitol infusion and dural incision from approximately 40 to 66 minutes can improve brain relaxation and decrease subdural ICP in elective supratentorial tumor resection.

Non-English Primary Language Is Associated with Short-Term Outcomes after Supratentorial Tumor Resection

2021 ◽  
Author(s):  
Emily E. Witt ◽  
Chukwuma N. Eruchalu ◽  
Tanujit Dey ◽  
David W. Bates ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Primary Language ◽  
Short Term ◽  
Supratentorial Tumor

The Rostral Mucosa: The Door to Open and Close for Targeted Endoscopic Endonasal Approaches to the Clivus

2021 ◽  
Author(s):  
Paolo di Russo ◽  
Arianna Fava ◽  
Lorenzo Giammattei ◽  
Thibault Passeri ◽  
Atsushi Okano ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tumor Resection ◽  
Skin Incision ◽  
Reconstruction Technique ◽  
Endoscopic Endonasal ◽  
Invasive Approach ◽  
Mucosal Incision ◽  
Reconstruction Strategy ◽  
Further Development ◽  
Targeted Approach

Abstract BACKGROUND Extended endoscopic endonasal approaches (EEAs) have progressively widened the armamentarium of skull base surgeons. In order to reduce approach-related morbidity of EEAs and closure techniques, the development of alternative strategies that minimize the resection of normal tissue and alleviate the use of naso-septal flap (NSF) is needed. We report on a novel targeted approach to the clivus, with incision and closure of the mucosa of the rostrum, as the initial and final step of the approach. OBJECTIVE To present an alternative minimally invasive approach and reconstruction technique for selected clival chordomas. METHODS Three cases of clival chordomas illustrating this technique are provided, together with an operative video. RESULTS The mucosa of the rostrum is incised and elevated from the underlying bone, as first step of surgery. Following tumor resection with angled scope and instruments, the mucosa of the sphenoid sinus (SS) is removed and the tumor cavity and SS are filled with abdominal fat. The mucosal incision of the rostrum is then sutured. A hangman knot is prepared outside the nasal cavity and tightened after the first stitch and a running suture is performed. CONCLUSION We propose, in this preliminary report, a new targeted approach and reconstruction strategy, applying to EEAs the classic concept of skin incision and closure for transcranial approaches. With further development in the instrumentations and visualization tools, this technique may become a valuable minimally invasive endonasal approach for selected lesions.

\"Balanced hyperosmolar therapy\" using 3% hypertonic saline - 20% mannitol versus an equiosmolar volume of either 3% hypertonic saline or mannitol 20% in supratentorial tumor resection: A new approach to achieve hemodynamic stability

2021 ◽  
Vol 8 (2) ◽  
pp. 221-229
Author(s):  
Samir A Elkafrawy ◽  
Mahmoud K Khames ◽  
Islam M Kandeel
Keyword(s):  
Hypertonic Saline ◽  
Urine Output ◽  
Fluid Intake ◽  
Tumor Resection ◽  
Double Blind Study ◽  
Hemodynamic Stability ◽  
Hyperosmolar Therapy ◽  
Significant Difference ◽  
Brain Relaxation ◽  
The Brain

Both 3% hypertonic saline (3% HTS) and 20% mannitol were proven to be effective in relaxing the brain during supratentorial surgeries. This work aimed to study the effect of consecutive use of both drugs on the brain relaxation score and hemodynamic status during such surgeries.Ninety patients scheduled for supratentorial brain surgeries included in this prospective, randomized and double-blind study. Patients were allocated in three groups; HTS group (n=30) received 3 ml/kg 3% NaCl infusion over 30 minutes, HTS/M group (n=30) received mannitol 20% (1.4 ml/kg) as an infusion over 15 minute followed by 1.5 ml/kg 3% NaCl infused over 15 minutes and M group (n=30) received 3.2 ml/kg mannitol 20% infusion over 30 minutes. Brain relaxation was estimated. MAP and serum Na level were recorded at baseline and then at 30, 90 and 150 min. Total fluid intake, total urine output and operative time were recorded. Fluid intake and urine output were the highest with 20% mannitol (p ˂ 0.001). HTS/M and HTS groups showed no significance when satisfactory and fairly brain relaxation scores were added (p=0.862). MAP and CVP were near to baseline in HTS/M group at 30 and 90 min, while at 150 min no significant difference between groups. Serum hyperosmolarity was noticed in all groups at all check points but maximally with HTS group at 30 min (321.1 mOsm/L). Balanced hyperosmolar therapy using 3% HTS and 20% mannitol consecutively resulted in a satisfactory brain relaxation and allowed more hemodynamic stability.

Abstract 122: Effects of Early Administration of Argatroban on CPR Quality in Porcine Model of Prolonged Out-of-Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jensyn J VanZalen ◽  
Annie G Phillips ◽  
Stephen L Harvey ◽  
Joseph E Hill ◽  
Olivia L Pak ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Porcine Model ◽  
Diastolic Pressure ◽  
Randomized Study ◽  
Coronary Perfusion ◽  
Hemodynamic Parameters ◽  
Early Administration ◽  
Intravascular Thrombosis ◽  
Arterial Blood ◽  
The Impact

Background: The effectiveness of CPR declines over time during prolonged cardiac arrest (CA). Intravascular thrombosis may be a contributing factor. As part of a larger study examining antithrombotic therapy in a porcine model of prolonged CA, the impact of early administration of argatroban on CPR hemodynamics is reported. Hypothesis: Early administration of argatroban during CPR improves the quality of goal-directed CPR (gdCPR). Methods: In a blinded and randomized study, 48 swine (40±5kg) underwent an 8min untreated period of ventricular fibrillation CA followed by a gdCPR protocol for 30min (total arrest time 38min). Manual and mechanical chest compressions with the use of an impedance threshold device (ITD) were introduced to maintain end-tidal CO 2 (Et-CO 2 ) >20mmHg. Argatroban (350mg/kg) or placebo (20mL NSS) were administered to respective groups (n=24 per group) 12mins after initiation of CA. Et-CO 2 , coronary perfusion pressure (CPP), end-diastolic pressure (EDP), and intracranial pressure (ICP) were monitored continuously. Averages were taken over the course of gdCPR for hemodynamic parameters. Arterial blood gases (ABGs) were obtained at the end of gdCPR. Analysis between groups was performed using an unpaired t-test (significance = p <0.05). Results: Average hemodynamic parameters were not statistically different between argatroban vs. placebo groups (Et-CO 2 22.6±6.7 vs. 21.5±5.9 mmHg; EDP 25.6±10.7 vs. 23.7±9.6 mmHg; ICP 25.7±2.0 vs.20.9±2.7 cmH 2 O; CPP 8.7±11.2 vs. 7.0±11.2 mmHg). Final ABG values were also not statistically different between argatroban vs. placebo groups (pH 7.23±0.1 vs. 7.23±0.2; PaO 2 187.4±146.3 vs. 132.2±187.4 mmHg; PaCO 2 38.8±16.6 vs. 43.0±26.1 mmHg; lactate 8.5±1.7 vs. 8.8±1.4 mmol/L). Conclusion: These results demonstrate that early administration of argatroban during CPR did not have a significant effect on gdCPR quality in a porcine model of prolonged CA.

scholarly journals Navigation-Linked Heads-Up Display in Intracranial Surgery: Early Experience

2017 ◽  
Vol 15 (2) ◽  
pp. 184-193 ◽  
Author(s):  
Justin R Mascitelli ◽  
Leslie Schlachter ◽  
Alexander G Chartrain ◽  
Holly Oemke ◽  
Jeffrey Gilligan ◽  
...  
Keyword(s):  
Choroid Plexus Papilloma ◽  
Cerebrospinal Fluid Leak ◽  
Skin Incision ◽  
Cavernous Malformations ◽  
Intracranial Surgery ◽  
Head Positioning ◽  
Teflon Granuloma ◽  
Dural Opening ◽  
Fluid Leak ◽  
Navigation Information

Abstract BACKGROUND The use of intraoperative navigation during microscope cases can be limited when attention needs to be divided between the operative field and the navigation screens. Heads-up display (HUD), also referred to as augmented reality, permits visualization of navigation information during surgery workflow. OBJECTIVE To detail our initial experience with HUD. METHODS We retrospectively reviewed patients who underwent HUD-assisted surgery from April 2016 through April 2017. All lesions were assessed for accuracy and those from the latter half of the study were assessed for utility. RESULTS Seventy-nine patients with 84 pathologies were included. Pathologies included aneurysms (14), arteriovenous malformations (6), cavernous malformations (5), intracranial stenosis (3), meningiomas (27), metastasis (4), craniopharygniomas (4), gliomas (4), schwannomas (3), epidermoid/dermoids (3), pituitary adenomas (2) hemangioblastoma (2), choroid plexus papilloma (1), lymphoma (1), osteoblastoma (1), clival chordoma (1), cerebrospinal fluid leak (1), abscess (1), and a cerebellopontine angle Teflon granuloma (1). Fifty-nine lesions were deep and 25 were superficial. Structures identified included the lesion (81), vessels (48), and nerves/brain tissue (31). Accuracy was deemed excellent (71.4%), good (20.2%), or poor (8.3%). Deep lesions were less likely to have excellent accuracy (P = .029). HUD was used during bed/head positioning (50.0%), skin incision (17.3%), craniotomy (23.1%), dural opening (26.9%), corticectomy (13.5%), arachnoid opening (36.5%), and intracranial drilling (13.5%). HUD was deactivated at some point during the surgery in 59.6% of cases. There were no complications related to HUD use. CONCLUSION HUD can be safely used for a wide variety of vascular and oncologic intracranial pathologies and can be utilized during multiple stages of surgery.

Electro-Acupuncture Decreases Postoperative Pain and Improves Recovery in Patients Undergoing a Supratentorial Craniotomy

2014 ◽  
Vol 42 (05) ◽  
pp. 1099-1109 ◽  
Author(s):  
Li-Xin An ◽  
Xue Chen ◽  
Xiu-Jun Ren ◽  
Hai-Feng Wu
Keyword(s):  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Tumor Resection ◽  
Postoperative Nausea And Vomiting ◽  
Control Group ◽  
Anesthesia Induction ◽  
Supratentorial Tumor ◽  
Intravenous Analgesia ◽  
Group A ◽  
Vas Scores

We performed this study to examine the effect of electro-acupuncture (EA) on postoperative pain, postoperative nausea and vomiting (PONV) and recovery in patients after a supratentorial tumor resection. Eighty-eight patients requiring a supratentorial tumor resection were anesthetized with sevoflurane and randomly allocated to a no treatment group (Group C) or an EA group (Group A). After anesthesia induction, the patients in Group A received EA at LI4 and SJ5, at BL63 and LR3 and at ST36 and GB40 on the same side as the craniotomy. The stimulation was continued until the end of the operation. Patient-controlled intravenous analgesia (PCIA) was used for the postoperative analgesia. The postoperative pain scores, PONV, the degree of dizziness and appetite were recorded. In the first 6 hours after the operation, the mean total bolus, the effective times of PCIA bolus administrations and the VAS scores were much lower in the EA group (p < 0.05). In the EA group, the incidence of PONV and degree of dizziness and feeling of fullness in the head within the first 24 hours after the operation was much lower than in the control group (p < 0.05). In the EA group, more patients had a better appetite than did the patients in group C (51.2% vs. 27.5%) (p < 0.05). The use of EA in neurosurgery patients improves the quality of postoperative analgesia, promotes appetite recovery and decreases some uncomfortable sensations, such as dizziness and feeling of fullness in the head.

scholarly journals Application of indocyanine green video angiography in parasagittal meningioma surgery

2014 ◽  
Vol 36 (2) ◽  
pp. E13 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Oriela Rustemi ◽  
Giorgio Gioffrè ◽  
Giuseppe Rolma ◽  
Marzia Grandis ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Indocyanine Green ◽  
Tumor Resection ◽  
Postoperative Outcome ◽  
Extent Of Resection ◽  
Morbidity Rate ◽  
Flow Measurements ◽  
Dural Opening ◽  
Meningioma Surgery ◽  
Parasagittal Meningioma

Object There are no doubts about the role that indocyanine green video angiography (ICGVA) can play in current vascular neurosurgery. Conversely, in brain tumor surgery, and particularly in meningioma surgery, this role is still unclear. Vein management is pivotal for approaching parasagittal meningiomas, because venous preservation is strictly connected to both extent of resection and clinical outcome. The authors present the technical traits and the postoperative outcome of the application of ICGVA in patients undergoing parasagittal meningioma surgery. Methods The authors retrospectively collected demographic, radiological, intraoperative, and follow-up data in 43 patients with parasagittal meningiomas who underwent surgery with the assistance of ICGVA at Padua Neurosurgical Department between October 2010 and July 2013. Intraoperative ICGVA findings at different stages (before dural opening, after dural opening, during resection, after resection) were reviewed. Additional data on functional monitoring, temporary venous clipping, and flow measurements were also recorded. The overall postoperative outcome was evaluated by assessing both the extent of resection and the clinical outcome data. Results The ICGVA studies were performed 125 times in 43 patients, providing helpful data for vein management and tumor resection in all stages of surgery. In 16% of meningiomas completely occluding the superior sagittal sinus, the ICGVA data differed from radiological findings and changed the surgical approach. In 20% of cases the intraoperative ICGVA findings directly guided the surgical strategy: venous sacrifice was necessary in 7 cases, without postoperative consequences; temporary clipping with neurophysiological monitoring proved to be predictive of safe venous sacrifice. In 7% of cases the ICGVA data needed to be supplemented with flow measurements. Simpson Grade I–II and Grade III resections were achieved in 86% and 14% of cases, respectively, with a 4.6% rate of overall morbidity. Conclusions This study shows that ICGVA can assist the different stages of parasagittal meningiomas surgery, guiding the vein management and tumor resection strategies with a favorable final clinical outcome. However, in the authors' experience the use of other complementary tools was mandatory in selected cases to preserve functional areas. Further studies are needed to confirm that the application of ICGVA in parasagittal meningioma surgery may improve the morbidity rate, as reported in this study.

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