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Sample records for medpor craniotomy gap

  1. Evaluation of Osseointegration Ability of Porous Polyethylene Implant (Medpor Treated with Chitosan

    Directory of Open Access Journals (Sweden)

    Kwang Kim

    2014-01-01

    Full Text Available Purpose. We suggest a successful and simple Medpor treated way with chitosan and evaluate more improved osseointegration ability of it than the orignal. Materials and Methods. Medpor was punched into circular shape and dipped into the chitosan gel solution. The Medpor plates soaked with chitosan were identified by the SEM images. We evaluated the growth rate of MC3T3-E1 cell using Von Kossa staining and MTT assay as in vitro experiment. And we implanted both Medpor plates into skull of domestic rabbits for in vivo experiment. We evaluated the osseointegration result with an optical microscope in postoperative 3 weeks and 6 weeks histologically. Results. The in vitro MC3T3-E1 cell growth rate on Medpor soaking with chitosan was faster than the original one in both Von Kossa staining and MTT assay. In animal test, Medpor soaking with chitosan shows more pronounced new bone than original Medpor too. Conclusion. Medpor soaking with chitosan was a successful modification. It is believed that the upgraded osseointegration ability of Medpor soaking with chitosan gives many benefits to clinicians using a Medpor implant for oral and maxillofacial reconstruction surgery.

  2. Pretemporal craniotomy

    Directory of Open Access Journals (Sweden)

    Feres Chaddad-Neto

    2014-02-01

    Full Text Available This paper aims to describe the performance of the pretemporal craniotomy performed didactically from 2002 to 2012 in eighty patients. It is therefore a fundamentally descriptive text, organized in the sequence of the main stages in which such a craniotomy is performed, and describing in detail the technique with which this group of evolutionarily authors came to accomplish the task.

  3. Awake craniotomy

    Science.gov (United States)

    Bajunaid, Khalid M.; Ajlan, Abdulrazag M.

    2015-01-01

    Objective: To report the personal experiences of patients undergoing awake craniotomy for brain tumor resection. Methods: We carried out a qualitative descriptive survey of patients’ experiences with awake craniotomies for brain tumor resection. The survey was conducted through a standard questionnaire form after the patient was discharged from the hospital. Results: Of the 9 patients who met the inclusion criteria and underwent awake craniotomy, 3 of those patients reported no recollection of the operation. Five patients had auditory recollections from the operation. Two-thirds (6/9) reported that they did not perceive pain. Five patients remembered the head clamp fixation, and 2 of those patients classified the pain from the clamp as moderate. None of the patients reported that the surgery was more difficult than anticipated. Conclusion: Awake craniotomy for surgical resection of brain tumors was well tolerated by patients. Most patients reported that they do not recall feeling pain during the operation. However, we feel that further work and exploration are needed in order to achieve better control of pain and discomfort during these types of operations. PMID:26166593

  4. Plasma Treated High-Density Polyethylene (HDPE Medpor Implant Immobilized with rhBMP-2 for Improving the Bone Regeneration

    Directory of Open Access Journals (Sweden)

    Jin-Su Lim

    2014-01-01

    Full Text Available We investigate the bone generation capacity of recombinant human bone morphogenetic protein-2 (rhBMP-2 immobilized Medpor surface through acrylic acid plasma-polymerization. Plasma-polymerization was carried out at a 20 W at an acrylic acid flow rate of 7 sccm for 5 min. The plasma-polymerized Medpor surface showed hydrophilic properties and possessed a high density of carboxyl groups. The rhBMP-2 was immobilized with covalently attached carboxyl groups using 1-ethyl-3-(3-dimethylaminopropyl carbodiimide and N-hydroxysuccinimide. Carboxyl groups and rhBMP-2 immobilization on the Medpor surface were identified by Fourier transform infrared spectroscopy. The activity of Medpor with rhBMP-2 immobilized was examined using an alkaline phosphatase assay on MC3T3-E1 cultured Medpor. These results showed that the rhBMP-2 immobilized Medpor increased the level of MC3T3-E1 cell differentiation. These results demonstrated that plasma surface modification has the potential to immobilize rhBMP-2 on polymer implant such as Medpor and can be used for the binding of bioactive nanomolecules in bone tissue engineering.

  5. [History of the craniotomy].

    Science.gov (United States)

    González-Darder, José Manuel

    2016-01-01

    Craniotomy can be defined as the neurosurgical procedure aimed at achieving a wide cranial opening with the final purpose of performing a surgical therapeutic manoeuvre within the intracranial space. The current surgical technique for craniotomy is the final result of the development of the procedure since its introduction at the end of the 19th century. The very first wide cranial approach was introduced in 1889 by Wagner, and described as a 'temporary cranial resection'. This procedure could be named today as 'osteoplastic craniotomy with pedicle bone flap'. The final result of the procedural development of the craniotomy is the 'osteoplastic craniotomy with free bone flap', used widely around the world. In this paper, we review the historic evolution of craniotomy from a technical perspective. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Clinical observation on the reconstruction of large areas lower eyelid defect with Medpor spacer graft

    Directory of Open Access Journals (Sweden)

    Hai-Yan Li

    2014-08-01

    Full Text Available AIM: To observe the effects of porous polyethylene(Medporas a spacer graft in the reconstruction of large areas eyelid defect after the operation of malignant tumors of lower eyelids.METHODS: Nineteen cases(19 eyesof malignant tumors of lower eyelid underwent the eyelid reconstruction were selected. Medpor lower eyelid inserts implantation were used to replace tarsal joint sliding conjunctival flap and pedicle flap, and repaired full-thickness lower eyelid defects then underwent eyelid reconstruction. RESULTS: Appearance of eyelids and functional improvements were satisfactory with no stimulation on the eyeball and no effect on the visual function. Implants is with no absorption, shift, exclusion or infection and no tumor recurrence in all cases during the follow up for 6-36mo.CONCLUSION: Medpor lower eyelid inserts implantation can instead tarsal plate for the reconstruction of medium to large areas lower eyelid defect, which is easy performing with rare complications. It is an ideal alternatives of tarsal plate.

  7. Suboptimal pain treatment after craniotomy

    DEFF Research Database (Denmark)

    Hansen, Morten Sejer; Brennum, Jannick; Moltke, Finn Borgbjerg

    2013-01-01

    Only few studies have investigated pain, nausea, sedation and analgesic strategies in post-craniotomy patients. The aim of this observational study was to explore pain, nausea, sedation and analgesic procedures after craniotomy, and to evaluate the quality of current analgesic therapy administered...... to post-craniotomy patients....

  8. Awake Craniotomy and Coaching

    NARCIS (Netherlands)

    Ruis, Carla; Huenges Wajer, Irene; Robe, Pierre; van Zandvoort, Martine

    2014-01-01

    Background: The importance of monitoring cognition during awake craniotomy has been well described in previous studies. The relevance of being coached during such a procedure has received less attention and questions still remain unanswered about what factors are the most important herein.

  9. Vertical Diplopia and Ptosis from Removal of the Orbital Roof in Pterional Craniotomy

    Science.gov (United States)

    Desai, Shilpa J.; Lawton, Michael T.; McDermott, Michael W.; Horton, Jonathan C.

    2014-01-01

    Purpose To describe a newly recognized clinical syndrome consisting of ptosis, diplopia, vertical gaze limitation, and abduction weakness that can occur following orbital roof removal during orbito-zygomatic-pterional craniotomy. Design Case series. Participants Eight study patients, ages 44 – 80 years, 7 female, with neuro-ophthalmic symptoms after pterional craniotomy. Methods Case description of eight study patients. Main Outcome Measures Presence of ptosis, diplopia, and gaze limitation. Results Eight patients had neuro-ophthalmic findings after pterional craniotomy for meningioma removal or aneurysm clipping. The cardinal features were ptosis, limited elevation and hypotropia. Three patients also had limitation of downgaze and two had limitation of abduction. Imaging showed loss of the fat layers which normally envelop the superior rectus/levator palpebrae superioris. The muscles appeared attached to the defect in the orbital roof. Ptosis and diplopia developed in two patients despite Medpor titanium mesh implants. Deficits in all patients showed spontaneous improvement. In two patients a levator advancement was required to repair ptosis. In three patients an inferior rectus recession using an adjustable suture was performed to treat vertical diplopia. Follow-up a mean of 6.5 years later revealed that all patients had a slight residual upgaze deficit, but alignment was orthotropic in primary gaze. Conclusions After pterional craniotomy, ptosis, diplopia and vertical gaze limitation can result from tethering of the superior rectus/levator palpebrae superioris complex to the surgical defect in the orbital roof. Lateral rectus function is sometimes compromised by muscle attachment to the lateral orbital osteotomy. This syndrome occurs in about 1% of patients after removal of the orbital roof and can be treated, if necessary, by prism glasses or surgery. PMID:25439610

  10. Vertical diplopia and ptosis from removal of the orbital roof in pterional craniotomy.

    Science.gov (United States)

    Desai, Shilpa J; Lawton, Michael T; McDermott, Michael W; Horton, Jonathan C

    2015-03-01

    To describe a newly recognized clinical syndrome consisting of ptosis, diplopia, vertical gaze limitation, and abduction weakness that can occur after orbital roof removal during orbito-zygomatic-pterional craniotomy. Case series. Eight study patients (7 women), 44 to 80 years of age, with neuro-ophthalmic symptoms after pterional craniotomy. Case description of 8 study patients. Presence of ptosis, diplopia, and gaze limitation. Eight patients had neuro-ophthalmic findings after pterional craniotomy for meningioma removal or aneurysm clipping. The cardinal features were ptosis, limited elevation, and hypotropia. Three patients also had limitation of downgaze and 2 patients had limitation of abduction. Imaging showed loss of the fat layers that normally envelop the superior rectus and levator palpebrae superioris. The muscles appeared attached to the defect in the orbital roof. Ptosis and diplopia developed in 2 patients despite Medpor titanium mesh implants. Deficits in all patients showed spontaneous improvement. In 2 patients, a levator advancement was required to repair ptosis. In 3 patients, an inferior rectus recession using an adjustable suture was performed to treat vertical diplopia. Follow-up a mean of 6.5 years later revealed that all patients had a slight residual upgaze deficit, but alignment was orthotropic in primary gaze. After pterional craniotomy, ptosis, diplopia, and vertical gaze limitation can result from tethering of the superior rectus-levator palpebrae superioris complex to the surgical defect in the orbital roof. Lateral rectus function sometimes is compromised by muscle attachment to the lateral orbital osteotomy. This syndrome occurs in approximately 1% of patients after removal of the orbital roof and can be treated, if necessary, by prism glasses or surgery. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  11. Transient cognitive changes after craniotomy.

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    Hannegan, L

    1989-06-01

    Little has been written on the subject of cognitive and behavioral changes that may follow craniotomy. Neuroscience nurses who care for craniotomy patients often see transient alterations in behavior, intellect and personality similar to those occurring after minor head injury or subarachnoid hemorrhage. These changes may lead to depression and alter family dynamics. Interventional strategies, including cognitive screening, family counseling and thorough discharge planning are essential for helping patients and family members anticipate potential deficits and cope with life after craniotomy.

  12. Suboptimal pain treatment after craniotomy

    DEFF Research Database (Denmark)

    Hansen, Morten Sejer; Brennum, Jannick; Moltke, Finn Borgbjerg

    2013-01-01

    Only few studies have investigated pain, nausea, sedation and analgesic strategies in post-craniotomy patients. The aim of this observational study was to explore pain, nausea, sedation and analgesic procedures after craniotomy, and to evaluate the quality of current analgesic therapy administered...

  13. The suprapetrosal craniotomy.

    Science.gov (United States)

    Ribas, Guilherme Carvalhal; Rodrigues, Aldo Junqueira Júnior

    2007-03-01

    The primary aim of this study was to establish standard sites for bur holes that maintain constant anatomical relationships with the skull base and neural structures and can serve as the basal aspect of supratentorial temporooccipital craniotomies. To determine cranial-cerebral relationships, the authors created bur holes in 16 adult cadaveric skulls. Three bur holes were made on each side of the skulls (32 cerebral hemispheres). The authors then introduced plastic catheters through the bur holes to evaluate pertinent cranial and neural landmarks. The first bur hole, located anterior to the auricle of the ear, appeared to have a particular anatomical relationship with the anterior aspect of the petrous portion of the temporal bone and the most anterior aspect of the midbrain. The second bur hole, whose base was located 1 cm above the interface of the parietomastoid and squamous sutures, had a particular relationship with the posterior border of the petrous portion of the temporal bone and with the posterior aspect of the midbrain. The third bur hole, whose base was located 1 cm above the asterion, was mostly supratentorial and particularly related to the preoccipital notch. The preauricular bur hole and the bur hole whose base was located 1 cm above the interface of the parietomastoid and squamous sutures delimit anteriorly and posteriorly the external projection of the petrous bone and the midbrain. The middle fossa floor is located anterior to the site of the preauricular bur hole, and the superior surface of the tentorium is posterior to the bur hole located above the parietomastoid-squamous suture interface. Together with the bur hole whose base is located above the asterion, these bur holes can be considered standards for temporooccipital craniotomies.

  14. Awake craniotomy for tumor resection

    OpenAIRE

    Mohammadali Attari; Sohrab Salimi

    2013-01-01

    Surgical treatment of brain tumors, especially those located in the eloquent areas such as anterior temporal, frontal lobes, language, memory areas, and near the motor cortex causes high risk of eloquent impairment. Awake craniotomy displays major rule for maximum resection of the tumor with minimum functional impairment of the Central Nervous System. These case reports discuss the use of awake craniotomy during the brain surgery in Alzahra Hospital, Isfahan, Iran. A 56-year-old woman with le...

  15. Estimated Blood Loss in Craniotomy

    OpenAIRE

    Sitohang, Diana; AM, Rachmawati; Arif, Mansyur

    2016-01-01

    Introduction: Estimated blood loss is an estimation of how much blood is loss during surgery. Surgical procedure requires a preparation of blood stock, but the demand for blood often larger than the actual blood used. This predicament happens because there is no blood requirement protocol being used. This study aims to determine the estimated blood loss during craniotomy procedure and it's conformity to blood units ordered for craniotomy procedure. Methods: This study is a retrospective study...

  16. Immediate post-craniotomy headache.

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    de Oliveira Ribeiro, Maria do Carmo; Pereira, Carlos U; Sallum, Ana Mc; Martins-Filho, Paulo Ricardo S; Desantana, Josimari M; da Silva Nunes, Mariangela; Hora, Edilene C

    2013-08-01

    Headache is the most common adverse event immediately following craniotomy and is due to the surgical procedure and meningeal irritation. The aim of this study was to investigate the prevalence of headache during the first week after a craniotomy, as well as headache intensity, whether pain was registered in the patient's medical records, the use of analgesics and predictors of headache. Ninety-one patients who underwent craniotomy were evaluated from the first to the seventh post-operative day. The variables analysed were gender, age, medical history, indication for craniotomy, surgery, occurrence of headache, pain registration in the medical records, length of hospital stay and analgesics consumption. On the second post-operative day, 29.2% of patients had a headache and there was under-reporting of this pain in the patients' records. The analgesics used were non-steroidal anti-inflammatory in 75% of cases. An age of 4 hours (odds ratio = 3.7, P  = 0.019) were associated with the occurrence of immediate post-craniotomy headache. Further training should be provided to professionals caring for patients undergoing craniotomy to better manage post-operative headache.

  17. Awake craniotomy for tumor resection

    Directory of Open Access Journals (Sweden)

    Mohammadali Attari

    2013-01-01

    Full Text Available Surgical treatment of brain tumors, especially those located in the eloquent areas such as anterior temporal, frontal lobes, language, memory areas, and near the motor cortex causes high risk of eloquent impairment. Awake craniotomy displays major rule for maximum resection of the tumor with minimum functional impairment of the Central Nervous System. These case reports discuss the use of awake craniotomy during the brain surgery in Alzahra Hospital, Isfahan, Iran. A 56-year-old woman with left-sided body hypoesthesia since last 3 months and a 25-year-old with severe headache of 1 month duration were operated under craniotomy for brain tumors resection. An awake craniotomy was planned to allow maximum tumor intraoperative testing for resection and neurologic morbidity avoidance. The method of anesthesia should offer sufficient analgesia, hemodynamic stability, sedation, respiratory function, and also awake and cooperative patient for different neurological test. Airway management is the most important part of anesthesia during awake craniotomy. Tumor surgery with awake craniotomy is a safe technique that allows maximal resection of lesions in close relationship to eloquent cortex and has a low risk of neurological deficit.

  18. Postoperative analgesia for supratentorial craniotomy.

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    Dilmen, Ozlem Korkmaz; Akcil, Eren Fatma; Tunali, Yusuf; Karabulut, Esra Sultan; Bahar, Mois; Altindas, Fatis; Vehid, Hayriye; Yentur, Ercument

    2016-07-01

    The prevalence of moderate to severe pain is high in patients following craniotomy. Although optimal analgesic therapy is mandatory, there is no consensus regarding analgesic regimen for post-craniotomy pain exists. This study aimed to investigate the effects of morphine and non-opioid analgesics on postcraniotomy pain. This prospective, randomized, double blind, placebo controlled study included eighty three patients (ASA 1, II, and III) scheduled for elective supratentorial craniotomy. Intravenous dexketoprofen, paracetamol and metamizol were investigated for their effects on pain intensity, morphine consumption and morphine related side effects during the first 24h following supratentorial craniotomy. Patients were treated with morphine based patient controlled analgesia (PCA) for 24h following surgery and randomized to receive supplemental IV dexketoprofen 50mg, paracetamol 1g, metamizol 1g or placebo. The primary endpoint was pain intensity, secondary endpoint was the effects on morphine consumption and related side effects. When the whole study period was analyzed with repeated measures of ANOVA, the pain intensity, cumulative morphine consumption and related side effects were not different among the groups (p>0.05). This study showed that the use of morphine based PCA prevented moderate to severe postoperative pain without causing any life threatening side effects in patients undergoing supratentorial craniotomy with a vigilant follow up during postoperative 24h. Although we could not demonstrate statistically significant effect of supplemental analgesics on morphine consumption, it was lower in dexketoprofen and metamizol groups than control group. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. [the Pterional Craniotomy: Step By Step].

    OpenAIRE

    Chaddad Neto, Feres; Ribas, Guilherme Carvalhal; Oliveira, Evandro de

    2015-01-01

    This article intends to describe in a didactical and practical manner the frontotemporosphenoidal craniotomy, that is usually known as pterional craniotomy and that constitute the cranial approach mostly utilized in the modern neurosurgery. This is then basically a descriptive text, divided according to the main stages involved in this procedure, and that describes with details how the authors currently perform this craniotomy.

  20. 573 OR Craniotomy.indd

    African Journals Online (AJOL)

    2010-04-27

    Apr 27, 2010 ... Original Research: Effect of clonidine, by infiltration and by intravenous route, on scalp block for supratentorial craniotomy. 2010;16(6). S Afr J Anaesthesiol Analg. Abstract. Background: The aim of this research was to study and compare the haemodynamic and analgesic effects of (A) scalp block with ...

  1. Antibiotic prophylaxis in craniotomy : a review

    NARCIS (Netherlands)

    Liu, Weiming; Ni, Ming; Zhang, Yuewei; Groen, Rob J. M.

    The effectiveness of antibiotic prophylaxis (AP) in craniotomies has been clarified through the accumulation of evidence and increased antibiotic knowledge. This paper focuses on the use of AP in craniotomies during different historical periods and collects highly relevant evidence on this issue.

  2. Awake craniotomy: improving the patient's experience.

    Science.gov (United States)

    Potters, Jan-Willem; Klimek, Markus

    2015-10-01

    Awake craniotomy patients are exposed to various stressful stimuli while their attention and vigilance is important for the success of the surgery. We describe several recent findings on the perception of awake craniotomy patients and address nonpharmacological perioperative factors that enhance the experience of awake craniotomy patients. These factors could also be applicable to other surgical patients. Proper preoperative counseling gives higher patient satisfaction and should be individually tailored to the patient. Furthermore, there is a substantial proportion of patients who have significant pain or fear during an awake craniotomy procedure. There is a possibility that this could induce post-traumatic stress disorder or related symptoms. Preoperative preparation is of utmost importance in awake craniotomy patients, and a solid doctor-patient relationship is an important condition. Nonpharmacological intraoperative management should focus on reduction of fear and pain by adaptation of the environment and careful and well considered communication.

  3. How I do it: Awake craniotomy.

    Science.gov (United States)

    Hill, Ciaran Scott; Severgnini, Flavio; McKintosh, Edward

    2017-01-01

    Awake craniotomy allows continuous assessment of a patient's clinical and neurological status during open brain surgery. This facilitates early detection of interference with eloquent cortex, and hence can allow a surgeon to maximize resection margins without compromising neurological function. Awake craniotomy requires an effective scalp blockade, intraoperative assessment, and a carefully co-ordinated theatre team. A variety of clinical and electrophysiological techniques can be used to assess cortical function. Effective scalp blockade and awake craniotomy provides the opportunity to intraoperatively assess cortical function in the awake patient, thus providing an important neurosurgical option for lesions near eloquent cortex.

  4. Predicting sleepiness during an awake craniotomy.

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    Itoi, Chihiro; Hiromitsu, Kentaro; Saito, Shoko; Yamada, Ryoji; Shinoura, Nobusada; Midorikawa, Akira

    2015-12-01

    An awake craniotomy is a safe neurological surgical technique that minimizes the risk of brain damage. During the course of this surgery, the patient is asked to perform motor or cognitive tasks, but some patients exhibit severe sleepiness. Thus, the present study investigated the predictive value of a patient's preoperative neuropsychological background in terms of sleepiness during an awake craniotomy. Thirty-seven patients with brain tumor who underwent awake craniotomy were included in this study. Prior to craniotomy, the patient evaluated cognitive status, and during the surgery, each patient's performance and attitude toward cognitive tasks were recorded by neuropsychologists. The present findings showed that the construction and calculation abilities of the patients were moderately correlated with their sleepiness. These results indicate that the preoperative cognitive functioning of patients was related to their sleepiness during the awake craniotomy procedure and that the patients who exhibited sleepiness during an awake craniotomy had previously experienced reduced functioning in the parietal lobe. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Inflammatory profile of awake function-controlled craniotomy and craniotomy under general anesthesia

    NARCIS (Netherlands)

    M. Klimek (Markus); J.W. Hol (Jaap Willem); S.C.A. Wens (Stephan); C. Heijmans-Antonissen (Claudia); S.P. Niehof (Sjoerd); A.J. Vincent (Arnaud); J. Klein (Jan); F.J. Zijlstra (Freek)

    2009-01-01

    textabstractBackground. Surgical stress triggers an inflammatory response and releases mediators into human plasma such as interleukins (ILs). Awake craniotomy and craniotomy performed under general anesthesia may be associated with different levels of stress. Our aim was to investigate whether

  6. Post-Craniotomy Pain Management: Beyond Opioids.

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    Dunn, Lauren K; Naik, Bhiken I; Nemergut, Edward C; Durieux, Marcel E

    2016-10-01

    Craniotomy pain may be severe and is often undertreated. Pain management following craniotomy is a balancing act of achieving adequate analgesia but avoiding sedation, respiratory depression, hypercapnia, nausea and vomiting, and hypertension. Opioids are a first-line analgesic therapy; however, concern that opioid-related adverse effects (sedation, respiratory depression) may interfere with neurologic assessment and increase intracranial pressure has limited use of these drugs for intracranial surgery. Non-opioid analgesics avoid these effects and may be useful as part of a multimodal regimen for post-craniotomy pain. Regional scalp blocks, paracetamol, and non-steroidal anti-inflammatory drugs are beneficial in the early post-operative period. Recent studies suggest a role for novel analgesics: dexmedetomidine, gabapentinoids, and ketamine, though additional studies are necessary.

  7. Inflammatory Profile of Awake Function-Controlled Craniotomy and Craniotomy under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Markus Klimek

    2009-01-01

    Results. Plasma IL-6 level significantly increased with time similarly in both groups. No significant plasma IL-8 and IL-10 change was observed in both experimental groups. The VAS pain score was significantly lower in the awake group compared to the anesthesia group at 12 hours postoperative. Postoperative anxiety and stress declined similarly in both groups. Conclusion. This study suggests that awake function-controlled craniotomy does not cause a significantly different inflammatory response than craniotomy performed under general anesthesia. It is also likely that function-controlled craniotomy does not cause a greater emotional challenge than tumor resection under general anesthesia.

  8. Frontozygomatic titanium cranioplasty in frontosphenotemporal ("pterional") craniotomy.

    Science.gov (United States)

    Raza, Shaan M; Thai, Quoc-Anh; Pradilla, Gustavo; Tamargo, Rafael J

    2008-03-01

    One of the most common problems after frontosphenotemporal, or pterional, craniotomy is the marked depression of the frontozygomatic fossa caused by atrophy of the temporalis muscle. Although temporalis muscle reconstruction techniques have been proposed to prevent this problem, a definitive solution has not been achieved. We report the results of a titanium cranioplasty technique in a prospective series of patients who underwent frontosphenotemporal craniotomy. Between April 2002 and June 2006, 209 consecutive patients underwent a frontosphenotemporal craniotomy for aneurysms, vascular malformations, or tumors. At the time of surgery, the patients underwent a frontozygomatic fossa cranioplasty with a titanium plate, to which the temporalis muscle was attached. In this series, 194 patients had documented follow-up periods averaging 9.5 months (range, 1 mo-4 yr; median, 7.5 mo), and the cosmetic results of the cranioplasty have been assessed. The cosmetic outcomes have been outstanding in all patients treated to date. Two patients had the cranioplasty removed due to either orbital pain or local infection secondary to sepsis. The frontozygomatic cranioplasty during frontosphenotemporal craniotomy prevents the characteristic depression at the frontozygomatic fossa and accomplishes an outstanding cosmetic result.

  9. Intraoperative seizures during craniotomy under general anesthesia.

    Science.gov (United States)

    Howe, John; Lu, Xiaoying; Thompson, Zoe; Peterson, Gordon W; Losey, Travis E

    2016-05-01

    An acute symptomatic seizure is a clinical seizure occurring at the time of or in close temporal association with a brain insult. We report an acute symptomatic seizure occurring during a surgical procedure in a patient who did not have a prior history of epilepsy and who did not have a lesion associated with an increased risk of epilepsy. To characterize the incidence and clinical features of intraoperative seizures during craniotomy under general anesthesia, we reviewed cases where continuous EEG was acquired during craniotomy. Records of 400 consecutive cases with propofol as general anesthesia during craniotomy were reviewed. Demographic data, indication for surgery, clinical history, history of prior seizures, duration of surgery and duration of burst suppression were recorded. Cases where seizures were observed were analyzed in detail. Two out of 400 patients experienced intraoperative seizures, including one patient who appeared to have an acute symptomatic seizure related to the surgical procedure itself and a second patient who experienced two seizures likely related to an underlying diagnosis of epilepsy. This is the first report of an acute symptomatic seizure secondary to a neurosurgical procedure. Overall, 0.5% of patients monitored experienced seizures, indicating that intraoperative seizures are rare, and EEG monitoring during craniotomies is of low yield in detecting seizures. Copyright © 2016. Published by Elsevier Ltd.

  10. Evaluation of Language Function under Awake Craniotomy.

    Science.gov (United States)

    Kanno, Aya; Mikuni, Nobuhiro

    2015-01-01

    Awake craniotomy is the only established way to assess patients' language functions intraoperatively and to contribute to their preservation, if necessary. Recent guidelines have enabled the approach to be used widely, effectively, and safely. Non-invasive brain functional imaging techniques, including functional magnetic resonance imaging and diffusion tensor imaging, have been used preoperatively to identify brain functional regions corresponding to language, and their accuracy has increased year by year. In addition, the use of neuronavigation that incorporates this preoperative information has made it possible to identify the positional relationships between the lesion and functional regions involved in language, conduct functional brain mapping in the awake state with electrical stimulation, and intraoperatively assess nerve function in real time when resecting the lesion. This article outlines the history of awake craniotomy, the current state of pre- and intraoperative evaluation of language function, and the clinical usefulness of such functional evaluation. When evaluating patients' language functions during awake craniotomy, given the various intraoperative stresses involved, it is necessary to carefully select the tasks to be undertaken, quickly perform all examinations, and promptly evaluate the results. As language functions involve both input and output, they are strongly affected by patients' preoperative cognitive function, degree of intraoperative wakefulness and fatigue, the ability to produce verbal articulations and utterances, as well as perform synergic movement. Therefore, it is essential to appropriately assess the reproducibility of language function evaluation using awake craniotomy techniques.

  11. Preservation of bone flap after craniotomy infection.

    Science.gov (United States)

    Delgado-López, Pedro David; Martín-Velasco, V; Castilla-Díez, J M; Galacho-Harriero, A M; Rodríguez-Salazar, A

    2009-04-01

    The estimated incidence of craniotomy infection is 5%, ranging from 1-11% depending on the presence of certain risk factors, such as, prior radiation therapy, repeated surgery, CSF leak, duration of surgery over 4h, interventions involving nasal sinuses and emergency surgeries. The standard treatment for infected craniotomies is bone flap discarding and delayed cranioplasty. Adequate cosmetic results, unprotected brain and disfiguring deformity until cranioplasty are controversial features following bone removal. We present a limited series of five patients with craniotomy infection, that were successfully treated with wound debridement, in situ bone sterilization, reposition of the bone flap and antibiotic irrigation through a wash-in and wash-out draining system, all in the same surgical procedure. All infections cleared and every patient saved his/her bone flap. We retrospectively reviewed the records of 5 patients with craniotomy infection that presented with wound swelling, purulent discharge and fever. The operative technique consisted on three manoeuvres: wound debridement, bone flap sterilization (either autoclaved or soaked in a sterilizing solution), and insertion of subgaleal/epidural drains for non-continuous antibiotic irrigation (vancomycin 50mg in 20cc of saline every 12h alternating with cephotaxime 100mg in 20cc of saline every 12h). Also, patients received equal systemic endovenous antibiotherapy and oral antibiotics after discharge, until complete resolution of infection and wound healing. Patients in the series (2 women and 3 men) ranged in age from 36 to 77. No patient had received prior radiation therapy and only one had undergone surgery involving nasal sinuses. The initial operations correspond to craniotomies performed for two intracranial tumours (meningiomas), one arteriovenous malformation and two decompressive craniotomies (haemorrhagic contusions and acute subdural haematoma). The duration of surgeries ranged from 1h30' to 5h30', only

  12. Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis.

    Science.gov (United States)

    Kourbeti, Irene S; Vakis, Antonis F; Ziakas, Panayiotis; Karabetsos, Dimitris; Potolidis, Evangelos; Christou, Silvana; Samonis, George

    2015-05-01

    OBJECT The authors performed a prospective study to define the prevalence and microbiological characteristics of infections in patients undergoing craniotomy and to clarify the risk factors for post-craniotomy meningitis. METHODS Patients older than 18 years who underwent nonstereotactic craniotomies between January 2006 and December 2008 were included. Demographic, clinical, laboratory, and microbiological data were systemically recorded. Patient characteristics, craniotomy type, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS Three hundred thirty-four procedures were analyzed (65.6% involving male patients). Traumatic brain injury was the most common reason for craniotomy. Almost 40% of the patients developed at least 1 infection. Ventilator-associated pneumonia (VAP) was the most common infection recorded (22.5%) and Acinetobacter spp. were isolated in 44% of the cases. Meningitis was encountered in 16 procedures (4.8%), and CSF cultures were positive for microbial growth in 100% of these cases. Gram-negative pathogens (Acinetobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Enterobacter cloaceae, Proteus mirabilis) represented 88% of the pathogens. Acinetobacter and Klebsiella spp. demonstrated a high percentage of resistance in several antibiotic classes. In multivariate analysis, the risk for meningitis was independently associated with perioperative steroid use (OR 11.55, p = 0.005), CSF leak (OR 48.03, p meningitis in this study. Ventilator-associated pneumonia was the most common infection overall. The offending pathogens presented a high level of resistance to several antibiotics.

  13. Anaesthesia for awake craniotomy is safe and well-tolerated

    DEFF Research Database (Denmark)

    Andersen, Jakob Hessel; Olsen, Karsten Skovgaard

    2010-01-01

    Awake craniotomy for tumour resection has been performed at Glostrup Hospital since 2004. We describe and discuss the various anaesthetic approaches for such surgery and retrospectively analyse the 44 planned awake craniotomies performed at Glostrup Hospital. The surgery falls into four phases......: craniotomy, mapping, tumour resection and closing. Three methods are being used: monitored anaesthetic care, asleep-awake-asleep and asleep-awake (AA)....

  14. Evaluation of Language Function under Awake Craniotomy

    OpenAIRE

    KANNO, Aya; MIKUNI, Nobuhiro

    2015-01-01

    Awake craniotomy is the only established way to assess patients’ language functions intraoperatively and to contribute to their preservation, if necessary. Recent guidelines have enabled the approach to be used widely, effectively, and safely. Non-invasive brain functional imaging techniques, including functional magnetic resonance imaging and diffusion tensor imaging, have been used preoperatively to identify brain functional regions corresponding to language, and their accuracy has increase...

  15. Meningeal enhancement on MRI after craniotomy

    Energy Technology Data Exchange (ETDEWEB)

    Nomura, Motohiro; Hasegawa, Mitsuhiro; Yamashima, Tetsumori; Yamashita, Junkoh; Suzuki, Masayuki (Kanazawa Univ. (Japan). School of Medicine)

    1991-08-01

    Gd-DPTA-enhanced MR images in 94 patients who had undergone craniotomy were studied, with particular attention paid to the meningeal enhancement. Such enhancement was noted in 26 of the 94 (27.6%) in the portion surrounding the craniotomy site. Meningeal enhancement, presumably of the subdural neomembrane, was apparent as a third line of a high signal intensity on T{sub 1}-weighted MR images. The outer two high-intensity lines were derived from fat in the subcutaneous tissues of the scalp and fat in the bone marrow of the calvaria. We designated this characteristic enhancement as a 'triple white line'. Of the 26 patients with meningeal enhancement, 22 cases (23.4%) showed such a 'triple white line', 11 cases (11.7%) showed falx enhancement, and 12 cases (12.8%) showed tentorial enhancement. The intervals between surgery and the appearance of the meningeal enhancement ranged from 4 days to 88 weeks. A small amount of bleeding into the dura-arachnoid interface induced by surgery might result in the subdural neomembrane, as has previously been reported. This neomembrane might be enhanced by the leakage of Gd-DTPA through the proliferating capillaries. As meningeal enhancement occurs in approximately a third of the cases following craniotomy, much care should be taken in the differential diagnosis of the infection, inflammation, and metastasis or dissemination of malignant brain tumors. (author).

  16. Meningeal enhancement on MRI after craniotomy

    International Nuclear Information System (INIS)

    Nomura, Motohiro; Hasegawa, Mitsuhiro; Yamashima, Tetsumori; Yamashita, Junkoh; Suzuki, Masayuki

    1991-01-01

    Gd-DPTA-enhanced MR images in 94 patients who had undergone craniotomy were studied, with particular attention paid to the meningeal enhancement. Such enhancement was noted in 26 of the 94 (27.6%) in the portion surrounding the craniotomy site. Meningeal enhancement, presumably of the subdural neomembrane, was apparent as a third line of a high signal intensity on T 1 -weighted MR images. The outer two high-intensity lines were derived from fat in the subcutaneous tissues of the scalp and fat in the bone marrow of the calvaria. We designated this characteristic enhancement as a 'triple white line'. Of the 26 patients with meningeal enhancement, 22 cases (23.4%) showed such a 'triple white line', 11 cases (11.7%) showed falx enhancement, and 12 cases (12.8%) showed tentorial enhancement. The intervals between surgery and the appearance of the meningeal enhancement ranged from 4 days to 88 weeks. A small amount of bleeding into the dura-arachnoid interface induced by surgery might result in the subdural neomembrane, as has previously been reported. This neomembrane might be enhanced by the leakage of Gd-DTPA through the proliferating capillaries. As meningeal enhancement occurs in approximately a third of the cases following craniotomy, much care should be taken in the differential diagnosis of the infection, inflammation, and metastasis or dissemination of malignant brain tumors. (author)

  17. Removal of symptomatic titanium fixation plates after craniotomy.

    Science.gov (United States)

    Gupta, Raghav; Adeeb, Nimer; Griessenauer, Christoph J; Moore, Justin M; Patel, Apar S; Thomas, Ajith J; Ogilvy, Christopher S

    2016-10-01

    Titanium fixation plates are routinely used for rigid fixation of bone flaps after craniotomy. In craniofacial surgery or after craniotomy involving orbitozygomatic osteotomies, these plates are occasionally removed because of infection, pain, protrusion, soft tissue erosion, and plate malfunction. However, plate removal because of pain and protrusion after craniotomy without orbitozygomatic osteotomy has rarely been reported. A retrospective analysis of all patients who underwent removal of cranial fixation plates after craniotomy, performed by the senior authors at one institution between 2014 and 2016, was conducted. A total of 319 patients underwent bone flap fixation after craniotomy using cranial fixation plates between 2014 and 2016. Five of those patients (1.6 %) had their cranial plates removed because of pain and protrusion. An additional four patients had a cranial fixation plate removed during that time frame with the original craniotomy performed before 2014. All nine patients had immediate resolution of symptoms after plate removal. We report our experience with cranial fixation plate removal because of pain and protrusion in patients who underwent craniotomy without orbitozygomatic osteotomy, particularly frontotemporal craniotomy. In an attempt to reduce this complication, we recently stopped placing a full-size burr hole in the keyhole area of a frontotemporal craniotomy, eliminating the need for a titanium burr hole cover plate.

  18. Delayed Effect of Craniotomy on Experimental Seizures in Rats

    Science.gov (United States)

    Forcelli, Patrick A.; Kalikhman, David; Gale, Karen

    2013-01-01

    Neurosurgical therapeutic interventions include components that are presumed to be therapeutically inert, such as craniotomy and electrode implantation. Because these procedures may themselves exert neuroactive actions, with anecdotal evidence suggesting that craniotomy and electrode placement may have a particularly significant impact on epileptic seizures, the importance of their inclusion in sham control groups has become more compelling. Here we set out to test the hypothesis that craniotomy alone is sufficient to alter experimental seizures in rats. We tested adult male rats for seizures evoked by pentylenetetrazole (70 mg/kg) between 3 and 20 days following placement of bilateral craniotomies (either 2.5 or 3.5 mm in diameter) in the parietal bone of the skull, without penetrating the dura. Control (sham-operated) animals underwent anesthesia and surgery without craniotomy. We found that craniotomy significantly decreased the severity of experimental seizures on postoperative days 3, 6, and 10; this effect was dependent on the size of craniotomy. Animals with craniotomies returned to control seizure severity by 20 days post-craniotomy. These data support the hypothesis that damage to the skull is sufficient to cause a significant alteration in seizure susceptibility over an extended postoperative period, and indicate that this damage should not be considered neurologically inert. PMID:24324691

  19. Dynamic Decompressive Craniotomy with a Novel Reversibly Expandable Plate.

    Science.gov (United States)

    Khanna, Rohit

    2017-07-01

    Objective  To assess the feasibility of a dynamic craniotomy procedure with the use of a novel reversibly expandable cranial bone flap fixation plate. The expandable plate allows outward bone flap migration with an increase in intracranial volume or intracranial pressure (ICP). Methods  Dynamic craniotomy intracranial hypertension compliance was evaluated in a skull model with progressive increase in intracranial volume and compared with the standard craniotomy with fixed plates. Results  Dynamic craniotomy provided significant control of ICP with increasing intracranial volume compared with the standard craniotomy. With an incremental increase in intracranial volume from 360 mL to 600 mL, the ICP increased from 2.6 to 91.9 mm Hg with the standard craniotomy, whereas with the dynamic craniotomy the ICP for similar intracranial volume increased from 2.5 to 25 mm Hg ( p  craniotomy procedure provides superior control of ICP with an abrupt intracranial volume increase when compared with the standard craniotomy. Georg Thieme Verlag KG Stuttgart · New York.

  20. Image guided surgery versus conventional brain tumor and craniotomy localization.

    Science.gov (United States)

    Mahvash, Mehran; Boettcher, Ioannis; Petridis, Athanasios K; Besharati Tabrizi, Leila

    2017-02-01

    Accurate brain lesion and craniotomy localization is an essential step in neurosurgical procedures. Image guided techniques transfer the information of neuroimaging about brain lesion localization to the patient. A critical view is necessary to find out how safe and reliable it is to transfer this information to the patient's head without using image guided systems. The aim of this study was to investigate the value of image guided brain lesion and craniotomy localization compared to conventional methods. A new developed test was performed with 10 neurosurgeons from different clinics. The first task was to perform the conventional tumor localization, planning of craniotomy and skin incision using the MRI dataset of a patient with a left temporal brain tumor. Second, the neurosurgeons were asked to plan the craniotomy and skin incision using MRI based 3D visualization with the exact localization of the segmented brain tumor. Both plans of each neurosurgeon were compared and analyzed according to the calculated brain tumor localization, location, shape and size of craniotomy. All neurosurgeons changed the craniotomy localization and skin incision in the second part of the task using the image guided tumor visualization. The mean error (±standard deviation) of tumor localization of the conventional planning was 11.45±5.09 mm in the anterior-posterior (AP) and 12±7.91 mm in the superior-inferior (SI) direction. The mean error of the craniotomy localization using conventional planning was 10.18±6.09 mm in the AP and 10.75±8.18 mm in the SI direction. The craniotomy size was significantly larger using conventional planning of the craniotomy (P=0.035). Conventional brain tumor and craniotomy localization leads more frequently to errors and oversized craniotomy. Image guided surgery can reduce these errors and increase the safety and orientation for preoperative planning.

  1. Awake craniotomy and multilingualism: language testing during anaesthesia for awake craniotomy in a bilingual patient.

    Science.gov (United States)

    Costello, T G

    2014-08-01

    An awake craniotomy for epilepsy surgery is presented where a bilingual patient post-operatively reported temporary aphasia of his first language (Spanish). This case report discusses the potential causes for this clinical presentation and methods to prevent the occurrence of this in future patients undergoing this form of surgery. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Suboccipital Craniotomy Versus Craniectomy: A Survey of Practice Patterns.

    Science.gov (United States)

    Kuhn, Elizabeth N; Chagoya, Gustavo; Agee, Bonita S; Harrigan, Mark R

    2018-01-01

    Open surgical access to the posterior fossa traditionally has been achieved by permanent bone removal and remains the mainstay of posterior fossa surgery, although craniotomy is an alternative. Considerable variation exists at both the national and international levels within a variety of neurologic and neurosurgical disciplines. In this study, we surveyed current practice patterns regarding preference of suboccipital craniotomy or craniectomy. The membership directory of the American Academy of Neurological Surgeons was reviewed. SurveyMonkey was used to distribute the survey to members of the American Academy of Neurological Surgeons via a modified Dillman method for e-mail correspondence. Comparisons of frequency distributions, means, and medians, as well as multiple logistic regression were used to determine surgical preferences for craniotomy versus craniectomy. We received 1102 responses (19.6%). Overall, 542 (49.7%) respondents prefer craniotomy and 548 (50.3%) prefer craniectomy. Respondents who prefer craniotomy had completed a residency more recently than respondents who preferred craniectomy (15.9 vs. 21.1 years, P craniotomy compared with 43.6% of adult neurosurgeons (P Craniotomy was most highly preferred for tumor resection and vascular malformation. Within the United States, there was significant variation in preference for craniotomy based on geographic region, with New England most commonly preferring craniotomy and the Mid-Atlantic region most commonly preferring craniectomy. Our results show that preference for suboccipital craniotomy or craniectomy varies according to geographic location of practice, time since completing residency, and age of patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Awake craniotomy versus craniotomy under general anesthesia for the surgical treatment of insular glioma: choices and outcomes

    NARCIS (Netherlands)

    Gravesteijn, B.Y. (B. Y.); Keizer, M.E. (M. E.); A. Vincent (Audrey); J.W. Schouten (Joost); R.J. Stolker (Robert); M. Klimek (Markus)

    2017-01-01

    textabstractObjective: To investigate differences in outcomes in patients who underwent surgery for insular glioma using an awake craniotomy (AC) vs. a craniotomy under general anesthesia (GA). Methods: Data from patients treated at our hospital between 2005 and 2015 were analyzed retrospectively.

  4. Investigating bone chip formation in craniotomy.

    Science.gov (United States)

    Huiyu, He; Chengyong, Wang; Yue, Zhang; Yanbin, Zheng; Linlin, Xu; Guoneng, Xie; Danna, Zhao; Bin, Chen; Haoan, Chen

    2017-10-01

    In a craniotomy, the milling cutter is one of the most important cutting tools. The operating performance, tool durability and cutting damage to patients are influenced by the tool's sharpness, intensity and structure, whereas the cutting characteristics rely on interactions between the tool and the skull. In this study, an orthogonal cutting experiment during a craniotomy of fresh pig skulls was performed to investigate chip formation on the side cutting and face cutting of the skull using a high-speed camera. The cutting forces with different combinations of cutting parameters, such as the rake angle, clearance angle, depth of cut and cutting speed, were measured. The skull bone microstructure and cutting damage were observed by scanning electron microscope. Cutting models for different cutting approaches and various depths of cut were constructed and analyzed. The study demonstrated that the effects of shearing, tension and extrusion occur during chip formation. Various chip types, such as unit chips, splintering chips and continuous chips, were generated. Continuous pieces of chips, which are advisable for easy removal from the field of operation, were formed at greater depths of cut and tool rake angles greater than 10°. Cutting damage could be relieved with a faster recovery with clearance angles greater than 20°.

  5. Comparison of the exposure rate of wrapped hydroxyapatite (Bio-Eye) versus unwrapped porous polyethylene (Medpor) orbital implants in enucleated patients.

    Science.gov (United States)

    Tabatabaee, Ziaeddin; Mazloumi, Mehdi; Rajabi, Mohammad Taher; Khalilzadeh, Omid; Kassaee, Abolfazl; Moghimi, Sasan; Eftekhar, Hassan; Goldberg, Robert A

    2011-01-01

    To compare the exposure rate of wrapped hydroxyapatite versus unwrapped porous polyethylene orbital implants in enucleated patients. Medical records of the patients who underwent primary placement of hydroxyapatite (Bio-Eye) or porous polyethylene (Medpor) orbital implants after enucleation between 2002 and 2005 in Farabi Eye Hospital were reviewed, and the occurrence of implant exposure during follow-up visits was recorded. The exclusion criteria were secondary implantation, evisceration, or follow up of less than 1 year unless the exposure had occurred in the year after surgery. In the hydroxyapatite group, the implants were wrapped either in Mersilene mesh (65%) or in donor sclera (35%). Wrapping was not performed for any patient in the porous polyethylene group. A total of 198 cases with hydroxyapatite and 53 cases with porous polyethylene implant were identified. The most common causes of enucleation in both groups were globe trauma and painful blind eye. Rate of exposure was significantly higher [odds ratio (OR) = 7.97, p < 0.001] in patients with porous polyethylene (34.0%) than in those with hydroxyapatite implant (6.1%). This association remained significant after adjustment for potential confounders. Mean time of exposure after surgery was significantly (p < 0.001) longer in patients with porous polyethylene implant. Kaplan-Meier plots depicted a significantly (p < 0.001) higher rate of exposure in patients with porous polyethylene implant during the follow-up time. Unwrapped porous polyethylene implants demonstrated a higher rate of exposure, and longer time interval to exposure, compared with wrapped hydroxyapatite implants.

  6. Occipital Artery Pseudoaneurysm After Posterior Fossa Craniotomy.

    Science.gov (United States)

    Srinivasan, Visish M; Karas, Patrick J; Sen, Anish N; Fridley, Jared S; Chen, Stephen R; Gopinath, Shankar P

    2017-02-01

    Pseudoaneurysms of scalp arteries have been reported in rare cases after iatrogenic injury; however, they are far more commonly seen after traumatic injuries. They are usually associated with the superficial temporal artery; however, there have been a few reports of psuedoaneurysms of the occipital artery (OA). We present a unique case of an OA pseudoaneurysm presenting with delayed postoperative hemorrhage after a retrosigmoid craniotomy. The pseudoaneurysm was treated by coil embolization. The patient recovered fully after endovascular embolization. Other treatment options for pseudoaneurysms of facial, temporal, and scalp arteries include surgical clipping/trapping with excision, Hunterian ligation, or direct compression. Pseudoaneurysms of extracranial scalp arteries are rare and most often caused by traumatic compression of the artery against a bony ridge. Despite their rarity, pseudoaneurysms secondary to iatrogenic injury to extracranial arteries should be considered in the differential diagnosis in patients presenting with delayed incisional pain, redness, and swelling. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. The influence of awake craniotomy on postoperative neuropsychology

    OpenAIRE

    YANG Ming-yuan; GENG Ying; WANG Gang; HAN Ru-quan

    2012-01-01

    Objective To assess the neuropsychological function and quality of life of the patients after awake craniotomy (AC). Methods A case-control study was conducted among 81 patients who underwent awake craniotomy, and a 1-to-1 control group (matched by age, gender, degree of education, tumor location and characteristic) undergoing general anesthesia (GA) in glioma resections was assembled. The incidence of postoperative neurological deficits, psychological disorders and recurrence were investigat...

  8. Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy.

    Science.gov (United States)

    Algattas, Hanna; Kimmell, Kristopher T; Vates, G Edward; Jahromi, Babak S

    2015-11-01

    Craniotomy poses a risk for postoperative venous thromboembolism (VTE), but the utility of anticoagulation in this patient population is unclear. We sought to identify risk factors predictive of VTE in patients undergoing craniotomy. The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was reviewed for patients undergoing craniotomy. Clinical factors provided by the database were analyzed for association with VTE. A total of 10,477 adult patients who underwent craniotomy from 2011-2012 were identified. The rate of VTE was 3.2% (pulmonary embolism [PE] was 1.3%; deep vein thrombosis [DVT] was 2.4%). Several factors were significant in univariate analysis, and a subset persisted after multivariate analysis. Patients were assigned a risk score on the basis of the presence of those variables. Higher risk scores were predictive of VTE risk, as well as increasing time from surgery to discharge and mortality. A receiver operating characteristics curve revealed a significant area under the curve (0.719) for scores being predictive of VTE risk. The model was validated against our similar analysis of 2006-2010 NSQIP data and demonstrated comparable findings. The risk of postoperative VTE after craniotomy can be quantified by a simple risk score, with increasing risk factors conferring increased risk of VTE. On the basis of risk scoring, a subset of patients who would benefit from anticoagulation post craniotomy may be identified. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Awake Craniotomy: First-Year Experiences and Patient Perception.

    Science.gov (United States)

    Joswig, Holger; Bratelj, Denis; Brunner, Thomas; Jacomet, Alfred; Hildebrandt, Gerhard; Surbeck, Werner

    2016-06-01

    Awake craniotomy for brain lesions in or near eloquent brain regions enables neurosurgeons to assess neurologic functions of patients intraoperatively, reducing the risk of permanent neurologic deficits and increasing the extent of resection. A retrospective review was performed of a consecutive series of patients with awake craniotomies in the first year of their introduction to our tertiary non-university-affiliated neurosurgery department. Operation time, complications, and neurologic outcome were assessed, and patient perception of awake craniotomy was surveyed using a mailed questionnaire. There were 24 awake craniotomies performed in 22 patients for low-grade/high-grade gliomas, cavernomas, and metastases (average 2 cases per month). Mean operation time was 205 minutes. Failure of awake craniotomy because of intraoperative seizures with subsequent postictal impaired testing or limited cooperation occurred in 2 patients. Transient neurologic deficits occurred in 29% of patients; 1 patient sustained a permanent neurologic deficit. Of the 18 patients (82%) who returned the questionnaire, only 2 patients recalled significant fear during surgery. Introducing awake craniotomy to a tertiary non-university-affiliated neurosurgery department is feasible and resulted in reasonable operation times and complication rates and high patient satisfaction. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Post-Operative Intensive Care Unit Requirements Following Elective Craniotomy

    Science.gov (United States)

    HANAK, BRIAN W.; WALCOTT, BRIAN P.; NAHED, BRIAN V.; MUZIKANSKY, ALONA; MIAN, MATTHEW K.; KIMBERLY, WILLIAM T.; CURRY, WILLIAM T.

    2012-01-01

    Objective Commonly, patients undergoing craniotomy are admitted to an intensive care setting post-operatively to allow for close monitoring. We aim to determine the frequency with which patients who have undergone elective craniotomies require intensive care unit level interventions or experience significant complications during the post-operative period to identify a subset of patients for whom an alternative to ICU level care may be appropriate. Methods Following Institutional Review Board approval, a prospective, consecutive cohort of adult patients undergoing elective craniotomy was established at the Massachusetts General Hospital between the dates of April 2010 and March 2011. Inclusion criteria were intradural operations requiring craniotomy performed on adults (18 years of age or greater). Exclusion criteria were cases of an urgent or emergent nature, patients who remained intubated post-operatively, and patients who had a ventriculostomy drain in place at the conclusion of the case. Results 400 patients were analyzed. Univariate analysis revealed that diabetics (p = 0.00047), patients who required intra-operative blood product administration (p = 0.032), older patients (p craniotomy. Properly selected patients may not require post-craniotomy ICU monitoring. Further study of resource utilization is necessary to validate these preliminary findings, particularly in different hospital types. PMID:23182731

  11. Patient response to awake craniotomy - a summary overview.

    Science.gov (United States)

    Milian, Monika; Tatagiba, Marcos; Feigl, Guenther C

    2014-06-01

    Awake craniotomy is a valuable procedure since it allows brain mapping and live monitoring of eloquent brain functions. The advantage of minimizing resource utilization is also emphasized by some physicians in North America. Data on how well an awake craniotomy is tolerated by patients and how much stress it creates is available from different studies, but this topic has not consequently been summarized in a review of the available literature. Therefore, it is the purpose of this review to shed more light on the still controversially discussed aspect of an awake craniotomy. We reviewed the available English literature published until December 2013 searching for studies that investigated patients' responses to awake craniotomies. Twelve studies, published between 1998 and 2013, including 396 patients with awake surgery were identified. Eleven of these 12 studies set the focus on the perioperative time, one study focused on the later postoperative time. The vast majority of patients felt well prepared and overall satisfaction with the procedure was high. In the majority of studies up to 30 % of the patients recalled considerable pain and 10-14 % experienced strong anxiety during the procedure. The majority of patients reported that they would undergo an awake craniotomy again. A post traumatic stress disorder was present neither shortly nor years after surgery. However, a normal human response to such an exceptional situation can for instance be the delayed appearance of unintentional distressing recollections of the event despite the patients' satisfaction concerning the procedure. For selected patients, an awake craniotomy presents the best possible way to reduce the risk of surgery related neurological deficits. However, benefits and burdens of this type of procedure should be carefully considered when planning an awake craniotomy and the decision should serve the interests of the patient.

  12. Anaesthesia for awake craniotomy: A retrospective study of 54 cases

    Directory of Open Access Journals (Sweden)

    Navdeep Sokhal

    2015-01-01

    Full Text Available Background and Aims: The anaesthetic challenge of awake craniotomy is to maintain adequate sedation, analgesia, respiratory and haemodynamic stability in an awake patient who should be able to co-operate during intraoperative neurological assessment. The current literature, sharing the experience on awake craniotomy, in Indian context, is minimal. Hence, we carried out a retrospective study with the aim to review and analyse the anaesthetic management and perioperative complications in patients undergoing awake craniotomy, at our centre. Methods: Medical records of 54 patients who underwent awake craniotomy for intracranial lesions over a period of 10 years were reviewed, retrospectively. Data regarding anaesthetic management, intraoperative complications and post-operative course were recorded. Results: Propofol (81.5% and dexmedetomidine (18.5% were the main agents used for providing conscious sedation to facilitate awake craniotomy. Hypertension (16.7% was the most commonly encountered complication during intraoperative period, followed by seizures (9.3%, desaturation (7.4%, tight brain (7.4%, and shivering (5.6%. The procedure had to be converted to general anaesthesia in one of patients owing to refractory brain bulge. The incidence of respiratory and haemodynamic complications were comparable in the both groups (P > 0.05. There was less incidence of intraoperative seizures in patients who received propofol (P = 0.03. In post-operative period, 20% of patients developed new motor deficit. Mean intensive care unit stay was 2.8 ± 1.9 day (1-14 days and mean hospital stay was 7.0 ± 5.0 day (3-30 days. Conclusions: ′Conscious sedation′ was the technique of choice for awake craniotomy, at our institute. Fentanyl, propofol, and dexmedetomidine were the main agents used for this purpose. Patients receiving propofol had less incidence of intraoperative seizure. Appropriate selection of patients, understanding the procedure of surgery, and

  13. Ammonia encephalopathy and awake craniotomy for brain language mapping: cause of failed awake craniotomy.

    Science.gov (United States)

    Villalba Martínez, G; Fernández-Candil, J L; Vivanco-Hidalgo, R M; Pacreu Terradas, S; León Jorba, A; Arroyo Pérez, R

    2015-05-01

    We report the case of an aborted awake craniotomy for a left frontotemporoinsular glioma due to ammonia encephalopathy on a patient taking Levetiracetam, valproic acid and clobazam. This awake mapping surgery was scheduled as a second-stage procedure following partial resection eight days earlier under general anesthesia. We planned to perform the surgery with local anesthesia and sedation with remifentanil and propofol. After removal of the bone flap all sedation was stopped and we noticed slow mentation and excessive drowsiness prompting us to stop and control the airway and proceed with general anesthesia. There were no post-operative complications but the patient continued to exhibit bradypsychia and hand tremor. His ammonia level was found to be elevated and was treated with an infusion of l-carnitine after discontinuation of the valproic acid with vast improvement. Ammonia encephalopathy should be considered in patients treated with valproic acid and mental status changes who require an awake craniotomy with patient collaboration. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Perspective of the frontolateral craniotomies Perspectivas das craniotomias frontolaterais

    Directory of Open Access Journals (Sweden)

    Eberval Gadelha Figueiredo

    2010-06-01

    Full Text Available The pterional craniotomy is one of the most frequently surgical approaches used in neurosurgery and currently it has become a mainsteam. It allows excellent microsurgical exposure of anterior and posterior regions of the arterial circle of Willis, supra and paraselar regions, the superior orbital fissure of sphenoid bone, cavernous sinus, orbit, temporal lobe, midbrain and the frontal lobe. Like others techniques, the pterional craniotomy presented disadvantages related to dissection of the temporal muscle. From the first fronto lateral craniotomy described by Dandy to expose the optic chiasm and the pituitary we pass through the Yasargil's classical description of craniotomy centered in fronto-temporal sylvian fissure until reaching the recent"minipterional craniotomy", modifications of the pterional craniotomy were proposed to reduce the extra cranial tissue trauma and reduce the area of craniotomy without affecting the exposure of surgical targets, thus improving their aesthetic and functional results. An historical analysis of the frontolateral approaches has demonstrated that they have evolved from larger craniotomies to smaller ones, however only the minipterional craniotomy is able to offer similar surgical exposure.A craniotomia pterional é um dos acessos cirúrgicos mais freqüentemente utilizados. Esta técnica permite excelente exposição microcirúrgica das regiões anterior e posterior do polígono de Willis, regiões supra-selar, fissura orbital superior do osso esfenóide, seio cavernoso, órbita, lobo temporal, mesencéfalo e lobo frontal. Como outras técnicas, a craniotomia pterional tem desvantagens relacionadas à manipulação do músculo temporal. Desde a primeira craniotomia fronto lateral descrita por Dandy para expor o quiasma óptico e a hipófise, passando pela descrição clássica de Yasrgil para craniotomia centrada na fissura silviana, até chegar em craniotomias recentes como a"minipterional", modificações da

  15. A 3-dimensional computed tomographic procedure for planning retrosigmoid craniotomy.

    Science.gov (United States)

    Hamasaki, Tadashi; Morioka, Motohiro; Nakamura, Hideo; Yano, Shigetoshi; Hirai, Toshinori; Kuratsu, Jun-ichi

    2009-05-01

    The planning of retrosigmoid craniotomies often relies on anatomic landmarks on the posterolateral surface of the cranium, such as the asterion. However, the location of the asterion is not fixed with respect to the underlying transverse-sigmoid sinus complex. We introduce a simple procedure that uses 3-dimensional (3D) computed tomographic imaging to project the transverse-sigmoid sinus complex onto the external surface of the cranium. We enrolled 8 patients scheduled for retrosigmoid craniotomy (Group 1) and 30 patients without posterior fossa lesions (Group 2). The procedure consists of 3 steps: 1) marking the sinus on the internal surface on 3D images of the cranium, 2) transferring the marks to the external surface on axial images, and 3) checking the transferred marks on the external surface of the cranium on 3D images. In Group 1, the craniotomies planned with the aid of our procedure coincided with findings made at surgery, indicating the accuracy of our procedure. When we applied it in morphometric studies in Group 2, we found that the relative location of the transverse-sigmoid sinus junction to the asterion, the superior nuchal line, and the posterior edge of the mastoid process exhibited a high degree of individual variation. Retrosigmoid craniotomy standardized according to anatomic landmarks raises the risk for sinus injury because of variations in their location. We offer our 3D computed tomographic imaging-based procedure as a useful device for the planning of safer retrosigmoid craniotomies.

  16. Free craniotomy versus osteoplastic craniotomy, assessment of flap viability using 99mTC MDP SPECT.

    Science.gov (United States)

    Shelef, Ilan; Golan, Haim; Merkin, Vladimir; Melamed, Israel; Benifla, Mony

    2016-09-01

    There are currently two accepted neurosurgical methods to perform a bony flap. In an osteoplastic flap, the flap is attached to surrounding muscle. In a free flap, the flap is not attached to adjacent tissues. The former is less common due to its complexity and the extensive time required for the surgery; yet the rate of infection is significantly lower, a clear explanation for which is unknown. The objective of this study was to test the hypothesis that the osteoplastic flap acts as a live implant that resumes its blood flow and metabolic activity; contrasting with the free flap, which does not have sufficient blood flow, and therefore acts as a foreign body. Seven patients who underwent craniotomy with osteoplastic flaps and five with free flaps had planar bone and single photon emission computed tomography (SPECT) scans of the skull at 3-7days postoperative, after injection of the radioisotope, 99m-technetium-methylene diphosphonate (99m-Tc-MDP). We compared radioactive uptake as a measure of metabolic activity between osteoplastic and free flaps. Mean normalized radioactive uptakes in the centers of the flaps, calculated as the ratios of uptakes in the flap centers to uptakes in normal contralateral bone, were [mean: 1.7 (SD: 0.8)] and [0.6 (0.1)] for the osteoplastic and free flap groups respectively and were [2.4 (0.8)] and [1.3 (0.4)] in the borders of the flaps. Our analyses suggest that in craniotomy, the use of an osteoplastic flap, in contrast to free flap, retains bone viability. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Anaesthetic management for awake craniotomy in brain glioma ...

    African Journals Online (AJOL)

    The awake brain surgery is an innovative approach in the treatment of tumors in the functional areas of the brain. There are various anesthetic techniques for awake craniotomy (AC), including asleep-awake-asleep technique, monitored anesthesia care, and the recent introduced awakeawake- awake method. We describe ...

  18. Risk of Reoperation for Hemorrhage in Patients After Craniotomy.

    Science.gov (United States)

    Algattas, Hanna; Kimmell, Kristopher T; Vates, George Edward

    2016-03-01

    To identify clinical factors predictive of patients returning to the operating room (OR) for hemorrhage after craniotomy. A national surgical quality database (American College of Surgeons National Surgical Quality Improvement Project) was reviewed for patients undergoing craniotomy based on Current Procedural Terminology (CPT) code. CPT codes were also used to identify patients returning to the OR for hemorrhage. Of 5520 patients who underwent craniotomy in 2012, 81 (1.5%) had a reoperation for hematoma evacuation. Preoperative and intraoperative factors associated with reoperation for hemorrhage included preexisting hypertension, bleeding disorder, and primary craniotomy for hematoma evacuation. Postoperative factors included ventilator dependence >48 hours, unplanned reintubation, and blood transfusion during or after the index operation. A risk score based on these factors was predictive of reoperation for hemorrhage with a receiver operating characteristic area under the curve of 0.767. Restricting the score to preoperative factors was still predictive of reoperation (area under the curve = 0.683). Reoperation for evacuation of hematoma is influenced by several clinical factors. A risk score based on these factors is predictive of return to the OR and may be used to identify patients at risk. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Cosmetic Frontotemporal Craniotomy Using an Osteotome: Technical Note

    Science.gov (United States)

    Sakata, Yoshinori; Hadeishi, Hiromu; Moroi, Junta

    2013-01-01

    A frontotemporal craniotomy is usually performed using a “keyhole,” made at the union of the zygomatic arch and frontal bone. Consequently, skull depression may occur postoperatively, leading to temporal area deformities and poor cosmetic results. To prevent these complications, we describe our technique for frontotemporal craniotomy using an osteotome to prevent cosmetic deformities. After the temporal muscle is dissected and reflected with the scalp flap, a total of 3 burr holes are made in the frontal and temporal bones. In the lateral greater wing of the sphenoid, where a keyhole is usually made, a bone incision is made anteriorly-posteriorly with an osteotome. The bone flap is lifted upward, and the osteotome is inserted from behind to continue the incision. At craniotomy closure, the bone flap is fixed using a cranial bone flap fixation clamp. This procedure involves almost no removal of frontal or inferior temporal bone, resulting in virtually no bone defect. The absence of skull depression or deformity in the temples postoperatively leads to excellent cosmetic results. Our technique for frontotemporal craniotomy using an osteotome does not create bone defects, and use of titanium clamps for bone flap fixation provides normal skull bone alignment. This procedure provides excellent postoperative cosmetic results. PMID:24067778

  20. The Use of Vancomycin Powder for Surgical Prophylaxis Following Craniotomy.

    Science.gov (United States)

    Ravikumar, Vinod; Ho, Allen L; Pendhakar, Arjun V; Sussman, Eric S; Kwong-Hon Chow, Kevin; Li, Gordon

    2017-05-01

    Intrawound vancomycin powder has been studied extensively in spinal fusion surgeries and been found to reduce rates of surgical site infections (SSIs) significantly. Despite its success in spinal surgeries, topical vancomycin has not been extensively studied with respect to cranial neurosurgery. To evaluate the efficacy of intrawound topical vancomycin for prevention of SSIs following open craniotomies. We retrospectively analyzed a large series of 350 patients from 2011 to 2015 in a pre/postintervention study of use of topical vancomycin to reduce postoperative craniotomy infection rates. We had a preintervention control group of 225 patients and a postintervention group of 125 patients that received intrawound topical vancomycin. Our preintervention incidence of SSI was 2.2% and this was significantly reduced to 0% following introduction of topical vancomycin ( P craniotomies. Our study found a significant reduction in SSI rates after introduction of topical vancomycin. Thus, this simple intervention should be considered in all open craniotomy patients as both infection prophylaxis and a potential cost saving intervention. Copyright © 2016 by the Congress of Neurological Surgeons.

  1. Craniotomy during ECMO in a severely traumatized patient

    NARCIS (Netherlands)

    Friesenecker, B. E.; Peer, R.; Rieder, J.; Lirk, P.; Knotzer, H.; Hasibeder, W. R.; Mayr, A. J.; Dünser, M. W.

    2005-01-01

    Extracorporeal membrane oxygenation (ECMO) can be a last resort treatment in acute respiratory distress syndrome after thoracic trauma. However, co-existent brain trauma is considered to be a contra-indication for ECMO. This is the first report on successful craniotomy under ECMO treatment in a

  2. Modified pterional craniotomy without "MacCarty keyhole".

    Science.gov (United States)

    Moscovici, Samuel; Mizrahi, Cezar José; Margolin, Emil; Spektor, Sergey

    2016-02-01

    Pterional craniotomy is one of the most widely used approaches in neurosurgery. The MacCarty keyhole has remained the preferred means of beginning the craniotomy to achieve a low access point; however, the bone opening may result in a residual defect and an aesthetically unpleasant depression in the periorbital area. We present our modification of the traditional technique. Instead of drilling the keyhole in the frontoperiorbital area, the classical location, we perform a 5 × 15 mm strip craniectomy at the lowest accessible point in the infratemporal fossa, corresponding to the projection of the most lateral point of the sphenoid ridge. The anterior half of this opening exposes the basal frontal dura, while the posterior half brings the temporal dura into view. This modified technique was applied in 48 pterional craniotomies performed for removal of a variety of neoplasms during 2014-2015. There were no approach-related complications. Aesthetic outcomes and patient acceptance have been good; no patient developed skin depression in the periorbital area. In our experience, craniotomy for a pterional approach with the lowest possible access to the frontotemporal skull base may be performed by drilling a narrow oblong opening, without the use of any keyhole or burr hole, to create a smaller skull defect and achieve optimal aesthetic outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Initial Experience with Awake Craniotomy In Sudan | Mohamed ...

    African Journals Online (AJOL)

    especially if the tumour is located in the anterior temporal or frontal lobes, near motor, language, or memory areas of the brain. Awake craniotomy has been proposed aiming for maximum resection with minimum impairment of neurological function. The technique should provide adequate sedation, analgesia, respiratory ...

  4. Pediatric awake craniotomy and intra-operative stimulation mapping.

    Science.gov (United States)

    Balogun, James A; Khan, Osaama H; Taylor, Michael; Dirks, Peter; Der, Tara; Carter Snead Iii, O; Weiss, Shelly; Ochi, Ayako; Drake, James; Rutka, James T

    2014-11-01

    The indications for operating on lesions in or near areas of cortical eloquence balance the benefit of resection with the risk of permanent neurological deficit. In adults, awake craniotomy has become a versatile tool in tumor, epilepsy and functional neurosurgery, permitting intra-operative stimulation mapping particularly for language, sensory and motor cortical pathways. This allows for maximal tumor resection with considerable reduction in the risk of post-operative speech and motor deficits. We report our experience of awake craniotomy and cortical stimulation for epilepsy and supratentorial tumors located in and around eloquent areas in a pediatric population (n=10, five females). The presenting symptom was mainly seizures and all children had normal neurological examinations. Neuroimaging showed lesions in the left opercular (n=4) and precentral or peri-sylvian regions (n=6). Three right-sided and seven left-sided awake craniotomies were performed. Two patients had a history of prior craniotomy. All patients had intra-operative mapping for either speech or motor or both using cortical stimulation. The surgical goal for tumor patients was gross total resection, while for all epilepsy procedures, focal cortical resections were completed without any difficulty. None of the patients had permanent post-operative neurologic deficits. The patient with an epileptic focus over the speech area in the left frontal lobe had a mild word finding difficulty post-operatively but this improved progressively. Follow-up ranged from 6 to 27 months. Pediatric awake craniotomy with intra-operative mapping is a precise, safe and reliable method allowing for resection of lesions in eloquent areas. Further validations on larger number of patients will be needed to verify the utility of this technique in the pediatric population. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Descriptive Study: Anesthesia for Awake Craniotomy in Siriraj Hospital

    Directory of Open Access Journals (Sweden)

    Saipin Muangman

    2016-03-01

    Full Text Available Background: The purpose of awake craniotomy is to test neurological functions to ensure accurate lesion surgery and lessen postoperative neurological complications. There are several methods to provide anesthesia during awake craniotomy including local anesthesia infiltration, local anesthesia plus conscious sedation, general anesthesia and wake-up during surgery and sleep again (asleep-awake-asleep or AAA. Each method has its pro and con with different complications. In Siriraj Hospital, there was no prior study of anesthetic techniques and complications of awake craniotomy. Methods: The retrospective descriptive study of awake craniotomy was carried out with 60 patients in Siriraj Hospital 2007-2011. Results: There were 35 males (58.3% with average age 40.7±12.6 years and weight 64.2±12 kilograms undergoing awake craniotomy. Twenty patients (33.3% presented with seizure before surgery. Most diagnosis was oligodendroglioma in 25 patients (41.7%, mostly at the frontal lobe (44 patients or 73.3%. The most common position was supine(46patientsor76.7%. ICU lengthof stay was1.4±0.9(0,6days. Hospital stay was11.1±9 (4,55days. Total intravenous anesthesia (TIVA was mostlyused(52patientsor90% while18patients (30% received scalp block. Most patients (85% did not require nasal airways while 8 patients (13.3% did, and only 1 patient (1.7% required laryngeal mask airway (LMA to help open up air passage. The drugs used during asleep1 and asleep2 were propofol together with dexmedetomidine and fentanyl in 34 patients (56.7% and 23 patients (38.3%, respectively. Whilebeingawake (15patientsor20%,dexmedetomidine and/or fentanyl were administered. Complications during anesthesia were hypertension (33.3%, hypotension (26.7%, upper airway obstruction(23.3%, bradycardia (15%, tachycardia (10%, seizure (1.7% andnausea (1.7%. Conclusion: The most common anesthesia method inSiriraj Hospital for awake craniotomy was TIVA (90%, using propofol together with

  6. The impact of several craniotomies on transcranial motor evoked potential monitoring during neurosurgery.

    Science.gov (United States)

    Tomio, Ryosuke; Akiyama, Takenori; Toda, Masahiro; Ohira, Takayuki; Yoshida, Kazunari

    2017-09-01

    OBJECTIVE Transcranial motor evoked potential (tMEP) monitoring is popular in neurosurgery; however, the accuracy of tMEP can be impaired by craniotomy. Each craniotomy procedure and changes in the CSF levels affects the current spread. The aim of this study was to investigate the influence of several craniotomies on tMEP monitoring by using C3-4 transcranial electrical stimulation (TES). METHODS The authors used the finite element method to visualize the electric field in the brain, which was generated by TES, using realistic 3D head models developed from T1-weighted MR images. Surfaces of 5 layers of the head (brain, CSF, skull, subcutaneous fat, and skin layer) were separated as accurately as possible. The authors created 5 models of the head, as follows: normal head; frontotemporal craniotomy; parietal craniotomy; temporal craniotomy; and occipital craniotomy. The computer simulation was investigated by finite element methods, and clinical recordings of the stimulation threshold level of upper-extremity tMEP (UE-tMEP) during neurosurgery were also studied in 30 patients to validate the simulation study. RESULTS Bone removal during the craniotomy positively affected the generation of the electric field in the motor cortex if the motor cortex was just under the bone at the margin of the craniotomy window. This finding from the authors' simulation study was consistent with clinical reports of frontotemporal craniotomy cases. A major decrease in CSF levels during an operation had a significantly negative impact on the electric field when the motor cortex was exposed to air. The CSF surface level during neurosurgery depends on the body position and location of the craniotomy. The parietal craniotomy and temporal craniotomy were susceptible to the effect of the changing CSF level, based on the simulation study. A marked increase in the threshold following a decrease in CSF was actually recorded in clinical reports of the UE-tMEP threshold from a temporal craniotomy

  7. Scar neuromas as triggers for headache after craniotomy: clinical evidence

    Directory of Open Access Journals (Sweden)

    Karen dos Santos Ferreira

    2012-03-01

    Full Text Available We present four cases of headache with variable intensity, located in close proximity to a craniotomy incision which was performed for non-traumatic reasons. Since manual palpation of the scar often triggers pain, and infiltration with local anesthetics reduce or abolish the pain in some patients, we suggest that neuromas or nerve entrapment in the scars, as a result of the surgery, are responsible for headaches. Although local infiltrations or nerve blocks are often used for diagnostic reasons, herein we consider that they are also of therapeutic value. We review the current known pathophysiology of post-craniotomy headaches and present a hypothesis suggesting a greater recognition of the potential contribution of neuroma formation in areas of scars tissue to contribute to this kind of headache.

  8. Pain treatment after craniotomy: where is the (procedure-specific) evidence? A qualitative systematic review

    DEFF Research Database (Denmark)

    Hansen, M.S; Brennum, Jannick; Moltke, Finn B

    2011-01-01

    Pain following craniotomy has been demonstrated to be frequent and moderate-to-severe in nature. In recent years, the focus on the challenges in treatment of postoperative pain following craniotomy has increased. Fear of using opioids because of their wide array of side-effects has led...... to the search for alternative analgesic options. The objective of this systematic review was to evaluate current evidence about analgesic therapy following craniotomy....

  9. Scalp Seeding Post Craniotomy and Radiosurgery for Solitary Brain Metastasis: A Case Report and Systematic Review

    OpenAIRE

    Sharieff, Waseem; Mulroy, Liam; Weeks, Adrienne; Mansoor, Samina; Pahil, Rajbir; Islam, Muhammad U

    2017-01-01

    Background?? Radiosurgery is being increasingly used post craniotomy for brain metastasis, instead of whole-brain radiation. We report a case of scalp metastasis following craniotomy and radiosurgery, along with a systematic review of the literature. Methods???????? Our patient was a 70-year-old male who presented with a scalp metastasis, two years after craniotomy and radiosurgery, for a solitary brain metastasis from esophageal carcinoma. Using Medline? (United States National Library of Me...

  10. Emergency craniotomy in a rural Level III trauma center.

    Science.gov (United States)

    Rinker, C F; McMurry, F G; Groeneweg, V R; Bahnson, F F; Banks, K L; Gannon, D M

    1998-06-01

    Patients with closed head injury and expanding epidural (EDH) or subdural (SDH) hematoma require urgent craniotomy for decompression and control of hemorrhage. In remote areas where neurosurgeons are not available, trauma surgeons may occasionally need to intervene to avert progressive neurologic injury and death. In 1990, a young man with rapidly deteriorating neurologic signs underwent emergency burr hole decompression of a combined EDH/SDH at our hospital, with complete recovery. In anticipation of future need, five surgeons at our rural, American College of Surgeons-verified Level III trauma center participated in a neurosurgeon-directed course in emergency craniotomy. Since January 1, 1991, 792 patients have been entered into the trauma registry, including 60 with closed head injury and Glasgow Coma Scale (GCS) score of 13 or less. All but seven were transferred to a regional Level II trauma center, which is a minimum flight time of 1 hour each way. All patients with EDH (5) and 2 of 14 with SDH were deemed too unstable for transport and underwent burr hole decompression followed by immediate transfer. All craniotomies were approved by the consulting neurosurgeon and were done for computed tomography-confirmed lesions combined with neurologic deterioration as demonstrated by (1) GCS score of 8 or less, (2) lateralizing signs (dilated pupil, hemiparesis), or (3) development of combined bradycardia and hypertension. One patient with a GCS score of 3 on arrival died. Seven survivors (mean follow-up, 3.9 years; range, 1-6.5 years), including the index case, function independently, although one survivor has moderate cognitive and motor impairment. We conclude that early craniotomy for expanding epidural and subdural hematomas by properly trained surgeons may save lives and reduce morbidity in properly selected cases when timely access to a neurosurgeon is not possible.

  11. Estimation of Penetrated Bone Layers During Craniotomy via Bioimpedance Measurement.

    Science.gov (United States)

    Teichmann, Daniel; Rohe, Lucas; Niesche, Annegret; Mueller, Meiko; Radermacher, Klaus; Leonhardt, Steffen

    2017-04-01

    Craniotomy is the removal of a bone flap from the skull and is a first step in many neurosurgical interventions. During craniotomy, an efficient cut of the bone without injuring adjoining soft tissues is very critical. The aim of this study is to investigate the feasibility of estimating the currently penetrated cranial bone layer by means of bioimpedance measurement. A finite-element model was developed and a simulation study conducted. Simulations were performed at different positions along an elliptical cutting path and at three different operation areas. Finally, the validity of the simulation was demonstrated by an ex vivo experiment based on use of a bovine shoulder blade bone and a commercially available impedance meter. The curve of the absolute impedance and phase exhibits characteristic changes at the transition from one bone layer to the next, which can be used to determine the bone layer last penetrated by the cutting tool. The bipolar electrode configuration is superior to the monopolar measurement. A horizontal electrode arrangement at the tip of the cutting tool produces the best results. This study successfully demonstrates the feasibility to detect the transition between cranial bone layers during craniotomy by bioimpedance measurements using electrodes located on the cutting tool. Based on the results of this study, bioimpedance measurement seems to be a promising option for intra operative ad hoc information about the bone layer currently penetrated and could contribute to patient safety during neurosurgery.

  12. Awake craniotomy using electromagnetic navigation technology without rigid pin fixation.

    Science.gov (United States)

    Morsy, Ahmed A; Ng, Wai Hoe

    2015-11-01

    We report our institutional experience using an electromagnetic navigation system, without rigid head fixation, for awake craniotomy patients. The StealthStation® S7 AxiEM™ navigation system (Medtronic, Inc.) was used for this technique. Detailed preoperative clinical and neuropsychological evaluations, patient education and contrast-enhanced MRI (thickness 1.5mm) were performed for each patient. The AxiEM Mobile Emitter was typically placed in a holder, which was mounted to the operating room table, and a non-invasive patient tracker was used as the patient reference device. A monitored conscious sedation technique was used in all awake craniotomy patients, and the AxiEM Navigation Pointer was used for navigation during the procedure. This offers the same accuracy as optical navigation, but without head pin fixation or interference with intraoperative neurophysiological techniques and surgical instruments. The application of the electromagnetic neuronavigation technology without rigid head fixation during an awake craniotomy is accurate, and offers superior patient comfort. It is recommended as an effective adjunctive technique for the conduct of awake surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. High incidence and spontaneous resolution of mastoid effusion after craniotomy on early postoperative magnetic resonance images

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, T.; Saito, N.; Takahashi, A.; Fujimaki, H.; Tosaka, M.; Sasaki, T. [Department of Neurosurgery, Gunma University School of Medicine, 3-39-22 Showa-machi, 371-8511, Maebashi, Gunma (Japan); Sato, N. [Department of Diagnostic Radiology, Gunma University School of Medicine, Maebashi, Gunma (Japan)

    2003-07-01

    Mastoid effusion is a poorly understood complication after craniotomy. The incidence and severity of postoperative mastoid effusion were retrospectively examined on postoperative magnetic resonance (MR) images to assess any association with craniotomy procedures, time course, and neuro-otological complications. We evaluated the early postoperative MR images (within 4 days of craniotomy) and medical records of 74 patients who underwent 77 operations for the treatment of various intracranial diseases from January 2000 to December 2001. Mastoid effusion was classified into four grades: none, partial, moderate, and severe diffuse effusion in the mastoid air cells. Thirty-three follow-up MR images from 26 patients were also reviewed. Postoperative mastoid effusion occurred ipsilateral to the craniotomy site in 62 cases and contralateral in 56 cases. Mastoid effusion was significantly more severe ipsilateral than contralateral to craniotomy with exposure of the mastoid air cells (P<0.0001). There was no significant difference in severity between the contralateral and ipsilateral sides after craniotomy without mastoid air cell opening (P=0.437). Mastoid effusion following craniotomy without exposure of mastoid air cells resolved within 3 months. However, otitis media with effusion developed in six patients with severe mastoid effusion ipsilateral to craniotomy with exposure of the mastoid air cells. Mastoid effusion frequently developed on both sides. Any grade of mastoid effusion on the ipsilateral side to craniotomy without exposure of mastoid air cells, or on the contralateral side, was asymptomatic or had a benign course, and disappeared within 3 months. (orig.)

  14. Effect of Ondansetron on Postoperative Shivering After Craniotomy.

    Science.gov (United States)

    Teymourian, Houman; Mohajerani, Seyed Amir; Bagheri, Parisa; Seddighi, Afsoun; Seddighi, Amir Saied; Razavian, Iman

    2015-12-01

    Postoperative shivering (POS) is an early complication after craniotomy. Preventive pharmacologic drugs are the mainstay of treatment. Meperidine is the drug of choice but with increased risk of apnea, nausea, and increased intracranial pressure. Some reports have suggested that ondansetron and meperidine have similar anti-shivering effects. To assess the preventive effect of ondansetron on POS after craniotomy. In a randomized, double-blind, placebo-controlled trial, 80 patients with American Society of Anesthesiologists status I to II between 20 and 60 years of age scheduled for elective craniotomy were enrolled in the study. Patients received either intravenous ondansetron 4 mg (n = 40) or saline (n = 40) 10 minutes before the end of surgery. POS was observed in 3 patients (7.5%) in the ondansetron group, significantly lower than in the control group (6 patients [15%]; P =0.048). Ondansetron decreased the relative risk of occurrence of POS after craniotomy from 4.42 (95% confidence interval [CI], 2.3-8.5; P = 0.0021) in the control group to 1.05 (95% CI, 0.76-2.20; P = 0.074). In the ondansetron group, the mean (± standard deviation) core temperature in the preoperative phase (36.6°C ± 0.66°C) was significantly higher than in the postoperative phase (34.2°C ± 0.56°C) (P = 0.001). In addition, the mean (± standard deviation) peripheral temperature in the preoperative phase (36.5°C ± 0.72°C) was significantly higher than in the postoperative phase (34.4°C ± 0.51°C) (P = 0.001). Ondansetron can effectively decrease POS after craniotomy. This effect is not mediated through maintenance of the core or peripheral temperature. Ondansetron probably acts by a central inhibitory mechanism on POS through 5-hydroxytryptaminergic pathways, not by changing thermoregulatory set points. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Antiepileptic drugs as prophylaxis for post-craniotomy seizures.

    Science.gov (United States)

    Weston, Jennifer; Greenhalgh, Janette; Marson, Anthony G

    2015-03-04

    The incidence of seizures following supratentorial craniotomy for non-traumatic pathology has been estimated to be between 15% to 20%; however, the risk of experiencing a seizure may vary from 3% to 92% over a five-year period. Postoperative seizures can precipitate the development of epilepsy; seizures are most likely to occur within the first month of cranial surgery. The use of antiepileptic drugs (AEDs) administered pre- or postoperatively to prevent seizures following cranial surgery has been investigated in a number of randomised controlled trials (RCTs). To determine the efficacy and safety of AEDs when used prophylactically in people undergoing craniotomy and to examine which AEDs are most effective. Searches were run for the original review in January 2012. We performed subsequent searches in September 2012 and up to 04 August 2014. We searched the Cochrane Epilepsy Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE. We did not apply any language restrictions. We included RCTs of people with no history of epilepsy who were undergoing craniotomy for either therapeutic or diagnostic reasons. Trials with adequate randomisation methods and concealment were included; these could either be blinded or unblinded parallel trials. We did not stipulate a minimum treatment period, and we included trials using active drugs or placebo as a control group. Two review authors (JP and JG) independently selected trials for inclusion and performed data extraction and risk of bias assessments. We resolved any disagreements through discussion. Outcomes investigated included the number of patients experiencing seizures (early - occurring within first week following craniotomy, and late - occurring after first week following craniotomy), the number of deaths and the number of people experiencing disability and adverse effects. Due to the heterogeneous nature of the trials, we did not combine data from the included trials in a

  16. The minipterional craniotomy for anterior circulation aneurysms: initial experience with 72 patients.

    Science.gov (United States)

    Caplan, Justin M; Papadimitriou, Kyriakos; Yang, Wuyang; Colby, Geoffrey P; Coon, Alexander L; Olivi, Alessandro; Tamargo, Rafael J; Huang, Judy

    2014-06-01

    The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes. The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap. To report our experience with the MPT craniotomy in select unruptured anterior circulation aneurysms. From January 2009 to July 2013, 82 unruptured aneurysms were treated in 72 patients, with 74 MPT craniotomies. Seven patients had multiple aneurysms treated with a single MPT craniotomy. The average patient age was 56 years (range: 24-87). Aneurysms were located along the middle cerebral artery (n = 36), posterior communicating (n = 22), paraophthalmic (n = 22), choroidal (n = 1), and dorsal ICA segments (n = 1). The MPT craniotomy utilized an incision just posterior to the hairline and a single myocutaneous flap. The average aneurysm size was 5.45 mm (range: 1-14). There were no instances of compromised operative corridors requiring craniotomy extension. Three significant early postoperative complications included epidural and subdural hematomas requiring evacuation, and a middle cerebral artery infarction. Average length of hospitalization was 3.96 days (range: 2-20). Two patients required reoperation for wound infections. Average follow-up was 421 days (range: 5-1618). Minimal to no temporalis muscle wasting was noted in 96% of patients. The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.

  17. Concept and Design of a Hand-held Mobile Robot System for Craniotomy

    OpenAIRE

    Kane, Gavin J.

    2013-01-01

    This work demonstrates a highly intuitive robot for Surgical Craniotomy Procedures. Utilising a wheeled hand-held robot, to navigate the Craniotomy Drill over a patient's skull, the system does not remove the surgeons from the procedure, but supports them during this critical phase of the operation.

  18. Teaching and sustainably implementing awake craniotomy in resource-poor settings.

    Science.gov (United States)

    Howe, Kathryn L; Zhou, Guosheng; July, Julius; Totimeh, Teddy; Dakurah, Thomas; Malomo, Adefolarin O; Mahmud, Muhammad R; Ismail, Nasiru J; Bernstein, Mark A

    2013-12-01

    Awake craniotomy for brain tumor resection has the benefit of avoiding a general anesthetic and decreasing associated costs (e.g., intensive care unit beds and intravenous line insertion). In low- and middle-income countries, significant resource limitations for the system and individual make awake craniotomy an ideal tool, yet it is infrequently used. We sought to determine if awake craniotomy could be effectively taught and implemented safely and sustainably in low- and middle-income countries. A neurosurgeon experienced in the procedure taught awake craniotomy to colleagues in China, Indonesia, Ghana, and Nigeria during the period 2007-2012. Patients were selected on the basis of suspected intraaxial tumor, absence of major dysphasia or confusion, and ability to tolerate the positioning. Data were recorded by the local surgeons and included preoperative imaging, length of hospital admission, final pathology, postoperative morbidity, and mortality. Awake craniotomy was performed for 38 cases of suspected brain tumor; most procedures were completed independently. All patients underwent preoperative computed tomography or magnetic resonance imaging. In 64% of cases, patients remained in the hospital craniotomy was successfully taught and implemented in 6 neurosurgical centers in China, Indonesia, Ghana, and Nigeria. Awake craniotomy is safe, resource-sparing, and sustainable. The data suggest awake craniotomy has the potential to significantly improve access to neurosurgical care in resource-challenged settings. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Pain treatment after craniotomy: where is the (procedure-specific) evidence? A qualitative systematic review

    DEFF Research Database (Denmark)

    Hansen, M.S; Brennum, Jannick; Moltke, Finn B

    2011-01-01

    Pain following craniotomy has been demonstrated to be frequent and moderate-to-severe in nature. In recent years, the focus on the challenges in treatment of postoperative pain following craniotomy has increased. Fear of using opioids because of their wide array of side-effects has led...

  20. The influence of awake craniotomy on postoperative neuropsychology

    Directory of Open Access Journals (Sweden)

    YANG Ming-yuan

    2012-12-01

    Full Text Available Objective To assess the neuropsychological function and quality of life of the patients after awake craniotomy (AC. Methods A case-control study was conducted among 81 patients who underwent awake craniotomy, and a 1-to-1 control group (matched by age, gender, degree of education, tumor location and characteristic undergoing general anesthesia (GA in glioma resections was assembled. The incidence of postoperative neurological deficits, psychological disorders and recurrence were investigated during telephone follow-ups, and Medical Outcomes Study Short Form 36 (SF-36 was adopted to evaluate the life quality of patients. Results Almost 73 pairs of patients fulfilled the survey of AC and GA group respectively. There were 21 patients and 28 patients with postoperative neurological deficits, and 12 patients and 8 patients with psychological disorders in AC and GA group respectively. Thirty patients of AC group had the recollection of being awake during the surgery. There were 9 patients in CA group having long-term ( > 6 months neurological deficits, which was less than the number of GA group (18 patients, P = 0.038. According to the assessment in short-term, medium-term and long-term postoperative neurological deficits, there was no significant difference in the quality-of-life scores between the two groups (P > 0.05, for all. Conclusion Awake craniotomy can be the main method for removing the lesions located in or close to functional areas with lower incidence of long?term postoperative neurological deficits, and it has no significant impact on the psychological status and the quality of life postoperatively.

  1. Tension pneumocephalus following suboccipital sitting craniotomy in the pediatric population.

    Science.gov (United States)

    Daszkiewicz, P; Dziedzic, D

    Sitting craniotomy often results in entrapment of air in fluid-filled intracranial cavities. Gas under pressure exerts a deleterious effect on adjacent nervous tissue, resulting in clinical deterioration. To assess the incidence of tension pneumocephalus (TP) and to define risk factors associated therewith. Analysis included 100 consecutive patients (57 boys, 43 girls, mean age 9.7 y) undergoing suboccipital sitting craniotomy since 2012 to 2014. In our material (n=100) TP was seen in 7 cases, asymptomatic pneumocephalus (AP) in 77 and no pneumocephalus (NP) in 16. Tumor types encountered were typical for pediatric population. In the TP group (n=7) the ratio of low-grade to high-grade tumors was 5:2, in the AP group (n=77) 2:1 and in the NP group (n=16) 1:1. Preoperative hydrocephalus was present in 21 cases (21%, mean incidence), thereof 3 in the TP group (3/7; 42.8%), 12 in AP group (12/77; 15.5%) and 6 in the NP group (6/16; 37.5%). All TP patients received an emergency external drainage, thereof 4 required a permanent ventriculo-peritoneal shunt (57.1%), while AP and NP patients combined (n=93) required a permanent shunt in 4 cases only (4.3%). TP-associated morbidity (n=2) consisted in a significant deterioration of neurological condition. TP is a relatively rare but potentially serious complication of suboccipital sitting craniotomy. Risk factors for TP are low-grade tumor and pre-existing long-standing hydrocephalus. TP requires emergency decompression by temporary external drainage. TP patients significantly more often require a permanent CSF shunt. Copyright © 2017. Published by Elsevier Urban & Partner Sp. z o.o.

  2. Cost-Effectiveness of Craniotomy for Epidural Hematomas at a Major Government Hospital in Cambodia.

    Science.gov (United States)

    Moran, Dane; Shrime, Mark G; Nang, Sam; Vycheth, Iv; Vuthy, Din; Hong, Raksmey; Padula, William V; Park, Kee B

    2017-09-01

    Epidural hematoma (EDH) is a common and potentially deadly occurrence following a severe traumatic brain injury. Our aim was to determine whether craniotomy is cost-effective when indicated for the treatment of EDH when a trained neurosurgeon is available. A decision tree was used to model the cost-effectiveness of craniotomy available versus craniotomy unavailable for the management of traumatic EDH from a Cambodian societal and provider perspective. Costs and effectiveness parameters were obtained from patient data at a large government hospital in Cambodia. Outcomes were measured in quality-adjusted life years (QALYs). Incremental cost per QALY and budget impact were calculated for each intervention at a willingness-to-pay (WTP) threshold of $9787.80/QALY (3× GDP per capita PPP). The time horizon reflected full life span, and costs and QALYs were discounted at 3%. Sensitivity analysis was also conducted. Compared to craniotomy unavailable for EDH ($945.80; 11.78 QALYs), craniotomy available came at a higher cost and greater effectiveness ($1520.73; 12.78 QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $574.93. One-way analysis demonstrated that craniotomy unavailable became more cost-effective than craniotomy available when the percent chance of having a GOS of 4 or 5 was 60% for patients with an EDH where craniotomy was indicated but not performed. Probabilistic sensitivity analysis revealed that craniotomy available was more cost-effective than conservative management in 84.4% of simulations at the WTP threshold. Craniotomy is a cost-effective treatment for patients with a traumatic EDH who meet criteria for operation when trained neurosurgeons are available onsite.

  3. Awake craniotomy anesthetic management using dexmedetomidine, propofol, and remifentanil

    Science.gov (United States)

    Prontera, Andrea; Baroni, Stefano; Marudi, Andrea; Valzania, Franco; Feletti, Alberto; Benuzzi, Francesca; Bertellini, Elisabetta; Pavesi, Giacomo

    2017-01-01

    Introduction Awake craniotomy allows continuous monitoring of patients’ neurological functions during open surgery. Anesthesiologists have to sedate patients in a way so that they are compliant throughout the whole surgical procedure, nevertheless maintaining adequate analgesia and anxiolysis. Currently, the use of α2-receptor agonist dexmedetomidine as the primary hypnotic–sedative medication is increasing. Methods Nine patients undergoing awake craniotomy were treated with refined monitored anesthesia care (MAC) protocol consisting of a combination of local anesthesia without scalp block, low-dose infusion of dexmedetomidine, propofol, and remifentanil, without the need of airways management. Results The anesthetic protocol applied in our study has the advantage of decreasing the dose of each drug and thus reducing the occurrence of side effects. All patients had smooth and rapid awakenings. The brain remained relaxed during the entire procedure. Conclusion In our experience, this protocol is safe and effective during awake brain surgery. Nevertheless, prospective randomized trials are necessary to confirm the optimal anesthetic technique to be used. PMID:28424537

  4. Comparison of neuroendoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage

    Science.gov (United States)

    Ye, Zengpanpan; Ai, Xiaolin; Hu, Xin; Fang, Fang; You, Chao

    2017-01-01

    Abstract Background: In recent years, neuroendoscopy has been used as a method for treating intracerebral hemorrhages (ICHs). However, the efficacy and safety of neuroendoscopic surgery is still controversial compared with that of craniotomy. Our aim was to compare the outcomes of neuroendoscopic surgery and craniotomy in patients with supratentorial hypertensive ICH using a meta-analysis. Methods: We searched on PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of eligible studies was evaluated and the related data were extracted by 2 reviewers independently. This study assessed clinical outcomes, evacuation rates, complications, operation time, and hospital stay for patients who underwent neuroendoscopic surgery (NE group) or craniotomy (craniotomy group). Results: Meta-analysis included 1327 subjects from verified studies of acceptable quality. There was no significant heterogeneity between the included studies based on clinical outcomes. Compared with craniotomy, neuroendoscopic surgery significantly improved clinical outcomes in both randomized controlled studies (RCTs) group (relative risk: 0.62; 95% confidence interval [CI], 0.47–0.81, P craniotomy group for patients with supratentorial hypertensive ICH. Moreover, the patients who underwent neuroendoscopy had a higher evacuation rate, lower risk of complications, and shorter operation time compared with those that underwent a craniotomy. PMID:28858100

  5. Orbitozygomatic Craniotomy with Modified Zabramski's Technique: A Technical Note and Anatomic and Clinical Findings.

    Science.gov (United States)

    Kodera, Toshiaki; Arishima, Hidetaka; Yamada, Shinsuke; Arai, Hiroshi; Akazawa, Ayumi; Higashino, Yoshifumi; Kitai, Ryuhei; Iino, Satoshi; Bertalanffy, Helmut; Kikuta, Ken-Ichiro

    2017-01-01

    The surgical technique of orbitozygomatic craniotomy reported by Zabramski et al. is an excellent procedure, facilitating wide surgical exposure, easy orbital reconstruction, and a satisfactory postsurgical aesthetic outcome; however, it is anatomically complicated and technically difficult. We introduce a simplified technique of Zabramski's orbitozygomatic craniotomy and present the anatomic and clinical findings with cadaveric photos, illustrations, and a video. The orbitozygomatic craniotomy was performed on 20 sides of 11 cadaveric heads, in which the cut between the inferior orbital fissure and superior orbital fissure was modified and simplified, and the shortest distance between them was measured. This technique was applied to 13 clinical cases, and craniotomy-associated aesthetic and functional complications were evaluated. The average of the shortest distance from the inferior orbital fissure to superior orbital fissure was 21.3 mm (range, 19-23 mm) on the 20 sides of the 11 cadaveric heads. In all 13 clinical cases, orbitozygomatic craniotomy could be achieved in a short time, while preserving the structure of the orbital wall. A hollow at the temple was noted in 1 patient, cerebrospinal fluid leak occurred in 2 patients, and transient facial pain occurred in 1 patient; however, no other craniotomy-associated aesthetic or functional complications, including enophthalmos, were found in any of the 13 patients. With this modified technique, Zabramski's ideal orbitozygomatic craniotomy could be achieved easily with only minimal complications, while realizing all advantages of the technique. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Severe Intraoperative Hyperglycemia Is Independently Associated With Postoperative Composite Infection After Craniotomy: An Observational Study.

    Science.gov (United States)

    Gruenbaum, Shaun E; Toscani, Laura; Fomberstein, Kenneth M; Ruskin, Keith J; Dai, Feng; Qeva, Ega; Rosa, Giovanni; Meng, Lingzhong; Bilotta, Federico

    2017-08-01

    Postoperative infection after craniotomy carries an increased risk of morbidity and mortality. Identification and correction of the risk factors should be prioritized. The association of intraoperative hyperglycemia with postoperative infections in patients undergoing craniotomy is inadequately studied. A total of 224 patients were prospectively enrolled in 2 major medical centers to assess whether severe intraoperative hyperglycemia (SIH, blood glucose ≥180 mg/dL) is associated with an increased risk of postoperative infection in patients undergoing craniotomy. Arterial blood samples were drawn and analyzed immediately after anesthetic induction and again before tracheal extubation. The new onset of any type of infection within 7 days after craniotomy was determined. The incidence of new postoperative composite infection was 10% (n = 22) within the first week after craniotomy. Weight, sex, American Society of Anesthesiologists score, preoperative and/or intraoperative steroid use, and diabetes mellitus were not associated with postoperative infection. SIH was independently associated with postoperative infection (odds ratio [95% confidence interval], 4.17 [1.50-11.56], P = .006) after fitting a multiple logistic regression model to adjust for emergency surgery, length of surgery, and age ≥65 years. SIH is independently associated with postoperative new-onset composite infections in patients undergoing craniotomy. Whether prevention of SIH during craniotomy results in a reduced postoperative risk of infection is unknown and needs to be appraised by further study.

  7. Effect of craniotomy on oxidative stress and its effect on plasma L-carnitine levels.

    Science.gov (United States)

    Li, Huan-ting; Zhao, Zhen-huan; Ding, Hai-yan; Wang, Le-xin; Cao, Yu

    2014-11-01

    to investigate the impact of craniotomy on oxidative stress and its effect on levels of plasma L-carnitine (LC). plasma levels of reactive oxygen species, superoxide dismutase (SOD), glutathion peroxidase (GSH-Px), catalase (CAT), total antioxidative capacity (T-AOC), and thiobarbituric acid reactive substances (TBARS) were measured in 34 patients (26 males and 8 females, mean age 47.7 ± 6.7 years) before and after craniotomy. Plasma levels of LC, acetyl-L-carnitine (ALC), and propionyl-L-carnitine (PLC) were also measured before and after the craniotomy. the plasma concentrations of SOD, GSH-Px, CAT, and T-AOC within the first 4 h after craniotomy were lower than their baseline values (P craniotomy was lower than the pre-operative level (P 0.05). Plasma levels of LC, ALC, and PLC were lower after the craniotomy (P craniotomy and the associated procedures for surgery/anesthesia temporarily reduce antioxidant activity and plasma levels of L-carnitine.

  8. Comparison of neuroendoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta-analysis.

    Science.gov (United States)

    Ye, Zengpanpan; Ai, Xiaolin; Hu, Xin; Fang, Fang; You, Chao

    2017-09-01

    In recent years, neuroendoscopy has been used as a method for treating intracerebral hemorrhages (ICHs). However, the efficacy and safety of neuroendoscopic surgery is still controversial compared with that of craniotomy. Our aim was to compare the outcomes of neuroendoscopic surgery and craniotomy in patients with supratentorial hypertensive ICH using a meta-analysis. We searched on PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of eligible studies was evaluated and the related data were extracted by 2 reviewers independently. This study assessed clinical outcomes, evacuation rates, complications, operation time, and hospital stay for patients who underwent neuroendoscopic surgery (NE group) or craniotomy (craniotomy group). Meta-analysis included 1327 subjects from verified studies of acceptable quality. There was no significant heterogeneity between the included studies based on clinical outcomes. Compared with craniotomy, neuroendoscopic surgery significantly improved clinical outcomes in both randomized controlled studies (RCTs) group (relative risk: 0.62; 95% confidence interval [CI], 0.47-0.81, P craniotomy group for patients with supratentorial hypertensive ICH. Moreover, the patients who underwent neuroendoscopy had a higher evacuation rate, lower risk of complications, and shorter operation time compared with those that underwent a craniotomy.

  9. One-piece versus two-piece orbitozygomatic craniotomy: quantitative and qualitative considerations.

    Science.gov (United States)

    Tanriover, Necmettin; Ulm, Arthur J; Rhoton, Albert L; Kawashima, Masatou; Yoshioka, Nobutaka; Lewis, Stephen B

    2006-04-01

    The orbitozygomatic (OZ) craniotomy minimizes brain retraction and improves cranial base exposure by providing a multidirectional view, increased operative angles and working space. The two main variations of the approach include the one-piece and the two-piece types. The microsurgical anatomy of the one- and two-piece OZ craniotomies are presented with the goal of comparing the extent of orbital roof removal between these two craniotomies and the effect of orbital roof removal on operative exposure. Ten two-piece and 11 one-piece OZ craniotomies were performed in a stepwise manner simulating the approaches on formalin fixed specimens. The orbital surface area removed above the frontozygomatic suture extending medially over the orbital roof was measured from each bone flap. The two-sided unpaired t test using STATA 7.0 software was used to compare the amount of orbital roof removed using the two approaches. The two-piece OZ craniotomy allowed for the removal of a larger portion of the roof and lateral wall of the orbit than the one-piece. The total orbitotomy, including the orbital roof plus the part of the lateral wall above the frontozygomatic suture, had an average surface area of 996 +/- 229 mm for the two piece and 372 +/- 103 mm for the one-piece. The orbital roof made up 27 +/- 18% of the orbital osteotomy for the one-piece craniotomies and 67 +/- 10% of the osteotomy for the two-piece craniotomies (P piece OZ craniotomy allows for more extensive orbital roof removal and better visualization of the basal frontal lobe. Therefore, the two-piece may result in a lower incidence of enophtalmus and poor cosmetic outcomes, particularly if the remaining orbital roof must be removed piecemeal during the one-piece OZ craniotomy in order to obtain satisfactory exposure.

  10. Incidence, risk factors and outcomes of seizures occurring after craniotomy for primary brain tumor resection

    Science.gov (United States)

    Al-Dorzi, Hasan M.; Alruwaita, Abdullah A.; Marae, Bothaina O.; Alraddadi, Bushra S.; Tamim, Hani M.; Ferayan, Ahmad; Arabi, Yaseen M.

    2017-01-01

    Objective: To determine the incidence, risk factors and outcomes of early post-craniotomy seizures. Method: This was a retrospective cohort study of all patients who underwent craniotomy for primary brain tumor resection (2002-2011) and admitted postoperatively to the intensive care unit. The patients were divided into 2 groups depending on the occurrence of seizures within 7 days. Results: One-hundred-ninety-three patients were studied: 35.8% had preoperative seizure history and 16.6% were on prophylactic antiepileptic drugs (AEDs). Twenty-seven (14%) patients had post-craniotomy seizures. The tumors were mostly meningiomas (63% for the post-craniotomy seizures group versus 58.1% for the other group; p=0.63) and supratentorial (92.6% for the post-craniotomy seizures versus 78.4% for the other group, p=0.09) with tumor diameter=3.7±1.5 versus 4.2±1.6 cm, (p=0.07). One (3.1%) of the 32 patients on prophylactic AEDs had post-craniotomy seizures compared with 12% of the 92 patients not receiving AEDs preoperatively (p=0.18). On multivariate analysis, predictors of post-craniotomy seizures were preoperative seizures (odds ratio, 2.62; 95% confidence interval, 1.12-6.15) and smaller tumor size craniotomy seizures were not associated with increased morbidity or mortality. Conclusion: Early seizures were common after craniotomy for primary brain tumor resection, but were not associated with worse outcomes. Preoperative seizures and smaller tumor size were independent risk factors. PMID:28416781

  11. Thrombocytopenia and craniotomy for tumor: A National Surgical Quality Improvement Program analysis.

    Science.gov (United States)

    Dasenbrock, Hormuzdiyar H; Devine, Christopher A; Liu, Kevin X; Gormley, William B; Claus, Elizabeth B; Smith, Timothy R; Dunn, Ian F

    2016-06-01

    To the authors' knowledge, the current study is the first national analysis of the association between preoperative platelet count and outcomes after craniotomy. Patients who underwent craniotomy for tumor were extracted from the prospective National Surgical Quality Improvement Program registry (2007-2014) and stratified by preoperative thrombocytopenia, defined as mild (125,000-149,000/μL), moderate (100,000-124,000/μL), severe (75,000-99,000/μL), or very severe (craniotomy for tumor. Cancer 2016;122:1708-17. © 2016 American Cancer Society. © 2016 American Cancer Society.

  12. Pain following Craniotomy: Reassessment of the Available Options

    Science.gov (United States)

    Haldar, Rudrashish; Kaushal, Ashutosh; Gupta, Devendra; Srivastava, Shashi; Singh, Prabhat K.

    2015-01-01

    Pain following craniotomy has frequently been neglected because of the notion that postcraniotomy patients do not experience severe pain. However a gradual change in this outlook is observed because of increased sensitivity of neuroanaesthesiologists and neurosurgeons toward acute postcraniotomy pain. Multiple modalities exist for treating this variety of pain each with its own share of advantages and disadvantages. However, individually none of these modalities has been proclaimed as the best and applicable universally. A considerable amount of dispute remains to ascertain the appropriate therapeutic regimen for treating postcraniotomy pain in spite of numerous trials using different drugs and their combinations. This review aims to highlight the genesis, characteristics, and different strategies that are undertaken for management of acute postcraniotomy pain. Chronic postcraniotomy pain which can be debilitating sequelae is also discussed concisely. PMID:26495298

  13. Postoperative Submandibular Gland Swelling following Craniotomy under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Haruka Nakanishi

    2015-01-01

    Full Text Available Objective. Reporting of a rare case of postoperative submandibular gland swelling following craniotomy. Case Report. A 33-year-old male underwent resection for a brain tumor under general anesthesia. The tumor was resected via a retrosigmoid suboccipital approach and the patient was placed in a lateral position with his face down and turned to the right. Slight swelling of the right submandibular gland was observed just after the surgery. Seven hours after surgery, edematous change around the submandibular gland worsened and he required emergent reintubation due to airway compromise. The cause of submandibular gland swelling seemed to be an obstruction of the salivary duct due to surgical positioning. Conclusion. Once submandibular swelling and edematous change around the submandibular gland occur, they can worsen and compromise the air way within several hours after operation. Adequate precaution must be taken for any predisposing skull-base surgery that requires strong cervical rotation and flexion.

  14. Music is Beneficial for Awake Craniotomy Patients: A Qualitative Study.

    Science.gov (United States)

    Jadavji-Mithani, Radhika; Venkatraghavan, Lashmi; Bernstein, Mark

    2015-01-01

    Patients undergoing awake craniotomy may experience high levels of stress. Minimizing anxiety benefits patients and surgeons. Music has many therapeutic effects in altering human mood and emotion. Tonality of music as conveyed by composition in major or minor keys can have an impact on patients' emotions and thoughts. Assessing the effects of listening to major and minor key musical pieces on patients undergoing awake craniotiomy could help in the design of interventions to alleviate anxiety, stress and tension. Twenty-nine patients who were undergoing awake craniotomy were recruited and randomly assigned into two groups: Group 1 subjects listened to major key music and Group 2 listened to minor key compositions. Subjects completed a demographics questionnaire, a pre- and post-operative Beck Anxiety Inventory (BAI) and a semi-structured open-ended interview. RESULTS were analyzed using modified thematic analysis through open and axial coding. Overall, patients enjoyed the music regardless of the key distinctions and stated they benefitted from listening to the music. No adverse reactions to the music were found. Subjects remarked that the music made them feel more at ease and less anxious before, during and after their procedure. Patients preferred either major key or minor key music but not a combination of both. Those who preferred major key pieces said it was on the basis of tonality while the individuals who selected minor key pieces stated that tempo of the music was the primary factor. Overall, listening to music selections was beneficial for the patients. Future work should further investigate the effects of audio interventions in awake surgery through narrative means.

  15. [Complications and monitoring standards after elective craniotomy in Germany].

    Science.gov (United States)

    Henker, C; Schmelter, C; Piek, J

    2017-06-01

    The increasing endeavors to make inpatient treatment processes more effective leads to a reduction of the length of stay in hospital and minimization of postoperative monitoring. Therefore, the aim of our study was to determine potential postoperative complications for neurosurgical patients undergoing elective surgery with respect to assessment of the relevance for intensive medical care. Furthermore, our approach was compared with the standard of postoperative care of such patients in Germany. All 499 patients scheduled for elective craniotomy at our institute from 2010-2013 could be included corresponding to various treatment criteria for vascular diseases, such as aneurysms, arteriovenous malformation (AVM) and cavernous hemangioma as well as supratentorial and infratentorial tumors, transsphenoidally operated pituitary adenomas and stereotactic biopsies. All complications could be collated and categorized according to major and minor complications. Furthermore, a survey was conducted among 155 neurosurgical hospitals and departments with respect to the preferred postoperative monitoring strategy for the named treatment categories. The numbers of major complication were in accordance with data from other studies and although minor complications (13.4% in our collective) are rarely recorded in the literature, they do however indicate an adequate postoperative inpatient monitoring. The results of the survey showed a broad preference for intensive care unit monitoring of patients undergoing elective craniotomy in Germany. The undisputed gold standard of postoperative monitoring of neurosurgical patients undergoing elective surgery is still the intensive care unit. Although more flexible surveillance modalities are available, a cost-driven restructuring of postoperative monitoring and in particular reduction of the length of stay in hospital must be subjected to detailed scrutinization.

  16. Complications of ventricular entry during craniotomy for brain tumor resection.

    Science.gov (United States)

    John, Jessin K; Robin, Adam M; Pabaney, Aqueel H; Rammo, Richard A; Schultz, Lonni R; Sadry, Neema S; Lee, Ian Y

    2017-08-01

    OBJECTIVE Recent studies have demonstrated that periventricular tumor location is associated with poorer survival and that tumor location near the ventricle limits the extent of resection. This finding may relate to the perception that ventricular entry leads to further complications and thus surgeons may choose to perform less aggressive resection in these areas. However, there is little support for this view in the literature. This study seeks to determine whether ventricular entry is associated with more complications during craniotomy for brain tumor resection. METHODS A retrospective analysis of patients who underwent craniotomy for tumor resection at Henry Ford Hospital between January 2010 and November 2012 was conducted. A total of 183 cases were reviewed with attention to operative entry into the ventricular system, postoperative use of an external ventricular drain (EVD), subdural hematoma, hydrocephalus, and symptomatic intraventricular hemorrhage (IVH). RESULTS Patients in whom the ventricles were entered had significantly higher rates of any complication (46% vs 21%). Complications included development of subdural hygroma, subdural hematoma, intraventricular hemorrhage, subgaleal collection, wound infection, urinary tract infection/deep venous thrombosis, hydrocephalus, and ventriculoperitoneal (VP) shunt placement. Specifically, these patients had significantly higher rates of EVD placement (23% vs 1%, p entry (11% vs 0%, p = 0.001) with 3 of 4 of these patients having a large ventricular entry (defined here as entry greater than a pinhole [entry). Furthermore, in a subset of glioblastoma patients with and without ventricular entry, Kaplan-Meier estimates for survival demonstrated a median survival time of 329 days for ventricular entry compared with 522 days for patients with no ventricular entry (HR 1.13, 95% CI 0.65-1.96; p = 0.67). CONCLUSIONS There are more complications associated with ventricular entry during brain tumor resection than in

  17. Responsive Neurostimulation System (RNS in setting of cranioplasty and history of multiple craniotomies

    Directory of Open Access Journals (Sweden)

    Jason Ledesma

    2016-09-01

    Conclusion: The case illustrates a possible limitation of SEEG placement, particularly in patients with a history of cranioplasty and multiple prior craniotomies. We also describe the first placement of an RNS generator and system in the setting of prior cranioplasty.

  18. Immediate titanium mesh cranioplasty for treatment of post-craniotomy infections

    Science.gov (United States)

    Wind, Joshua J.; Ohaegbulam, Chima; Iwamoto, Fabio M.; Black, Peter McL.; Park, John K.

    2011-01-01

    OBJECTIVE Post craniotomy infections have generally been treated by debridement of infected tissues, disposal of the bone flap, and delayed cranioplasty several months later to repair the resulting skull defect. Debridement followed by retention of the bone flap has also been advocated. Here we propose an alternative operative strategy for the treatment of post craniotomy infections. METHODS Two patients presenting with clinical and radiographic signs and symptoms of post craniotomy infections were treated by debridement, bone flap disposal, and immediate titanium mesh cranioplasty. The patients were subsequently administered antibiotics and their clinical courses were followed. RESULTS The patients treated in this fashion did not have recurrence of their infections during three-year follow-up periods. CONCLUSIONS Surgical debridement, bone flap disposal and immediate titanium mesh cranioplasty may be a suitable option for the treatment of post craniotomy infections. This treatment strategy facilitates the eradication of infectious sources and obviates the risks and costs associated with a second surgical procedure. PMID:22120410

  19. Hemodynamic effects of decompressive craniotomy in MCA infarction: evaluation with perfusion CT

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    Bendszus, Martin; Weigand, Alexandra; Solymosi, Laszlo [Department of Neuroradiolgoy, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg (Germany); Muellges, Wolfgang [Department of Neurology, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg (Germany); Goldbrunner, Roland [Department of Neurosurgery, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg (Germany)

    2003-08-01

    Decompressive craniotomy in hemispheric infarction has been reported to reduce mortality and improve outcome. Identifying tissue at risk and monitoring the benefit of craniotomy is hardly practical and has not been reported thus far. Perfusion CT was applied before and immediately after decompressive craniotomy in a patient with space-occupying middle cerebral artery (MCA) infarction. Before surgery, perfusion CT revealed malperfused but still vital tissue in the vicinity of the infarction core which returned to normal after decompressive surgery. The final infarct size did not exceed the area of the initial hypodensity on unenhanced CT scan. In critically ill patients, the practicability of perfusion CT allows for demonstration of tissue at risk around the infarct core in space-occupying MCA infarction. Moreover, it may be used to monitor the effect of decompressive craniotomy. (orig.)

  20. Pediatric awake craniotomy for seizure focus resection with dexmedetomidine sedation-a case report.

    Science.gov (United States)

    Sheshadri, Veena; Chandramouli, B A

    2016-08-01

    Resection of lesions near the eloquent cortex of brain necessitates awake craniotomy to reduce the risk of permanent neurologic deficits during surgery. There are limited reports of anesthetic management of awake craniotomy in pediatric patients. This report is on use of dexmedetomidine sedation for awake craniotomy in a 11-year-old child, without any airway adjuncts throughout the procedure. Dexmedetomidine infusion administered at a dosage of 0.2 to 0.7μg kg(-1) h(-1) provided adequate sedation for the entire procedure. There were no untoward incidents or any interference with electrocorticography, intraoperative stimulation, and functional mapping. Adequate preoperative visits and counseling of patient and parents regarding course and nature of events along with well-planned intraoperative management are of utmost importance in a pediatric age group for successful intraoperative awake craniotomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Intraoperative ventricular puncture during supraorbital craniotomy via an eyebrow incision. Technical note.

    NARCIS (Netherlands)

    Menovsky, T.; Vries, J. de; Wurzer, J.A.; Grotenhuis, J.A.

    2006-01-01

    The authors determined the landmarks and coordinates for intraoperative ventricular puncture directly from the supraorbital craniotomy opening via an eyebrow incision. Fifty magnetic resonance (MR) imaging studies were obtained from patients with no pathological cerebral characteristics or

  2. Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Phan, Kevin; Moore, Justin M; Griessenauer, Christoph; Dmytriw, Adam A; Scherman, Daniel B; Sheik-Ali, Sharaf; Adeeb, Nimer; Ogilvy, Christopher S; Thomas, Ajith; Rosenfeld, Jeffrey V

    2017-05-01

    Acute subdural hematoma (SDH) is a major cause of morbidity after severe traumatic brain injury. Surgical evacuation of the hematoma, either via craniotomy or craniectomy, is the mainstay of treatment in patients with progressive neurologic deficits or significant mass effect. However, the decision to perform either procedure remains controversial. A literature search using major online databases and a manual search of references on the topic of craniotomy and craniectomy for evacuation of subdural hematoma until September 2016 was performed. The outcome variables were analyzed which included residual SDH, revision rate, and clinical outcome. Six comparison studies, with a total number of 2006 craniotomy and 451 craniectomy patients, fulfilled the inclusion criteria. Patients who underwent craniectomy scored significantly lower on the Glasgow Coma Scale at the time of initial presentation. Postoperatively, the rate of residual SDH was significantly lower in the craniectomy group than the craniotomy group (P = 0.004), with no difference in the revision rate. The odds of a poor outcome at follow-up was found to be lower in the craniotomy group (50.1% vs. 60.1%, respectively; P = 0.004). Similarly, mortality rates was lower in the craniotomy group than the craniectomy group (P = 0.004). The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial. In this study, craniectomy was associated with worse clinical presentation and postoperative outcome compared with craniotomy. However, craniectomy was associated with lower rate of residual SDH after treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas: Evaluating Perioperative Complications and Extent of Resection.

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    Eseonu, Chikezie I; Rincon-Torroella, Jordina; ReFaey, Karim; Lee, Young M; Nangiana, Jasvinder; Vivas-Buitrago, Tito; Quiñones-Hinojosa, Alfredo

    2017-09-01

    A craniotomy with direct cortical/subcortical stimulation either awake or under general anesthesia (GA) present 2 approaches for removing eloquent region tumors. With a reported higher prevalence of intraoperative seizures occurring during awake resections of perirolandic lesions, oftentimes, surgery under GA is chosen for these lesions. To evaluate a single-surgeon's experience with awake craniotomies (AC) vs surgery under GA for resecting perirolandic, eloquent, motor-region gliomas. Between 2005 and 2015, a retrospective analysis of 27 patients with perirolandic, eloquent, motor-area gliomas that underwent an AC were case-control matched with 31 patients who underwent surgery under GA for gliomas in the same location. All patients underwent direct brain stimulation with neuromonitoring and perioperative risk factors, extent of resection, complications, and discharge status were assessed. The postoperative Karnofsky Performance Score (KPS) was significantly lower for the GA patients at 81.1 compared to the AC patients at 93.3 ( P = .040). The extent of resection for GA patients was 79.6% while the AC patients had an 86.3% resection ( P = .136). There were significantly more 100% total resections in the AC patients 25.9% compared to the GA group (6.5%; P = .041). Patients in the GA group had a longer mean length of hospitalization of 7.9 days compared to the AC group at 4.2 days ( P = .049). We show that AC can be performed with more frequent total resections, better postoperative KPS, shorter hospitalizations, as well as similar perioperative complication rates compared to surgery under GA for perirolandic, eloquent motor-region glioma. Copyright © 2017 by the Congress of Neurological Surgeons

  4. Technical Aspects of Awake Craniotomy With Mapping for Brain Tumors in a Limited Resource Setting.

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    Leal, Rafael Teixeira Magalhaes; Barcellos, Bruno Mendonça; Landeiro, Jose Alberto

    2018-02-13

    Brain tumor surgery near or within eloquent regions is increasingly common and is associated with a high risk of neurological injury. Awake craniotomy with mapping has been shown to be a valid method to preserve neurological function while increasing the extent of resection. However, the technique used varies greatly among centers. Most count on professionals such as neuropsychologists, speech therapists, neurophysiologists or neurologists to help in intraoperative patient evaluation. We describe our technique with the sole participation of neurosurgeons and anesthesiologists. A retrospective review of 19 patients who underwent awake craniotomies for brain tumors between January 2013 and February 2017 at a tertiary university hospital was performed. We sought to identify and describe the most critical stages involved in this surgery as well as show the complications associated to our technique. Preoperative preparation, positioning, anesthesia, brain mapping, resection and management of seizures and pain were stages deemed relevant to the accomplishment of an awake craniotomy. Sixteen percent of the patients developed new post-operative deficit. Seizures occurred in 24%. None of them led to awake craniotomy failure. We provide a thorough description of the technique used in the awake craniotomies with mapping employed in our institution, where the intraoperative patient evaluation is carried out solely by neurosurgeons and anesthesiologists. The absence of other specialized personnel and equipment does not necessarily preclude successful mapping during awake craniotomy. Hopefully, we are providing helpful information for those who wish to offer function-guided tumor resection in their own centers. Copyright © 2018. Published by Elsevier Inc.

  5. Case-Control Study of Patients at Risk of Medical Complications after Elective Craniotomy.

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    Anthofer, Judith; Wester, Megan; Zeman, Florian; Brawanski, Alexander; Schebesch, Karl-Michael

    2016-07-01

    Medical complications severely impair recovery of neurosurgical patients after craniotomy. The purpose of this study was to identify patients at risk of peri- and postoperative medical complications. Therefore, we present a large population of patients with different medical complications after elective craniotomy. We retrospectively screened all patients who had been consecutively treated at our department between June 2009 and June 2014. Patients with any postoperative thromboembolic complication or pulmonary or systemic infection were compared with a control group without any medical complication. Peri- and postoperative complications were statistically analyzed with regard to their association with age, sex, comorbidity, indication for craniotomy, duration of surgery, surgical position, type of anesthesia, and previous craniotomy by means of logistic regression models. Of 1800 patients screened, 133 patients (67 women and 66 men aged between 14 and 85 years) had developed medical complications (overall morbidity, 7.4%). We found statistically significant correlations between thromboembolic events and meningioma, previous craniotomy, duration of surgery, and hypertension (P = 0.002, P = 0.032, P craniotomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Monitoring the depth of anaesthesia using the new modified entropy sensors during supratentorial craniotomy: Our experience

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    Richa Sharma

    2015-01-01

    Full Text Available Background: Monitoring the depth of anaesthesia can be a challenge in patients undergoing supratentorial craniotomy because the conventional sensors for both bispectral index and entropy monitors lose their contact with a brain after scalp elevation. The new sensors for the entropy monitor are more flexible and can be placed in different locations. The purpose of this study was to determine the feasibility on the use of new GE entropy sensors in monitoring depth of anaesthesia in patients undergoing supratentorial craniotomy. Materials and Methods: We retrospectively reviewed the data from 20 consecutive patients undergoing supratentorial craniotomy who had the monitoring of the depth of anaesthesia using modified entropy sensors. Prior to the induction of anaesthesia, the new GE entropy sensor (P/N M1038681 was applied in a modified fashion. We measured the state entropy (SE and response entropy (RE at 12 perioperative time points. Entropy values were compared with the clinical indices of depth of anaesthesia. Results: Data from 20 consecutive patients (orbitozygomatic craniotomy [10] and bifrontal craniotomy [10] were analysed. Monitoring was possible in all the patients. The changes in entropy values correlated with clinical indices of depth of anaesthesia. However, some patients showed variations in absolute values (RE and SE during the intraoperative period without any changes in the level of anaesthetic depth. Conclusions: Monitoring the depth of anaesthesia is feasible with the use of new entropy sensors in patients undergoing supratentorial craniotomy. In contrast to standard sensors, the new sensors offer flexibility with the placement.

  7. Patients' perspective on awake craniotomy for brain tumors-single center experience in Brazil.

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    Leal, Rafael Teixeira Magalhaes; da Fonseca, Clovis Orlando; Landeiro, Jose Alberto

    2017-04-01

    Awake craniotomy with brain mapping is the gold standard for eloquent tissue localization. Patients' tolerability and satisfaction have been shown to be high; however, it is a matter of debate whether these findings could be generalized, since patients across the globe have their own cultural backgrounds and may perceive and accept this procedure differently. We conducted a prospective qualitative study about the perception and tolerability of awake craniotomy in a population of consecutive brain tumor patients in Brazil between January 2013 and April 2015. Seventeen patients were interviewed using a semi-structured model with open-ended questions. Patients' thoughts were grouped into five categories: (1) overall perception: no patient considered awake craniotomy a bad experience, and most understood the rationale behind it. They were positively surprised with the surgery; (2) memory: varied from nothing to the entire surgery; (3) negative sensations: in general, it was painless and comfortable. Remarks concerning discomfort on the operating table were made; (4) postoperative recovery: perception of the postoperative period was positive; (5) previous surgical experiences versus awake craniotomy: patients often preferred awake surgery over other surgery under general anesthesia, including craniotomies. Awake craniotomy for brain tumors was well tolerated and yielded high levels of satisfaction in a population of patients in Brazil. This technique should not be avoided under the pretext of compromising patients' well-being.

  8. Clinical study of acute and chronic pain after temporal craniotomy

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    WANG Cheng-wei

    2013-10-01

    Full Text Available Objective To investigate the correlation of chronic pain after surgery and acute pain within 48 h after temporal craniotomy. Methods One hundred and seventy-six patients who underwent surgery through temporal approach were divided into 3 groups and treated with morphine 30 mg (Group M, N = 57, tramadol 1000 mg (Group T, N = 60 and morphine 20 mg + flurbiprofen 200 mg (Group F, N = 59 by patient-controlled intravenous analgesia (PCIA. Postoperative acute pain (resting and movement was evaluated by Visual Analogue Scale (VAS at 4, 16, 24 and 48 h respectively. Chronic pain was measured by Short-Form McGill Pain Questionnaire (SF-MPQ 3 months after surgery. The characteristics of acute and chronic pain, the relationship between them and analgesic effect of 3 kinds of analgesic drugs were analyzed. Results The differences of observed indicators including gender, age, weight and operating time, which might affect the degree of postoperative pain between before and after surgery were not statistically significant (P > 0.05. VAS scores at different time points within 48 h after surgery in each group decreased gradually. The VAS scores in group T (2.91 ± 1.64 was significantly higher than group M (2.19 ± 1.68 and group F (1.71 ± 1.17, P 0.05. The overall incidence rate of chronic pain was 71.02% (125/176, with moderate and severe pain in 15.91% (28/176. Chronic pain and acute postoperative pain severity were positively correlated (resting: rs = 0.171, P = 0.012; movement: rs = 0.190, P = 0.006. The difference of the acute pain (VAS corresponding to SF-MPQ Ⅱ score > 0 and SF-MPQ Ⅱ score = 0 was statistically significant (P < 0.05. Conclusion The postoperative chronic pain following temporal craniotomy is related to acute pain within 48 h after operation. Effective treatment of early postoperative acute pain may reduce the incidence of chronic pain.

  9. Modified “in-window” technique for decompressive craniotomy for severe brain injury

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    Jovanović Momir J.

    2015-01-01

    Full Text Available Increased intracranial pressure and decreased cerebral perfusion in patients with severe traumatic brain injury are associated with cerebral ischemia and poor outcome. Lowering intracranial pressure is one of the goals of treatment. We analyzed the effects of decompressive craniotomy on intracranial pressure levels and outcome. In addition, we compared the results of decompressive craniotomy performed with our original technique (modified “in-window” technique, with no need for cranioplasty with results of classic techniques. We formed two groups: 52 patients with TBI (GCS≤8, with monitored intracranial pressure, and the control: 45 patients without intracranial pressure monitoring. In the first group, malignant intracranial hypertension was treated by decompressive craniotomy, using a modified "in-window" technique. Results were analyzed using standard statistical methods. In the first group, with intracranial pressure monitoring, 17/52 had decompressive craniotomy, and significant reduction of intracranial pressure appeared in the early postoperative period (38.82 to 22.76 mmHg, mean, with significant decrease of intracranial pressure at the end of treatment, compared to the control group (mean=25.00, and 45.30 mmHg, respectively. Late complications were similar to results of other studies. Our results were 20% of epileptic seizures, 8% of hydrocephalus, 12% contusion/hematoma progression and 12% subdural hygroma. Outcome (measured with Glasgow Outcome Score-GOS in the first group, at the time of discharge, was better with decompressive craniotomy than without decompressive craniotomy (GOS=2.47, and GOS=1.00, respectively. Modified "in-window" technique for decompressive craniotomy in severe traumatic brain injury is safe, promising and according to our experience offers a lower rate of complications with no need for additional cranioplastic surgery.

  10. A STUDY ON MANAGEMENT OF CHRONIC SUBDURAL HAEMATOMA- BURR HOLE EVACUATION AND MINI CRANIOTOMY

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    Nandigama Pratap Kumar

    2016-11-01

    Full Text Available BACKGROUND Chronic SDH is one of the common neurosurgical conditions requiring surgical treatment. The incidence of chronic SDH is 1.7- 18 per 1,00,000 population. The incidence is higher in the elderly patients, i.e. 58 per 1,00,000. Various treatment modalities available for the treatment of chronic SDH indicate that there is no gold standard for the treatment of chronic SDH. Recurrence is the major problem following treatment and can be as high as 30%. Mini craniotomy is one of the surgical options that can offer better view of the subdural space and may allow us to efficiently clear the loculations and haematoma fluid and thereby decreasing the incidence of recurrences and the need for reoperations. Small craniotomies have not been studied well in the literature except for a few publications. In this study, we are comparing mini craniotomy and burr hole evacuation for the treatment of chronic SDH. MATERIALS AND METHODS All the patients with chronic subdural haematoma operated between August 2013 and January 2016. Patients with recurrent SDH on the same side and patients who underwent different procedures on either side (in case of bilateral haematomas were excluded from the study. The patients were operated by two senior surgeons with one surgeon doing burr hole evacuation and another doing mini craniotomy. Preoperative status and postoperative status was analysed. RESULTS All the patients were analysed both preoperatively and postoperatively. In both the groups, most of the patients shown improvement following surgery, but recurrences are more in burr hole group when compared to mini craniotomy. CONCLUSION Mini craniotomy allows better view of the subdural space and better evacuation of chronic subdural haematoma. Cure rate is higher with mini craniotomy compared to burr hole evacuation.

  11. Ipilimumab and craniotomy in patients with melanoma and brain metastases: a case series.

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    Jones, Pamela S; Cahill, Daniel P; Brastianos, Priscilla K; Flaherty, Keith T; Curry, William T

    2015-03-01

    OBJECT In patients with large or symptomatic brain lesions from metastatic melanoma, the value of resection of metastases to facilitate administration of systemic ipilimumab therapy has not yet been described. The authors undertook this study to investigate whether craniotomy creates the opportunity for patients to receive and benefit from ipilimumab who would otherwise succumb to brain metastasis prior to the onset of regression. METHODS All patients with metastatic melanoma who received ipilimumab and underwent craniotomy for metastasis resection between 2008 and 2014 at the Massachusetts General Hospital were identified through retrospective chart review. The final analysis included cases involving patients who underwent craniotomy within 3 months prior to initiation of therapy or up to 6 months after cessation of ipilimumab administration. RESULTS Twelve patients met the inclusion criteria based on timing of therapy (median age 59.2). The median number of metastases at the time of craniotomy was 2. The median number of ipilimumab doses received was 4. Eleven of 12 courses of ipilimumab were stopped for disease progression, and 1 was stopped for treatment-induced colitis. Eight of 12 patients had improvement in their performance status following craniotomy. Of the 6 patients requiring corticosteroids prior to craniotomy, 3 tolerated corticosteroid dose reduction after surgery. Ten of 12 patients had died by the time of data collection, with 1 patient lost to follow-up. The median survival after the start of ipilimumab treatment was 7 months. CONCLUSIONS In this series, patients who underwent resection of brain metastases in temporal proximity to receiving ipilimumab had qualitatively improved performance status following surgery in most cases. Surgery facilitated corticosteroid reduction in select patients. Larger analyses are required to better understand possible synergies between craniotomy for melanoma metastases and ipilimumab treatment.

  12. Integrative Review: Post-Craniotomy Pain in the Brain Tumor Patient

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    Guilkey, Rebecca Elizabeth; Von Ah, Diane; Carpenter, Janet S.; Stone, Cynthia; Draucker, Claire B.

    2015-01-01

    Aim To conduct an integrative review to examine evidence of pain and associated symptoms in adult (≥ 21 years of age), post-craniotomy, brain tumor patients hospitalized on intensive care units. Background Healthcare providers believe craniotomies are less painful than other surgical procedures. Understanding how post-craniotomy pain unfolds over time will help inform patient care and aid in future research and policy development. Design Systematic literature search to identify relevant literature. Information abstracted using the Theory of Unpleasant Symptoms’ concepts of influencing factors, symptom clusters and patient performance. Inclusion criteria were indexed, peer-reviewed, full-length, English-language articles. Keywords were ‘traumatic brain injury,’ ‘pain, post-operative,’ ‘brain injuries,’ ‘postoperative pain,’ ‘craniotomy,’ ‘decompressive craniectomy,’ and ‘trephining.’ Data sources Medline, OVID, PubMed and CINAHL databases from 2000 – 2014. Review Method Cooper’s five-stage integrative review method was used to assess and synthesize literature. Results The search yielded 115 manuscripts, with 26 meeting inclusion criteria. Most studies were randomized, controlled trials conducted outside of the United States. All tested pharmacological pain interventions. Post-craniotomy brain tumor pain was well-documented and associated with nausea, vomiting and changes in blood pressure and impacted patient length of hospital stay, but there was no consensus for how best to treat such pain. Conclusion The Theory of Unpleasant Symptoms provided structure to the search. Post-craniotomy pain is experienced by patients, but associated symptoms and impact on patient performance remain poorly understood. Further research is needed to improve understanding and management of post-craniotomy pain in this population. PMID:26734710

  13. Betadine irrigation and post-craniotomy wound infection

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    Patel, Kunal S.; Goldenberg, Brandon; Schwartz, Theodore H.

    2014-01-01

    Object The purpose of this study is to evaluate the efficacy of betadine irrigation in preventing postoperative wound infection in cranial neurosurgical procedures. Methods A total of 473 consecutive cranial neurosurgical procedures, including craniotomies and burr hole procedures were retrospectively reviewed. Patients had either antibiotic irrigation or dilute betadine plus antibiotic irrigation prior to skin closure. Infection was determined by purulence noted on reoperation and confirmed with bacterial growth culture. One and three month postoperative infection rates were calculated. Statistical analysis was performed using chi-squared tests. Results This study included 404 patients. Betadine was used in 117 (29.0%). At 1 month after surgery, there was no difference in the rate of wound infection between the two groups (1.7% each). However, at 90 days, the betadine group had a 2.6% infection rate compared with 3.8% in the antibiotic group, indicating a 33% decrease in infection rates with the addition of betadine (p=.527). The small sample size of the study produced a low power and high beta error. Conclusions In this small preliminary study, betadine decreased postoperative infection rates compared with antibiotic prophylaxis alone at 90 days but not 30 days. This was not statistically significant, but a larger sample size would lower the beta error and decrease confounding bias associated with group heterogeneity. The potential for betadine, a cheap, low toxicity antimicrobial, to decrease infection rates and reoperations for infection warrants a larger multicenter trial. PMID:24529229

  14. Electroacupuncture-Assisted Craniotomy on an Awake Patient

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    Amritpal Sidhu

    2017-02-01

    Full Text Available Although acupuncture has existed for over 2000 years, its application as an anesthetic aid began in the 1950s in China. The first surgical procedure performed under acupuncture anesthesia was a tonsillectomy. Soon thereafter, major and minor surgical procedures took place with electroacupuncture alone providing the anesthesia. The procedures performed were diverse, ranging from cardiothoracic surgery to dental extractions. Usage of acupuncture anesthesia, specifically in neurosurgery, has been well documented in hospitals across China, especially in Beijing, dating back to the 1970s. We present a case of a 65-year-old man who presented with right-sided body weakness. He had a past medical history of uncontrolled diabetes mellitus, hypertension, and obstructive sleep apnea requiring use of a nasal continuous positive airway pressure device during sleep. We performed a computed tomography brain scan, which revealed a left-sided acute on chronic subdural hemorrhage. Due to his multiple comorbidities, we decided to perform the surgical procedure under electroacupuncture anesthesia. The aim of this case report is to describe a craniotomy performed under electroacupuncture on an elderly patient with multiple comorbidities who was awake during the procedure and in whom this procedure, if it had been performed under general anesthesia, would have carried high risk.

  15. Smart bioimpedance-controlled craniotomy: Concept and first experiments.

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    Niesche, Annegret; Müller, Meiko; Ehreiser, Fritz; Teichmann, Daniel; Leonhardt, Steffen; Radermacher, Klaus

    2017-07-01

    Craniotomy is part of many neurosurgical interventions to create surgical access to intracranial structures. The procedure conventionally bears a high risk of unintended dural tears or damage of the soft tissue underneath the bone. A new synergistically controlled instrument has recently been introduced to address this problem by combining a soft tissue preserving saw with an automatic cutting depth control. Many approaches are known to obtain the information required on the local bone thickness. However, they suffer from unsatisfactory robustness against disturbances occurring during surgery and many approaches require additional intra- or preoperative steps in the workflow. This article presents first concepts for real-time cutting depth control based on in-process bioimpedance measurements. Furthermore, sensor integration into a synergistic surgical device incorporating a bidirectional oscillating saw is demonstrated and evaluated in first feasibility tests on a fresh bovine bone specimen. Results of bipolar measurements show that the transition of different layers of bicortical bone and bone breakthrough lead to characteristic impedance patterns that can be used for process control.

  16. Electroacupuncture-Assisted Craniotomy on an Awake Patient.

    Science.gov (United States)

    Sidhu, Amritpal; Murgahayah, Trushna; Narayanan, Vairavan; Chandran, Hari; Waran, Vicknes

    2017-01-01

    Although acupuncture has existed for over 2000 years, its application as an anesthetic aid began in the 1950s in China. The first surgical procedure performed under acupuncture anesthesia was a tonsillectomy. Soon thereafter, major and minor surgical procedures took place with electroacupuncture alone providing the anesthesia. The procedures performed were diverse, ranging from cardiothoracic surgery to dental extractions. Usage of acupuncture anesthesia, specifically in neurosurgery, has been well documented in hospitals across China, especially in Beijing, dating back to the 1970s. We present a case of a 65-year-old man who presented with right-sided body weakness. He had a past medical history of uncontrolled diabetes mellitus, hypertension, and obstructive sleep apnea requiring use of a nasal continuous positive airway pressure device during sleep. We performed a computed tomography brain scan, which revealed a left-sided acute on chronic subdural hemorrhage. Due to his multiple comorbidities, we decided to perform the surgical procedure under electroacupuncture anesthesia. The aim of this case report is to describe a craniotomy performed under electroacupuncture on an elderly patient with multiple comorbidities who was awake during the procedure and in whom this procedure, if it had been performed under general anesthesia, would have carried high risk. Copyright © 2016 Medical Association of Pharmacopuncture Institute. Published by Elsevier B.V. All rights reserved.

  17. Post-craniotomy headache: a clinical view with a focus on the persistent form.

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    Rocha-Filho, Pedro Augusto Sampaio

    2015-05-01

    Post-craniotomy headache is a frequent complication of neurosurgical procedures and is often a challenge for neurosurgeons, neurologists, and headache specialists. This was a narrative review. Surgical trauma, adherence of the musculature to the dura mater, peripheral nerve injury, development of neurinomas in the surgical scar, and central sensitization may be involved in the genesis of such headaches. Performing smaller craniotomies, replacement of the bone (craniotomy), performing cranioplasty, and infiltration of the surgical site with local anesthesia at the end of the surgical procedure are strategies used to prevent such headaches. Among the most frequent characteristics of post-craniotomy headaches are that they start on the first days after the operation, are located on the same side as and at the site of the surgical scar, and improve with the passage of time. Depression, anxiety, and temporomandibular disorders are frequently associated with these headaches. Abortive treatment such as opioids, ordinary analgesics, non-hormonal anti-inflammatory drugs, and triptans can be administered. There have been reports of improvements using sodium divalproex, verapamil, and local anesthetics. Post-craniotomy headaches can have significant repercussions on patients' quality of life. There is a need for clinical trials evaluating therapeutic options for treatment of this type of headache. © 2015 American Headache Society.

  18. Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy.

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    Yu, Y; Li, H J

    2017-04-20

    Intracranial infection is a common clinical complication after craniotomy. We aimed to explore the diagnostic and prognostic value of dynamic changing procalcitonin (PCT) in early intracranial infection after craniotomy. A prospective study was performed on 93 patients suspected of intracranial infection after craniotomy. Routine peripheral venous blood was collected on the day of admission, and C reactive protein (CRP) and PCT levels were measured. Cerebrospinal fluid (CSF) was collected for routine biochemical, PCT and culture assessment. Serum and CSF analysis continued on days 1, 2, 3, 5, 7, 9, and 11. The patients were divided into intracranial infection group and non-intracranial infection group; intracranial infection group was further divided into infection controlled group and infection uncontrolled group. Thirty-five patients were confirmed with intracranial infection after craniotomy according to the diagnostic criteria. The serum and cerebrospinal fluid PCT levels in the infected group were significantly higher than the non-infected group on day 1 (Pcraniotomy. Since CSF PCT levels have higher sensitivity and specificity, dynamic changes in this parameter could be used for early detection of intracranial infection after craniotomy, combined with other biochemical indicators.

  19. Recent trends in the anesthetic management of craniotomy for supratentorial tumor resection.

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    Gruenbaum, Shaun E; Meng, Lingzhong; Bilotta, Federico

    2016-10-01

    The article reviews the recent evidence on the anesthetic management of patients undergoing craniotomy for supratentorial tumor resection. A rapid recovery of neurological function after craniotomy for supratentorial tumor allows for the prompt diagnosis of intracranial complications and possibly an early hospital discharge. Intraoperative esmolol infusion was shown to reduce the anesthetic requirements, and may facilitate a more rapid recovery of neurological function. Outpatient craniotomy for supratentorial tumor resection has been associated with several clinical and economic benefits, but has not gained widespread use because of skepticism and medical-legal concerns. Awake craniotomy is associated with advantageous outcomes compared with surgery under general anesthesia, and is regarded as the standard of care for tumors that reside in or in close proximity to the eloquent brain. Recent studies have demonstrated that intraoperative electroacupuncture, dexmedetomidine, pregabalin, and lidocaine may facilitate postcraniotomy pain management. The use of volatile anesthetic agents in cancer surgery is associated with a worse survival compared with intravenous anesthetics, possibly by hindering immunologic defenses against cancer cells. Recent evidence has yielded valuable information regarding anesthetic management of patients undergoing supratentorial tumor craniotomy. Despite a plethora of studies that compare short-term outcomes using different anesthetic and analgesic regimens, randomized controlled trials that examine the long-term outcomes (i.e., neurocognitive function, quality of life, tumor recurrence, and survival) that are of particular interest to patients are needed.

  20. Perioperative Predictors of Extubation Failure and the Effect on Clinical Outcome After Infratentorial Craniotomy.

    Science.gov (United States)

    Cai, Ye-Hua; Wang, Hai-Tang; Zhou, Jian-Xin

    2016-07-12

    BACKGROUND The purpose of the study was to analyze the risk factors for failed extubation in subjects submitted to infratentorial craniotomy. MATERIAL AND METHODS Patients aged over 18 years who received infratentorial craniotomy for brain tumor resection were consecutively included in this study. Perioperative variables were collected and analyzed. Univariate analyses and multiple logistic regression were used to derive factors related to failed extubation. Patients had follow-up care until either out of hospital or death. RESULTS Throughout the course of the study, 2118 patients were eligible and 94 (4.4%) suffered from extubation failure at some point during their hospital stay. Five factors were recognized as independent risk factors for postoperative failed extubation: craniotomy history, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in blood pressure (BP) during the operation. Failed extubation was related to a higher incidence rate of pneumonia, mortality, unfavorable Glasgow Outcome Scale score, longer stay in the neuro-intensive care unit (ICU) and hospitalization, and higher hospitalization costs compared with successful extubation. CONCLUSIONS History of craniotomy, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in BP during the operation were independent risk factors related to postoperative failed extubation in patients submitted to infratentorial craniotomy. Extubation failure raises the incidences of postoperative pneumonia, mortality, and higher hospitalization costs, and prolongs neuro-ICU and postoperative length of stay.

  1. Modified concentric craniotomy for the removal of a huge calvarial metastatic tumor: technical note.

    Science.gov (United States)

    Kao, Ying; Yang, Shih-Hung; Kuo, Meng-Fai

    2016-02-01

    It is challenging for neurosurgeons to remove huge tumors involving the skull that may possibly invade the dura or intracranial neural tissue. In this situation, excision of the tumor may cause profound blood loss, unexpected opening of the dura, or neurological injury. We describe a technique of craniotomy in a pediatric patient to avoid surgical complications. A 15-year-old boy had a huge metastatic calvarial Ewing's sarcoma. We removed the tumor successfully with modified concentric craniotomy. First, two oval burr holes are made on both sides of the tumor. The inner craniotomy uses the internal margin of the oval holes, while the outer cut uses the outer margins. The skull bone in between the two craniotomies is removed easily in two pieces and the dura surrounding the tumor can be exposed early in the procedure. In this way, the huge skull tumor can be removed en bloc under direct vision to avoid unwanted complications. Minimal blood and bone loss can be achieved. Blood transfusion was not necessary during the surgery. The patient did not have new neurological symptoms and signs after surgery. The goal of the modified concentric craniotomy is to develop an accessible margin of the dura surrounding the bulky tumor in the early phase of surgery. Blood and bone loss can be reduced significantly.

  2. Craniotomy Versus Craniectomy for Acute Traumatic Subdural Hematoma in the United States: A National Retrospective Cohort Analysis.

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    Rush, Barret; Rousseau, Justin; Sekhon, Mypinder S; Griesdale, Donald E

    2016-04-01

    The optimal surgical management of acute traumatic subdural hematoma (ASDH) is controversial; both craniectomy and craniotomy are performed. The purpose of this study was to determine the current management of ASDH in the United States. This retrospective cohort study used the Nationwide Inpatient Sample from the years 2006-2011 to examine patients with a primary diagnosis of ASDH. All patients ≥18 years old with a primary diagnosis of ASDH were included in the analysis. Patients with procedure codes for craniectomy and craniotomy were isolated from the database. Propensity score matching based on logistic regression was used to match craniotomy to craniectomy in a 1:1 fashion. There were 47,911,414 hospitalizations analyzed. Of 60,435 patients with ASDH identified, 1763 underwent craniotomy and 177 underwent craniectomy. The average age of patients who underwent craniectomy was 49.5 years (SD 20.8) compared with an average age of 68.9 years (SD 17.1) of patients who underwent craniotomy (P craniotomy (median duration 14.3 days [interquartile range 25] for craniectomy vs. 10.9 days [interquartile range 9] for craniotomy, P Craniotomy is the preferred surgical technique for management of ASDH in the United States, being performed 10 times more frequently than craniectomy. Craniectomy was associated with significantly higher in-hospital mortality after propensity score matched analysis. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Frontal Sinus Breach During Routine Frontal Craniotomy Significantly Increases Risk of Surgical Site Infection: 10-Year Retrospective Analysis.

    Science.gov (United States)

    Linzey, Joseph R; Wilson, Thomas J; Sullivan, Stephen E; Thompson, B Gregory; Pandey, Aditya S

    2017-09-01

    Frontotemporal craniotomies are commonly performed for a variety of neurosurgical pathologies. Infections related to craniotomies cause significant morbidity. We hypothesized that the risk of cranial surgical site infections (SSIs) may be increased in patients whose frontal sinuses are breached during craniotomy. To compare the rate of cranial SSIs in patients undergoing frontotemporal craniotomies with and without frontal sinus breach (FSB). We performed a retrospective analysis of all patients undergoing frontotemporal craniotomies for the management of cerebral aneurysms from 2005 to 2014. This study included 862 patients undergoing 910 craniotomies. Primary outcome of interest was occurrence of a cranial SSI. Standard statistical methods were utilized to explore associations between a variety of variables including FSB, cranial SSI, and infections requiring reoperation. Of the 910 craniotomies, 141 (15.5%) involved FSB. Of those involving FSB, 22 (15.6%) developed a cranial SSI, compared to only 56 of the 769 without FSB (7.3%; P = .001). Cranial SSI requiring reoperation was much more likely in patients with FSB compared to those without a breach (7.8% vs 1.6%; P craniotomies are at significantly greater risk of serious cranial SSIs if the frontal sinus has been breached. Copyright © 2017 by the Congress of Neurological Surgeons

  4. [A Case of Emergency Cesarean Section and Craniotomy in a 26 Week Pregnant Woman].

    Science.gov (United States)

    Matsuda, Megumi; Yamazaki, Marie; Osada, Junko; Hirata, Manabu; Amaya, Fumimasa

    2015-02-01

    Intracranial hemorrhage is a rare complication during the pregnancy but carries a poor prognosis. We experienced a case of emergency cesarean section and craniotomy for removal of hematoma due to arteriovenous malformation (AVM) rupture. A 33-year-old woman at 26 weeks of pregnancy suffered a sudden onset of headache and disturbance of consciousness. She was diagnosed with left cerebral hemorrhage due to AVM rupture. Emergency cesarean section was followed by the surgical removal of the hematoma under general anesthesia. Postoperative courses of both mother and baby were satisfactory. The severity of illness of the mother strongly influences her fetus and vise versa. When performing cesarean section before craniotomy, anesthesia should be managed to prevent recurrence of intracranial hemorrhage during the cesarean section and atonic bleeding during the craniotomy. Anesthetist should have adequate knowledge and communicate adequately with obstetrician and pediatrician to achieve better prognosis for the intracranial hemorrhage during pregnancy.

  5. Prevalence and Risk Factors for Intraoperative Hypotension during Craniotomy for Traumatic Brain Injury

    Science.gov (United States)

    Sharma, Deepak; Brown, Michelle J; Curry, Parichat; Noda, Sakura; Chesnut, Randall M.; Vavilala, Monica S.

    2012-01-01

    Background Hypotension after traumatic brain injury (TBI) is associated with poor outcomes. However, data on intraoperative hypotension (IH) are scarce and the effect of anesthetic agents on IH is unknown. We examined the prevalence and risk factors for IH, including the effect of anesthetic agents during emergent craniotomy for isolated TBI. Methods A retrospective cohort study of patients ≥ 18 years who underwent emergent craniotomy for TBI at Harborview Medical Center (level-1 trauma center) between October 2007 and January 2010. Demographic, clinical and radiographic characteristics, hemodynamic and anesthetic data were abstracted from medical and electronic anesthesia records. Hypotension was defined as systolic blood pressure (SBP) craniotomy. The presence of multiple CT lesions, subdural hematoma, maximum thickness of CT lesion and longer duration of anesthesia increase the risk for IH. PMID:22504924

  6. Modeling of Brain Shift Phenomenon for Different Craniotomies and Solid Models

    Directory of Open Access Journals (Sweden)

    Alvaro Valencia

    2012-01-01

    Full Text Available This study investigates the effects of different solid models on predictions of brain shift for three craniotomies. We created a generic 3D brain model based on healthy human brain and modeled the brain parenchyma as single continuum and constrained by a practically rigid skull. We have used elastic model, hyperelastic 1st, 2nd, and 3rd Ogden models, and hyperelastic Mooney-Rivlin with 2- and 5-parameter models. A pressure on the brain surface at craniotomy region was applied to load the model. The models were solved with the finite elements package ANSYS. The predictions on stress and displacements were compared for three different craniotomies. The difference between the predictions of elastic solid model and a hyperelastic Ogden solid model of maximum brain displacement and maximum effective stress is relevant.

  7. Effect of operating microscope light on brain temperature during craniotomy.

    Science.gov (United States)

    Gayatri, Parthasarathi; Menon, Girish G; Suneel, Puthuvassery R

    2013-07-01

    Operating microscopes used during neurosurgery are fitted with xenon light. Burn injuries have been reported because of xenon microscope lighting as the intensity of xenon light is 300 W. We designed this study to find out if the light of operating microscope causes an increase in temperature of the brain tissue, which is exposed underneath. Twenty-one adult patients scheduled for elective craniotomies were enrolled. Distal esophageal temperature (T Eso), brain temperature under the microscope light (T Brain), and brain temperature under dura mater (T Dura) were measured continuously at 15-minute intervals during microscope use. The irrigation fluid temperature, room temperature, intensity of the microscope light, and the distance of the microscope from the brain surface were kept constant. The average age of the patients was 44±15 years (18 males and 3 females). The mean duration of microscope use was 140±39 minutes. There were no significant changes in T Brain and T Dura and T Eso over time. T Dura was significantly lower than T Brain both at time 0 and 60 minutes but not at 90 minutes. T Brain was significantly lower than T Eso both at time 0 and 60 minutes but not at 90 minutes. The T Dura remained significantly lower than T Eso at 0, 60, and 90 minutes. Our study shows that there is no significant rise in brain temperature under xenon microscope light up to 120 minutes duration, at intensity of 60% to 70%, from a distance of 20 to 25 cm from the brain surface.

  8. [Dexmedetomidine for neurocognitive testing in awake craniotomy: case report.].

    Science.gov (United States)

    Santos, Marcelo Cursino Pinto Dos; Vinagre, Ronaldo Contreras Oliveira

    2006-08-01

    Tumor resections in the speech areas of the brain are more safely done using cognitive tests to determine their exact location. Patients must be awake, comfortable, and cooperative for the precise identification of the areas to be preserved. The objective of this report is to present a surgical procedure done with the patient awake, without endotracheal intubation, using sevofluorane initially, followed by dexmedetomidine. This technique allowed the realization of motor and speech evaluation tests. Twenty-seven years old male patient, physical status ASA I, with a brain tumor. In the operating room, without pre-anesthetic medication, midazolam (1 mg) was administered, and general anesthesia was induced with propofol (80 mg). Maintenance was done with O2, N2O, and sevofluorane, with a mask, for catheterization of the right radial artery, introduction of a vesical catheter, and infiltration of the surgical site. This phase lasted around 20 minutes, and the infusion of dexmedetomidine was initiated in the last 10 minutes to maintain a level of sedation Ramsay score 2. Cortical mapping followed (75 minutes). Afterwards, tumor resection was done while the patient remained sedated with higher doses of dexmedetomidine. Hemodynamic and respiratory parameters remained stable, and the procedure was performed without complications, lasting a total of five hours. After the surgical procedure the patient was transferred to the ICU. He did not develop any neurological changes, being discharged to a regular ward the following day. Awake craniotomy with the proper mapping of speech and motor cortical areas was successfully done with the continuous infusion of dexmedetomidine. Both the patient and the surgical team were pleased with the technique.

  9. Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy.

    Science.gov (United States)

    Kimmell, Kristopher T; Jahromi, Babak S

    2015-05-01

    OBJECT Patients undergoing craniotomy are at risk for developing venous thromboembolism (VTE). The safety of anticoagulation in these patients is not clear. The authors sought to identify risk factors predictive of VTE in patients undergoing craniotomy. METHODS The authors reviewed a national surgical quality database, the American College of Surgeons National Surgical Quality Improvement Program. Craniotomy patients were identified by current procedural terminology code. Clinical factors were analyzed to identify associations with VTE. RESULTS Four thousand eight hundred forty-four adult patients who underwent craniotomy were identified. The rate of VTE in the cohort was 3.5%, including pulmonary embolism in 1.4% and deep venous thrombosis in 2.6%. A number of factors were found to be statistically significant in multivariate binary logistic regression analysis, including craniotomy for tumor, transfer from acute care hospital, age ≥ 60 years, dependent functional status, tumor involving the CNS, sepsis, emergency surgery, surgery time ≥ 4 hours, postoperative urinary tract infection, postoperative pneumonia, on ventilator ≥ 48 hours postoperatively, and return to the operating room. Patients were assigned a score based on how many of these factors they had (minimum score 0, maximum score 12). Increasing score was predictive of increased VTE incidence, as well as risk of mortality, and time from surgery to discharge. CONCLUSIONS Patients undergoing craniotomy are at low risk of developing VTE, but this risk is increased by preoperative medical comorbidities and postoperative complications. The presence of more of these clinical factors is associated with progressively increased VTE risk; patients possessing a VTE Risk Score of ≥ 5 had a greater than 20-fold increased risk of VTE compared with patients with a VTE score of 0.

  10. Craniotomy: True Sham for Traumatic Brain Injury, or a Sham of a Sham?

    Science.gov (United States)

    Yarnell, Angela; Kean, William S.; Gold, Eric; Lewis, Bobbi; Ren, Ming; McMullen, David C.; Jacobowitz, David M.; Pollard, Harvey B.; O'Neill, J. Timothy; Grunberg, Neil E.; Dalgard, Clifton L.; Frank, Joseph A.; Watson, William D.

    2011-01-01

    Abstract Neurological dysfunction after traumatic brain injury (TBI) is caused by both the primary injury and a secondary cascade of biochemical and metabolic events. Since TBI can be caused by a variety of mechanisms, numerous models have been developed to facilitate its study. The most prevalent models are controlled cortical impact and fluid percussion injury. Both typically use “sham” (craniotomy alone) animals as controls. However, the sham operation is objectively damaging, and we hypothesized that the craniotomy itself may cause a unique brain injury distinct from the impact injury. To test this hypothesis, 38 adult female rats were assigned to one of three groups: control (anesthesia only); craniotomy performed by manual trephine; or craniotomy performed by electric dental drill. The rats were then subjected to behavioral testing, imaging analysis, and quantification of cortical concentrations of cytokines. Both craniotomy methods generate visible MRI lesions that persist for 14 days. The initial lesion generated by the drill technique is significantly larger than that generated by the trephine. Behavioral data mirrored lesion volume. For example, drill rats have significantly impaired sensory and motor responses compared to trephine or naïve rats. Finally, of the seven tested cytokines, KC-GRO and IFN-γ showed significant increases in both craniotomy models compared to naïve rats. We conclude that the traditional sham operation as a control confers profound proinflammatory, morphological, and behavioral damage, which confounds interpretation of conventional experimental brain injury models. Any experimental design incorporating “sham” procedures should distinguish among sham, experimentally injured, and healthy/naïve animals, to help reduce confounding factors. PMID:21190398

  11. Burr hole washout versus craniotomy for chronic subdural hematoma: patient outcome and cost analysis.

    Science.gov (United States)

    Regan, Jacqueline M; Worley, Emmagene; Shelburne, Christopher; Pullarkat, Ranjit; Watson, Joseph C

    2015-01-01

    Chronic subdural hematomas (CSDH), which are frequently encountered in neurosurgical practice, are, in the majority of cases, ideally treated with surgical drainage. Despite this common practice, there is still controversy surrounding the best surgical procedure. With lack of clear evidence of a superior technique, surgeons are free to base the decision on other factors that are not related to patient care. A retrospective chart review of 119 patients requiring surgical drainage of CSDH was conducted at a large tertiary care center over a three-year period. Of the cases reviewed, 58 patients underwent craniotomy, while 61 patients underwent burr hole washout. The study focused on re-operation rates, mortality, and morbidity, as measured by Glasgow coma scores (GCS), discharge Rankin disability scores, and discharge disposition. Secondary endpoints included length of stay and cost of procedure. Burr hole washout was superior to craniotomy with respect to patient outcome, length of stay and recurrence rates. In both study groups, patients required additional surgical procedures (6.6% of burr hole patients and 24.1% of craniotomy patients) (P = 0.0156). Of the patients treated with craniotomy, 51.7% were discharged home, whereas 65.6% of the burr hole patients were discharged home. Patients who underwent burr hole washout spent a mean of 78.8 minutes in the operating suite while the patients undergoing craniotomy spent 129.4 minutes (P craniotomy group (P = 0.0465). Based on this retrospective study, burr hole washout is superior for both patients' clinical and financial outcome; however, prospective long-term multicenter clinical studies are required to verify these findings.

  12. Knowledge Gaps

    DEFF Research Database (Denmark)

    Lyles, Marjorie; Pedersen, Torben; Petersen, Bent

    2003-01-01

    , assimilating, and utilizing knowledge - are crucial determinants ofknowledge gap elimination. In contrast, the two factors deemed essential in traditionalinternationalization process theory - elapsed time of operations and experientiallearning - are found to have no or limited effect.Key words......: Internationalization, knowledge gap, absorptive capacity, learning box....

  13. Gap Resolution

    Energy Technology Data Exchange (ETDEWEB)

    2017-04-25

    Gap Resolution is a software package that was developed to improve Newbler genome assemblies by automating the closure of sequence gaps caused by repetitive regions in the DNA. This is done by performing the follow steps:1) Identify and distribute the data for each gap in sub-projects. 2) Assemble the data associated with each sub-project using a secondary assembler, such as Newbler or PGA. 3) Determine if any gaps are closed after reassembly, and either design fakes (consensus of closed gap) for those that closed or lab experiments for those that require additional data. The software requires as input a genome assembly produce by the Newbler assembler provided by Roche and 454 data containing paired-end reads.

  14. Gap junctions.

    Science.gov (United States)

    Goodenough, Daniel A; Paul, David L

    2009-07-01

    Gap junctions are aggregates of intercellular channels that permit direct cell-cell transfer of ions and small molecules. Initially described as low-resistance ion pathways joining excitable cells (nerve and muscle), gap junctions are found joining virtually all cells in solid tissues. Their long evolutionary history has permitted adaptation of gap-junctional intercellular communication to a variety of functions, with multiple regulatory mechanisms. Gap-junctional channels are composed of hexamers of medium-sized families of integral proteins: connexins in chordates and innexins in precordates. The functions of gap junctions have been explored by studying mutations in flies, worms, and humans, and targeted gene disruption in mice. These studies have revealed a wide diversity of function in tissue and organ biology.

  15. The effects of indomethacin on intracranial pressure and cerebral haemodynamics in patients undergoing craniotomy

    DEFF Research Database (Denmark)

    Rasmussen, Mads; Tankisi, A; Cold, G E

    2004-01-01

    We compared the effects of indomethacin (bolus of 0.2 mg.kg-1 followed by an infusion of 0.2 mg.kg-1.h-1) and placebo on intracranial pressure and cerebral haemodynamics in 30 patients undergoing craniotomy for supratentorial brain tumours under propofol and fentanyl anaesthesia. Indomethacin...

  16. Mini-craniotomy under local anaesthesia and sedation as a less ...

    African Journals Online (AJOL)

    Mini-craniotomy under local anaesthesia and sedation as a less invasive procedure for spontaneous intracerebral haemorrhage in a developing country. ... The ICH showed evidence of significant mass effect on brain computed tomography (CT) scan in 95% and was associated with intraventricular haemorrhage in 43%.

  17. Double concentric craniotomy for a craniocerebral penetrating nail. Case report and technical note.

    Science.gov (United States)

    Spennato, Pietro; Bocchetti, Antonio; Mirone, Giuseppe; Savarese, Luciano; Squillante, Domenico; Rotondo, Michele; Natale, Massimo

    2005-10-01

    Craniocerebral penetrating injuries from nail-gun accidents are rare and usually are discovered immediately after the trauma. Several surgical procedures have been described to extract a foreign body that is infixed in the skull and has penetrated the surrounding structures; blind extraction, craniectomy, and craniotomy. We report the case of a 25-year-old ex-carpenter who presented with jacksonian seizure at the left limb. Plain radiography of the skull revealed the unexpected presence of a nail hammered in the right parietal bone, penetrating the underlying structures of the frontoparietal area up to a depth of 3 cm. The patient was operated on; a small craniotomy (1 x 1 cm) just around the head of the nail, and a concentric larger frontoparietal bone flap, involving the first craniotomy, were performed. The larger bone flap was elevated first, whereas the small bone flap with the nail infixed was carefully elevated along the axis of the nail, under direct vision of the nail tract. Double concentric craniotomy is the only technique that permits the removal of a foreign body that has penetrated both the skull and the brain, under direct vision, without transmitting any undue forces to the underlying structures. With this technique, control of bleeding can also be easily achieved.

  18. The Simple Urine Bag as Wound Drain Post-Craniotomy in a Low ...

    African Journals Online (AJOL)

    Methods: A 4-year prospective cohort study of the effectiveness, outcome with use and complications of the Uribag as post craniotomy wound drain in a consecutive cohort of neurosurgical patients. Data analyzed include the patients' brief demographics; the types of cranial surgery in which drain was used; the drain ...

  19. Anaesthesia for awake craniotomy: A report of two cases in national ...

    African Journals Online (AJOL)

    Anaesthesia for neurosurgery while the patient remains awake requires a highly motivated patient and provision of high safety standard. Resection of brain tumours may cause neurological sequelae especially in the eloquent cortex depending on the site and size of tumour. Awake craniotomy which allows monitoring and ...

  20. Application of COMPONT Medical Adhesive Glue for Tension-Reduced Duraplasty in Decompressive Craniotomy.

    Science.gov (United States)

    Zhou, Yujia; Wang, Gesheng; Liu, Jialin; Du, Yong; Wang, Lei; Wang, Xiaoyong

    2016-10-14

    BACKGROUND The aim of this study was to evaluate the application of medical adhesive glue for tension-reduced duraplasty in decompressive craniotomy. MATERIAL AND METHODS A total of 56 cases were enrolled for this study from Jan 2013 to May 2015. All patients underwent decompressive craniotomy and the dura was repaired in all of them with tension-reduced duraplasty using the COMPONT medical adhesive to glue artificial dura together. The postoperative complications and the healing of dura mater were observed and recorded. RESULTS No wound infection, epidural or subdural hematoma, cerebrospinal fluid leakage, or other complications associated with the procedure occurred, and there were no allergic reactions to the COMPONT medical adhesive glue. The second-phase surgery of cranioplasty was performed at 3 to 6 months after the decompressive craniotomy in 32 out of the 56 cases. During the cranioplasty we observed no adherence of the artificial dura mater patch to the skin flap, no residual COMPONT glue, or hydropic or contracture change of tissue at the surgical sites. Additionally, no defect or weakening of the adherence between the artificial dura mater patch and the self dura matter occurred. CONCLUSIONS COMPONT medical adhesive glue is a safe and reliable tool for tension-reduced duraplasty in decompressive craniotomy.

  1. Identification of Preoperative and Intraoperative Risk Factors for Complications in the Elderly Undergoing Elective Craniotomy.

    Science.gov (United States)

    Johans, Stephen J; Garst, Jonathan R; Burkett, Daniel J; Grahnke, Kurt; Martin, Brendan; Ibrahim, Tarik F; Anderson, Douglas E; Prabhu, Vikram C

    2017-11-01

    Neurosurgical patients are aging as the general population is becoming older. A retrospective review of patients ≥65 years of age who underwent an elective craniotomy from 2007 to 2015 to identify risk factors for 30-day morbidity/mortality was conducted. Key preoperative variables included age, comorbidities, and functional status based on the Karnofsky Performance Status score and modified Rankin Scale score. Outcome variables included long-term care (LTC) complications, neurologic complications, systemic/infectious complications, length of stay, functional outcomes, and mortality. A total of 286 patients ≥65 years underwent elective craniotomy at Loyola University Medical Center over 8 years. Seventy-two patients had a preoperative neurologic deficit and 95 had a systemic morbidity before surgery. Postoperative neurologic and systemic morbidity was 14% and 23%, respectively. 7% of patients experienced a LTC complication and 5 patients (1.7%) died. Worse preoperative scores on both the Karnofsky Performance Status and modified Rankin Scale predicted increased length of stay and mortality (P craniotomies, particularly congestive heart failure, smoking history, chronic steroid use, anesthesia time, and estimated blood loss. Age alone should not preclude elective craniotomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. The Efficacy of Antibacterial Prophylaxis Against the Development of Meningitis After Craniotomy: A Meta-Analysis.

    Science.gov (United States)

    Alotaibi, Amal F; Hulou, M Maher; Vestal, Matthew; Alkholifi, Faisal; Asgarzadeh, Morteza; Cote, David J; Bi, Wenya Linda; Dunn, Ian F; Mekary, Rania A; Smith, Timothy R

    2016-06-01

    Prophylactic antibiotics are widely used before craniotomy to prevent postoperative infections. A systematic review and meta-analysis was conducted to examine the effect of prophylactic antibiotics on meningitis after craniotomy. PubMed, EMBASE, and Cochrane databases were searched through October 2014 for randomized controlled trials that evaluated the effect of prophylactic antibiotics on meningitis after craniotomy. Pooled effect estimates were calculated using fixed-effects and random-effects models. Seven studies with 2365 patients were included in the final analysis. All studies were randomized controlled trials with different antibiotic regimens. Prophylactic antibiotic use reduced the rate of meningitis after neurosurgery, with a pooled Peto odds ratio of 0.34 (95% confidence interval 0.18-0.63). Cochran's Q test indicated no significant heterogeneity among studies (I(2) = 0; P value for heterogeneity = 0.44). Subgroup analysis based on Gram-negative coverage, blinding design, and study quality demonstrated no statistically significant difference among these groups (P> 0.05 for all). A meta-regression on surgery duration (P = 0.52) and on antibiotics duration (P = 0.59) did not show significant differences in the results among studies. This meta-analysis shows that prophylactic antibiotic use significantly decreases meningitis infections after craniotomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Technical note: Orbitozygomatic craniotomy using an ultrasonic osteotome for precise osteotomies

    Science.gov (United States)

    Ruzevick, Jacob; Raza, Shaan M.; Recinos, Pablo F.; Chaichana, Kaisorn; Pradilla, Gustavo; Kim, Jennifer E.; Olivi, Alessandro; Weingart, Jon; Evans, James; Quinones-Hinojosa, Alfredo; Lim, Michael

    2015-01-01

    Background The orbitozygomatic craniotomy is a fundamental procedure in neurosurgery, allowing access to orbital and skull base pathology. Objective Determine the feasibility of using an ultrasonic osteotome to safely perform orbitozygomatic osteotomies in patients with intracranial pathology. Methods The medical records of patients undergoing orbitozygomatic craniotomy using an ultrasonic osteotome (Aesculap BoneScalpel™) for tumor resection at johns Hopkins Hospital between November 2009 and March 2013 were retrospectively reviewed. Results Six patients underwent orbitozygomatic craniotomy for tumor resection using an ultrasonic osteotome at the johns Hopkins Hospital during the study period. All patients were female and the average age was 53.2 years. Patients were followed for an average of 375 days. There were two cases of transient diplopia. There were no cases of periorbital violation, orbital injury, enophthalmos, or orbital hematoma. Post-operative imaging showed the cuts were well opposed and no cosmetic issues were encountered. Conclusion Use of an ultrasonic osteotome allows for precise cuts under direct visualization with minimal risk to critical adjacent structures in our cohort of patients undergoing a two-piece orbitozygomatic craniotomy. This appears to be a safe instrument for osteotomy creation in skull base approaches. PMID:25935127

  4. The effect of single low-dose dexamethasone on vomiting during awake craniotomy.

    Science.gov (United States)

    Kamata, Kotoe; Morioka, Nobutada; Maruyama, Takashi; Komayama, Noriaki; Nitta, Masayuki; Muragaki, Yoshihiro; Kawamata, Takakazu; Ozaki, Makoto

    2016-12-01

    Intraoperative vomiting leads to serious respiratory complications that could influence the surgical decision-making process for awake craniotomy. However, the use of antiemetics is still limited in Japan. The aim of this study was to investigate the effect of prophylactically administered single low-dose dexamethasone on the incidence of vomiting during awake craniotomy. The frequency of hyperglycemia was also examined. We conducted a retrospective case review of awake craniotomy for glioma resection between 2012 and 2015. Of the 124 patients, 91 were included in the analysis. Dexamethasone was not used in 43 patients and the 48 remaining patients received an intravenous bolus of 4.95 mg dexamethasone at anesthetic induction. Because of stable operating conditions, no one required conscious sedation throughout functional mapping and tumor resection. Although dexamethasone pretreatment reduced the incidence of intraoperative vomiting (P = 0.027), the number of patients who complained of nausea was comparable (P = 0.969). No adverse events related to vomiting occurred intraoperatively. Baseline blood glucose concentration did not differ between each group (P = 0.143), but the samples withdrawn before emergence (P = 0.018), during the awake period (P craniotomy cases. However, as even a small dose of dexamethasone increases the risk for hyperglycemia, antiemetic prophylaxis with dexamethasone should be administered after careful consideration. Monitoring of perioperative blood glucose concentration is also necessary.

  5. The asleep-awake technique using propofol-remifentanil anaesthesia for awake craniotomy for cerebral tumours

    DEFF Research Database (Denmark)

    Olsen, Karsten Skovgaard

    2008-01-01

    Background and objective: We retrospectively reviewed the first 25 planned cases of awake craniotomies using the 'asleep-awake' technique, an alternative to the often-used 'asleep-awake-asleep' technique. Methods: The patients were anaesthetized using propofol/remifentanil anaesthesia, a laryngeal...

  6. Surgery-Independent Language Function Decline in Patients Undergoing Awake Craniotomy.

    Science.gov (United States)

    Gonen, Tal; Sela, Gal; Yanakee, Ranin; Ram, Zvi; Grossman, Rachel

    2017-03-01

    Despite selection process before awake-craniotomy, some patients experience an unexpected decline in language functions in the operating room (OR), compared with their baseline evaluation, which may impair their functional monitoring. To investigate this phenomenon we prospectively compared language function the day before surgery and on entrance to the OR. Data were collected prospectively from consecutive patients undergoing awake-craniotomy with intraoperative cortical mapping for resection of gliomas affecting language areas. Language functions of 79 patients were evaluated and compared 1-2 days before surgery and after entering the OR. Changes in functional linguistic performance were analyzed with respect to demographic, clinical, and pathologic characteristics. There was a significant decline in language function, beyond sedation effect, after entering the OR, (from median/interquartile range: 0.94/0.72-0.98 to median/interquartile range: 0.86/0.51-0.94; Z = -7.19, P craniotomy may experience a substantial decline in language functioning after entering the OR. Tumor grade and the presence of preoperative language deficits were significant risk factors for this phenomenon, suggesting a possible relation between cognitive reserve, psychobehavioral coping abilities and histologic features of a tumor involving language areas. Capturing and identifying this unique population of patients who are prone to experience such language decline may improve our ability in the future to select patients eligible for awake-craniotomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Heterotopic Intracranial Skin Presenting as Chronic Draining Sinus After Remote Craniotomy.

    Science.gov (United States)

    Al-Qattan, Husain; Gernsback, Joanna E; Nugent, Ajani G; Lyapichev, Kirill A; Komotar, Ricardo J; Chim, Harvey

    2017-02-01

    Craniotomies for trauma are associated with a significant risk of wound complications. We report a case in which a chronic nonhealing draining sinus was caused by an ectopic epidermal lining deep to the craniotomy bone flap, adherent to the underlying dura. A 61-year-old man was examined for a 3-year-old, nonhealing scalp wound resulting after a traumatic brain injury. His initial surgery consisted of an intracranial hematoma evacuation through a temporoparietal craniotomy; this was complicated by wound dehiscence and a chronic sinus draining clear fluid that did not resolve with antimicrobial therapy. Intraoperatively, a layer of hair-bearing skin adherent to the dura was found deep to the entirety of the previous bone flap. There was no dura tear or overt cerebrospinal fluid leak. This necessitated removal of the skin over the dura as well as the overlying bone flap. The resultant defect was reconstructed with a titanium mesh and hydroxyapatite cranioplasty, with a scalp rotation flap for coverage of the cutaneous defect. Pathology confirmed skin with intact adnexal structures. This case demonstrates that it is possible for hair-bearing skin to grow directly on dura, deep to an intact craniotomy bone flap. With a chronic draining sinus in the absence of computed tomography and magnetic resonance imaging findings, this should be part of the differential diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Indocyanine green visualization of middle meningeal artery before craniotomy during surgical revascularization for moyamoya disease.

    Science.gov (United States)

    Tanabe, Nozomu; Yamamoto, Shusuke; Kashiwazaki, Daina; Akioka, Naoki; Kuwayama, Naoya; Noguchi, Kyo; Kuroda, Satoshi

    2017-03-01

    The middle meningeal artery (MMA) is well known to function as an important collateral channel to the territory of the anterior cerebral artery in moyamoya disease. This study was aimed to evaluate whether indocyanine green (ICG) videoangiography could visualize the anterior branch of the MMA before craniotomy during surgical revascularization for moyamoya disease. This study included 19 patients who developed TIA, ischemic stroke or hemorrhagic stroke due to moyamoya disease. Plain CT scan and three-dimensional time-of-flight MR angiography were performed in all patients before surgery. All of them underwent superficial temporal artery to middle temporal artery anastomosis and indirect bypass on 27 sides in total. ICG videoangiography could clearly visualize the anterior branch of the MMA in 10 (37%) of 27 sides. The patients with a "visible" MMA are significantly younger than those without. Radiological analysis revealed that ICG videoangiography could visualize it through the cranium when the diameter of the MMA is >1.3 mm and the sphenoid bone thickness over the MMA is craniotomy in all "visible" MMAs, but not in 4 (23.5%) of 17 "invisible" MMAs. The results strongly suggest that ICG videoangiography can visualize the anterior branch of the MMA before craniotomy in about one-third of patients with a large-diameter MMA (>1.3 mm) and thin sphenoid bone (craniotomy for moyamoya disease.

  9. Pain after Major Craniotomy in a University Hospital: A Prospective Cohort Study.

    Science.gov (United States)

    Suksompong, Sirilak; Chaikittisilpa, Nophanan; Rutchadawong, Tadrawee; Chankaew, Ekawut; von Bormann, Benno

    2016-05-01

    Pain after major craniotomy has been believed to be less severe than the other operations. To determine the incidence and risk factors of moderate to severe pain after major craniotomy. This is a prospective observational study in a neurosurgical intensive care unit and wards of a university, tertiary hospital. After institutional IRB approval, patients undergoing major craniotomy during May 2011-August 2012 were interviewed preoperatively and 24 and 48 hours postoperatively. Demographic data, preoperative anxiety scores, operative data and postoperative pain characteristics were recorded. Two hundred and eighty patients completed the study. The incidence of moderate to severe pain was 75%. Mean pain score during 24 and 48 hours were 5.5 ± 2.7 and 3.5 ± 2.6, respectively. Univariate analysis identified age under 45 years and perioperative steroid therapy as predictors of moderate to severe postoperative pain. Using multivariate analysis, only age under 45 years was a significant risk factor. Patients' satisfaction scores were good in both mild and moderate to severe pain groups (9.49 ± 1.08 and 8.37 ± 1.76). During postoperative period, almost all of the patients received intravenous opioid and oral acetaminophen for pain treatment. No respiratory depression occurred, but postoperative nausea and vomiting occurred in 51.7% and pruritus in 23.6%. Incidence of pain after craniotomy was high especially in younger age group, which is not in accordance with all similar reports. However we believe pain management after major craniotomy in our hospital requires improvement.

  10. Fosaprepitant versus droperidol for prevention of PONV in craniotomy: a randomized double-blind study.

    Science.gov (United States)

    Atsuta, Jun; Inoue, Satoki; Tanaka, Yuu; Abe, Keiko; Nakase, Hiroyuki; Kawaguchi, Masahiko

    2017-02-01

    Postoperative nausea and vomiting (PONV) is a common complication after craniotomy. Vomiting may be a potentially hazardous complication in neurosurgical patients. We compared the efficacy of fosaprepitant and droperidol for the prevention of PONV, vomiting in particular, after craniotomy. Patients scheduled to undergo elective craniotomy were enrolled in the study and randomly divided in a double-blind manner into two groups to receive either 150 mg of fosaprepitant (group F) or 1.25 mg of droperidol (group D). Dexamethasone (9.9 mg) was given to all patients, except those with diabetes mellitus. The incidence of PONV, frequency of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery were assessed at five time intervals (0-2, 2-6, 6-24, 24-48, and 48-72 h). Of the 200 randomized patients eligible for entry into the study, 186 were ultimately included for analysis. There were no significant differences in demographics or intraoperative variables between the two treatment groups. Over the entire 72-h post-craniotomy observation period the overall and cumulative incidence of vomiting was significantly lower in group F patients than in group D patients, while there were no between-group differences in the overall and cumulative incidence of PONV or in complete response (no PONV and no rescue antiemetic). The incidence and frequency of vomiting during each of the five observational periods were significantly lower in group F patients than group D patients, although there were no differences in the nausea score and antiemetic use between the groups. Based on the results, fosaprepitant was more effective than droperidol in the prevention of vomiting after craniotomy over the entire 72-h study period. However, there was no difference in the incidence of nausea and antiemetic use.

  11. Impacts of pressure bonding fixation on a bone flap depression and resorption in patients with craniotomy.

    Science.gov (United States)

    Matsukawa, Hidetoshi; Miyama, Masataka; Miyazaki, Takanori; Uemori, Genki; Kinoshita, Yu; Sakakibara, Fumihiro; Saito, Norihiro; Tsuboi, Toshiyuki; Noda, Kosumo; Ota, Nakao; Tokuda, Sadahisa; Kamiyama, Hiroyasu; Tanikawa, Rokuya

    2017-07-01

    Fixation of bone flaps after craniotomy is a routine part of every neurosurgical procedure. Common problems encountered are bone flap depression and resorption. Authors performed the pressure-bonding bone flap fixation (PBFF) using absorbable craniofix (AC) and hydroxyapatite wedge (HW). The aim of the present study is to evaluate the efficacy of PBFF to prevent a bone flap depression and resorption in patients treated with craniotomy. Four-hundred fifty-four patients underwent craniotomies. Authors collected the following data: age, sex, type of craniotomy, what kind of surgery, whether bypass surgery was performed, whether surgery was the initial, whether AC and the HW were used, bone flap depression and resorption at 6-month after the craniotomy. PBFF was defined as a bone flap fixation using both AC and HW to impress a bone flap to forehead. The mean age was 62±13years and 404 (89%) patients were women. PBFF was performed in 71 patients (16%), either AC or HW was used in 141 (31%), only AC was used in 116 (25%), and only HW was used in 25 (5.5%). At 6-month after the surgery, a bone flap depression was seen in 38 patients (8.4%), and a bone flap resorption was seen in 66 (15%). Multivariate analysis showed that only a PBBF showed a negative correlation with bone flap depression (p=0.044) and resorption (p=0.011). The results of the present study showed that PBFF reduced a bone flap depression and resorption and provided excellent postoperative cosmetic results. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Craniotomy of the Fused Sagittal Suture Over the Superior Sagittal Sinus Is a Safe Procedure.

    Science.gov (United States)

    Kölby, David; Fischer, Sara; Arab, Khalid; Maltese, Giovanni; Olsson, Robert; Paganini, Anna; Tarnow, Peter; Kölby, Lars

    2017-05-01

    Spring-assisted cranioplasty to correct sagittal synostosis is based on midline craniotomy through the closed sagittal suture, over the superior sagittal sinus (SSS). The aim of the present study was to evaluate the perioperative safety of this technique. This is a retrospective study of all patients operated with median craniotomy and springs from 1998 to the end of 2015. For comparison, all Pi-plasties performed during the same time interval were also evaluated. The safety measures were evaluated based on incidence of damage to SSS, incidence of dural tears, perioperative blood loss, operative time, and hospital stay. In the group that had undergone midline craniotomy combined with springs (n = 225), 4 perioperative damages to SSS and 1 dural tear were seen. The perioperative blood loss was 62.8 ± 65.3 mL (mean ± standard deviation). The operative time was 67.9 ± 21.5 minutes and the hospital stay was 4.8 ± 1.1 days. In the group that had undergone pi-plasty (n = 105), no damages to SSS but 3 dural tears were seen. The perioperative blood loss was 352.8 ± 174.4 mL. The operative time was 126.0 ± 31.7 minutes and the hospital stay was 7.1 ± 1.4 days. Craniotomy SSS in sagittal synostosis is a safe procedure with low morbidity in terms of damage to the SSS. Midline craniotomy combined with springs has significantly lower preoperative blood loss, operative time, and hospital stay (P < 0.001 for all) compared to pi-plasty.

  13. Differential Effects of Intraoperative Positive End-expiratory Pressure (PEEP) on Respiratory Outcome in Major Abdominal Surgery Versus Craniotomy

    DEFF Research Database (Denmark)

    de Jong, Myrthe A C; Ladha, Karim S; Melo, Marcos F Vidal

    2015-01-01

    abdominal surgery patients and 5063 craniotomy patients. Analysis was performed using multivariable logistic regression. The primary outcome was a composite of major postoperative respiratory complications (respiratory failure, reintubation, pulmonary edema, and pneumonia) within 3 days of surgery. RESULTS...

  14. Use of movable high-field-strength intraoperative magnetic resonance imaging with awake craniotomies for resection of gliomas: preliminary experience.

    LENUS (Irish Health Repository)

    Leuthardt, Eric C

    2011-07-01

    Awake craniotomy with electrocortical mapping and intraoperative magnetic resonance imaging (iMRI) are established techniques for maximizing tumor resection and preserving function, but there has been little experience combining these methodologies.

  15. Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects

    NARCIS (Netherlands)

    Beenen, L. F.; Lindeboom, J.; Kasteleijn-Nolst Trenité, D. G.; Heimans, J. J.; Snoek, F. J.; Touw, D. J.; Adèr, H. J.; van Alphen, H. A.

    1999-01-01

    OBJECTIVE: To determine the efficacy, tolerability, and impact on quality of life and cognitive functioning of anticonvulsant prophylaxis with phenytoin or sodium valproate in patients after craniotomy. METHODS: A prospective, stratified, randomised, double blind single centre clinical trial was

  16. Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy : efficacy, tolerability, and cognitive effects

    NARCIS (Netherlands)

    Beenen, L F; Lindeboom, J; Kasteleijn-Nolst Trenité, D G; Heimans, J J; Snoek, F J; Touw, D J; Adèr, H J; van Alphen, H A

    1999-01-01

    OBJECTIVE: To determine the efficacy, tolerability, and impact on quality of life and cognitive functioning of anticonvulsant prophylaxis with phenytoin or sodium valproate in patients after craniotomy. METHODS: A prospective, stratified, randomised, double blind single centre clinical trial was

  17. Quantifying surgical access in eyebrow craniotomy with and without orbital bar removal: cadaver and surgical phantom studies.

    Science.gov (United States)

    Zador, Zsolt; Coope, David J; Gnanalingham, Kanna; Lawton, Michael T

    2014-04-01

    Eyebrow craniotomy is a recently described minimally invasive approach for tackling primarily pathology of the anterior skull base. The removal of the orbital bar may further expand the surgical corridor of this exposure, but the extent of benefit is poorly quantified. We assessed the effect of orbital bar removal with regards to surgical access in the eyebrow craniotomy using classic morphometric measurements in cadaver heads. Using surgical phantoms and neuronavigation, we also measured the 'working volume', a new parameter for characterising the volume of surgical access in these approaches. Silicon injected cadaver heads (n = 5) were used for morphometric analysis of the eyebrow craniotomy with and without orbital bar removal. Working depths and 'working areas' of surgical access were measured as defined by key anatomical landmarks. The eyebrow craniotomy with or without orbital bar removal was also simulated using surgical phantoms (n = 3, 90-120 points per trial), calibrated against a frameless neuronavigation system. Working volume was derived from reference coordinates recorded along the anatomical borders of the eyebrow craniotomy using the "α-shape algorithm" in R statistics. In cadaver heads, eyebrow craniotomy with removal of the orbital bar reduced the working depth to the ipsilateral anterior clinoid process (42 ± 2 versus 33 ± 3 mm; p craniotomies was increased with orbital bar removal (16 ± 1 cm(3) versus 21 ± 1 cm(3); p craniotomy provides a modest reduction in working depth and increase in the working volume. But this must be weighed up against the added morbidity of the procedure. Working volume, a newly developed parameter may provide a more meaningful endpoint for characterising the surgical access for different surgical approaches and it could be applied to other operative cases undertaken with frameless neuronavigation.

  18. Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects

    OpenAIRE

    Beenen, L.F.M.; Lindeboom, J.; Kasteleijn-Nolst Trenite, D.G.; Heimans, J.J.; Snoek, F.J.; Touw, D.J.; Ader, H.J.; Alphen, van, H.A.M.

    1999-01-01

    OBJECTIVE—To determine the efficacy, tolerability, and impact on quality of life and cognitive functioning of anticonvulsant prophylaxis with phenytoin or sodium valproate in patients after craniotomy.
METHODS—A prospective, stratified, randomised, double blind single centre clinical trial was performed, comparing two groups of 50patients each, who underwent craniotomy for different pathological conditions and who were treated for 1 year after surgery with either 300 mg p...

  19. Questioning the need for ICU level of care in pediatric patients following elective uncomplicated craniotomy for brain tumors.

    Science.gov (United States)

    Gabel, Brandon C; Martin, Joel; Crawford, John R; Levy, Michael

    2016-05-01

    OBJECTIVE The object of this study is to address what factors may necessitate the need for intensive care monitoring after elective uncomplicated craniotomy in pediatric patients who are initially managed in a non-intensive care unit setting postoperatively. METHODS A retrospective chart review was undertaken for all patients who underwent elective craniotomy for brain tumor between April of 2007 and April of 2012 and who were directly admitted to the floor postoperatively. Factors such as age, tumor type, craniotomy location, neurological comorbidities, reason for transfer to intensive care unit (ICU) level of care (if applicable), time between admittance to floor and transfer to ICU level of care, and reason for transfer to ICU level of care were assessed. RESULTS Adjusted logistic regression found 2 significant positive predictors of postoperative transfer to the ICU after initial admission to the floor: primitive neuroectodermal tumor pathology (OR 44.10, 95% CI 1.24-1572.16, p = 0.04), and repeat craniotomy during the same hospitalization (OR 13.97, 95% CI 1.21-160.66, p = 0.03). Conversely, 1 negative factor was found: low-grade glioma pathology (OR 0.05, 95% CI 0.00-0.87, p = 0.04). CONCLUSIONS Select pediatric patients may not require ICU level of care after elective uncomplicated pediatric craniotomy. Additional studies are needed to adequately address which patients would benefit from initial ICU admittance following elective craniotomies for brain tumors.

  20. Temporomandibular dysfunction post-craniotomy: evaluation between pre- and post-operative status.

    Science.gov (United States)

    Costa, André Luiz Ferreira; Yasuda, Clarissa Lin; França, Marcondes; de Freitas, Claudio Fróes; Tedeschi, Helder; de Oliveira, Evandro; Cendes, Fernando

    2014-10-01

    To identify risk factors associated with post-operative temporomandibular joint dysfunction after craniotomy. The study sample included 24 patients, mean age of 37.3 ± 10 years; eligible for surgery for refractory epilepsy, evaluated according to RDC/TMD before and after surgery. The primary predictor was the time after the surgery. The primary outcome variable was maximal mouth opening. Other outcome variables were: disc displacement, bruxism, TMJ sound, TMJ pain, and pain associated to mandibular movements. Data analyses were performed using bivariate and multiple regression methods. The maximal mouth opening was significantly reduced after surgery in all patients (p = 0.03). In the multiple regression model, time of evaluation and pre-operative bruxism were significantly (p temporomandibular joint dysfunction after craniotomy. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  1. Takotsubo Cardiomyopathy Triggered by Venous Air Embolism During Craniotomy in the Sitting Position.

    Science.gov (United States)

    Raimann, Florian; Senft, Christian; Honold, Jörg; Zacharowski, Kai; Seifert, Volker; Mersmann, Jan

    2017-11-01

    We present a case of stress-induced cardiomyopathy (Takotsubo cardiomyopathy) caused by a venous air embolism during a craniotomy performed in the sitting position. A 69-year-old woman was admitted to the neurosurgical department and scheduled for elective resection of a cerebellar metastasis in the sitting position. After craniotomy and opening of the posterior fossa, a venous air embolism was detected via transesophageal echocardiography. The patient immediately presented with cardiac decompensation with signs of takotsubo or stress-induced cardiomyopathy. Intensivists and anesthesiologists in the operating room and in intensive care units need to be aware of stress-induced cardiomyopathy as a probably underdiagnosed disease entity, especially as management differs significantly from other forms of cardiogenic shock. Diagnosis can be accomplished quickly by bedside echocardiography, emphasizing the need for availability of this tool and the integration of stress-induced cardiomyopathy in diagnostic algorithms in the intensive care unit. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Removal of symptomatic craniofacial titanium hardware following craniotomy: Case series and review

    Directory of Open Access Journals (Sweden)

    Sheri K. Palejwala

    2015-06-01

    Full Text Available Titanium craniofacial hardware has become commonplace for reconstruction and bone flap fixation following craniotomy. Complications of titanium hardware include palpability, visibility, infection, exposure, pain, and hardware malfunction, which can necessitate hardware removal. We describe three patients who underwent craniofacial reconstruction following craniotomies for trauma with post-operative courses complicated by medically intractable facial pain. All three patients subsequently underwent removal of the symptomatic craniofacial titanium hardware and experienced rapid resolution of their painful parasthesias. Symptomatic plates were found in the region of the frontozygomatic suture or MacCarty keyhole, or in close proximity with the supraorbital nerve. Titanium plates, though relatively safe and low profile, can cause local nerve irritation or neuropathy. Surgeons should be cognizant of the potential complications of titanium craniofacial hardware and locations that are at higher risk for becoming symptomatic necessitating a second surgery for removal.

  3. A Method to Make a Craniotomy on the Ventral Skull of Neonate Rodents

    Science.gov (United States)

    Rodríguez-Contreras, Adrián; Shi, Lingyan; Fu, Bingmei M.

    2014-01-01

    The use of a craniotomy for in vivo experiments provides an opportunity to investigate the dynamics of diverse cellular processes in the mammalian brain in adulthood and during development. Although most in vivo approaches use a craniotomy to study brain regions located on the dorsal side, brainstem regions such as the pons, located on the ventral side remain relatively understudied. The main goal of this protocol is to facilitate access to ventral brainstem structures so that they can be studied in vivo using electrophysiological and imaging methods. This approach allows study of structural changes in long-range axons, patterns of electrical activity in single and ensembles of cells, and changes in blood brain barrier permeability in neonate animals. Although this protocol has been used mostly to study the auditory brainstem in neonate rats, it can easily be adapted for studies in other rodent species such as neonate mice, adult rodents and other brainstem regions. PMID:24894439

  4. Simultaneous Spinal and Intracranial Chronic Subdural Hematoma Cured by Craniotomy and Laminectomy: A Video Case Report

    Directory of Open Access Journals (Sweden)

    Hideki Kanamaru

    2016-04-01

    Full Text Available Simultaneous spinal and intracranial chronic subdural hematoma (CSDH is a rare entity. A 67-year-old man visited our hospital due to headache after diving into a river 2 weeks before. Non-enhanced computed tomography (CT and magnetic resonance imaging (MRI revealed bilateral intracranial CSDH. The bilateral CSDH was evacuated and his symptoms improved. Three days after craniotomy, he complained of sensory disturbance on his buttocks. Lumbar MRI showed a space-occupying lesion behind the thecal sac at L5. CT with myelography showed a subdural mass lesion; there was no communication with the subarachnoid space. Fourteen days after craniotomy, L5 laminectomy was performed and the dura mater was incised carefully. The video shows that a liquid hematoma similar to the intracranial CSDH flowed out, followed by cerebrospinal fluid. His symptoms improved after the operation and the hematoma did not recur. This is a rare condition of spinal CSDH demonstrated by neuroimaging and intraoperative video.

  5. Simultaneous Spinal and Intracranial Chronic Subdural Hematoma Cured by Craniotomy and Laminectomy: A Video Case Report.

    Science.gov (United States)

    Kanamaru, Hideki; Kanamaru, Kenji; Araki, Tomohiro; Hamada, Kazuhide

    2016-01-01

    Simultaneous spinal and intracranial chronic subdural hematoma (CSDH) is a rare entity. A 67-year-old man visited our hospital due to headache after diving into a river 2 weeks before. Non-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed bilateral intracranial CSDH. The bilateral CSDH was evacuated and his symptoms improved. Three days after craniotomy, he complained of sensory disturbance on his buttocks. Lumbar MRI showed a space-occupying lesion behind the thecal sac at L5. CT with myelography showed a subdural mass lesion; there was no communication with the subarachnoid space. Fourteen days after craniotomy, L5 laminectomy was performed and the dura mater was incised carefully. The video shows that a liquid hematoma similar to the intracranial CSDH flowed out, followed by cerebrospinal fluid. His symptoms improved after the operation and the hematoma did not recur. This is a rare condition of spinal CSDH demonstrated by neuroimaging and intraoperative video.

  6. Surgery for Pyogenic Brain Abscess over 30 Years: Evaluation of the Roles of Aspiration and Craniotomy.

    Science.gov (United States)

    Aras, Yavuz; Sabanci, Pulat Akın; Izgi, Nail; Boyali, Osman; Ozturk, Onur; Aydoseli, Aydin; Ali, Achmet; Sencer, Altay; Hepgul, Kemal; Unal, Faruk; Barlas, Orhan

    2016-01-01

    To evaluate the roles of craniotomy and aspiration in the treatment of pyogenic brain abscess throughout 30 years of computerized tomography. A retrospective study of 224 patients who were surgically treated at Istanbul Medical Faculty, Department of Neurosurgery between 1982 and 2012 was undertaken. The records were analyzed for demographic, clinical and radiological findings, surgical interventions (resection, free-hand aspiration and image-guided aspiration), data regarding abscesses (etiological factors, site, size, number, localization and identified microorganism), corticosteroid and antibiotic usage and complications, and the outcomes were reviewed. The male-to-female ratio was 2.2, and the mean age was 26.2±1.25 years. The most common presenting symptom was headache (56.7%), followed by nausea and vomiting (28.5%). Otitis media and mastoiditis were the most common causes of abscess (41.9%), and 44 patients had multiple abscesses. Aerobic gram-positive microorganisms were the most frequently isolated pathogens in culture (51.5%). Primary surgical interventions were as follows: craniotomy and resection (38.8%), free-hand aspiration (49.1%) and image-guided aspiration (12.1%). The aspiration-to-resection ratio was 1.36 (64/47) in the first decade, 2.94 (50/17) in the second decade and 1 (23/23) in the last decade. Age, level of consciousness at the time of admission and potent corticosteroid usage were found to be significantly associated with mortality (p=0.001, p≤0.001 and p=0,038, respectively). The total morbidity and mortality ratios were 4.9% and 9.8%, respectively. Seizures were more common in patients of craniotomy group (p=0.023). Treatment of pyogenic brain abscess remains challenging, despite advances in surgical and imaging technology, and craniotomy retains a significant role in surgical treatment.

  7. Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis.

    Science.gov (United States)

    Dasenbrock, Hormuzdiyar H; Liu, Kevin X; Devine, Christopher A; Chavakula, Vamsidhar; Smith, Timothy R; Gormley, William B; Dunn, Ian F

    2015-12-01

    OBJECT Although the length of hospital stay is often used as a measure of quality of care, data evaluating the predictors of extended hospital stay after craniotomy for tumor are limited. The goals of this study were to use multivariate regression to examine which preoperative characteristics and postoperative complications predict a prolonged hospital stay and to assess the impact of length of stay on unplanned hospital readmission. METHODS Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2013. Patients who underwent craniotomy for resection of a brain tumor were included. Stratification was based on length of hospital stay, which was dichotomized by the upper quartile of the interquartile range (IQR) for the entire population. Covariates included patient age, sex, race, tumor histology, comorbidities, American Society of Anesthesiologists (ASA) class, functional status, preoperative laboratory values, preoperative neurological deficits, operative time, and postoperative complications. Multivariate logistic regression with forward prediction was used to evaluate independent predictors of extended hospitalization. Thereafter, hierarchical multivariate logistic regression assessed the impact of length of stay on unplanned readmission. RESULTS The study included 11,510 patients. The median hospital stay was 4 days (IQR 3-8 days), and 27.7% (n = 3185) had a hospital stay of at least 8 days. Independent predictors of extended hospital stay included age greater than 70 years (OR 1.53, 95% CI 1.28%-1.83%, p craniotomy for tumor score was created based on preoperative factors significant in regression models, with a moderate correlation with length of stay (p = 0.43, p craniotomy for tumor, much of the variance in hospital stay was attributable to baseline patient characteristics, suggesting length of stay may be an imperfect proxy for quality. Additionally, longer hospitalizations were not found to be associated

  8. Effects of Anesthetic Management on Early Postoperative Recovery, Hemodynamics and Pain After Supratentorial Craniotomy

    OpenAIRE

    Ayrian, Eugenia; Kaye, Alan David; Varner, Chelsia L.; Guerra, Carolina; Vadivelu, Nalini; Urman, Richard D.; Zelman, Vladimir; Lumb, Philip D.; Rosa, Giovanni; Bilotta, Federico

    2015-01-01

    Various clinical trials have assessed how intraoperative anesthetics can affect early recovery, hemodynamics and nociception after supratentorial craniotomy. Whether or not the difference in recovery pattern differs in a meaningful way with anesthetic choice is controversial. This review examines and compares different anesthetics with respect to wake-up time, hemodynamics, respiration, cognitive recovery, pain, nausea and vomiting, and shivering. When comparing inhalational anesthetics to in...

  9. Preservation and Microsurgical Repair of the Superficial Temporal Artery During Pterional Craniotomy.

    Science.gov (United States)

    Menovsky, Tomas; Sener, Suleyman; Kamerling, Niels; Plazier, Mark; Boogaarts, Jeroen; Lukes, Anton

    2016-05-01

    To study the rate of superficial temporal artery (STA) preservation and the effectiveness of STA reconstruction in patients undergoing a pterional craniotomy. Included patients (n = 136) underwent either an emergency or an elective pterional craniotomy. In case of deliberate transection or accidental damage of the STA, it was repaired microsurgically at the end of the procedure. Postoperatively, the patency of the STA was assessed on CT angiography, MR angiography, or conventional angiography and complications related to wound healing were recorded. Of the 136 operated patients, the STA could be identified in 120 cases (88%). Of these 120 cases, the STA could be dissected and left undamaged in 60 patients (44%). In 52 patients (38%), 1 of the 2 branches of the STA had to be transsected to elevate the muscle-skin flap. Forty-six of the transected arteries could be anastomosed at the end of the procedure. All of these arteries were patent directly after repair. In the remaining 16 patients (12%), the STA was not identified during approach. All anastomosed arteries (n = 46) were patent. Two patients developed a postoperative infection. Preserving or reconstructing of the STA during pterional craniotomy is feasible in the majority of the patients with very high rate of anastomosis patency. STA hinders elevation of the skin/muscle flap in approximately 38% of the pterional approaches and without reconstruction afterwards, the STA would been occluded. Copyright © 2016. Published by Elsevier Inc.

  10. Modified Cranialization and Secondary Cranioplasty for Frontal Sinus Infection after Craniotomy: Technical Note

    Science.gov (United States)

    YOSHIOKA, Nobutaka

    2014-01-01

    Frontal sinus infection after incorrect treatment of an opened frontal sinus may require extended approaches. This article aims to introduce modified cranialization technique and secondary cranioplasty for frontal sinus infection involving the frontal sinus outflow tract after craniotomy. Eight patients with delayed onset frontal sinus infection involving frontal outflow tract after craniotomy were treated from 2008 to 2012. Debridement and cranialization involving the elimination of the frontal outflow tract was performed. Unilateral sinus cranialization combined with reduction of the non-affected contralateral sinus was carried out for the patients with unilateral sinusitis. A pericranial-frontalis muscle flap was used to separate the intracranial and extracranial spaces. Secondary cranioplasty with hydroxyapatite was performed approximately 3 months after the cranialization. The patients’ original conditions included brain tumors (n = 3), frontal sinus fractures (n = 2), and subarachnoid hemorrhage (n = 3). The mean interval between the initial treatment and the onset of sinus infection was 23 years. The frontal sinus infection was bilateral in six cases and unilateral in two cases. Frontal sinus outflow tract was involved in sinus infection in every case. None of the patients suffered recurrent rhinogenic infections within the follow-up period (mean = 35 months) after the secondary cranioplasty. Aesthetic results were satisfactory in every case. Modified cranialization involving elimination of the frontal outflow tract is an alternative method for the patients with pathology in the frontal outflow tract after frontal craniotomy. Secondary cranioplasty provides an esthetically pleasing appearance in such cases. PMID:25169030

  11. Minipterional craniotomy with transsylvian-transinsular approach for hypertensive putaminal hemorrhage: A preliminary report

    Directory of Open Access Journals (Sweden)

    Bon-Jour Lin

    2017-01-01

    Full Text Available Background: There is no consensus regarding optimal treatment of spontaneous intracerebral hemorrhage (ICH till date. The role of surgery in managing spontaneous ICH is debatable because of lacking clear benefit as compared to conservative treatment. The aim of this study is to assess the clinical efficacy of minipterional craniotomy in the treatment of hypertensive putaminal hemorrhage (HPH. Materials and Methods: From January 2015 to December 2015, four patients with large HPHs accepting minipterional craniotomies and transsylvian-transinsular (TS-TI approaches were analyzed retrospectively in terms of hematoma evacuation rate, recovery of consciousness, and short-term functional prognosis. Results: The average volume of residual hematoma was 3.68 ml with 93.53% evacuation rate. There was no delayed hemorrhage or newly developed hypodense lesion on postoperative images. Three out of four patients got clear consciousness with improved muscle strength of involved limbs on discharge from our institute. The modified Rankin scale grades were 3 at 3 months postoperatively. Conclusions: Minipterional craniotomy with TS-TI approach is a feasible procedure for HPH in selected candidate. The recommendation of this procedure is due to satisfactory hematoma evacuation rate, minimal brain damage, and improved functional outcome.

  12. Post-operative orofacial pain, temporomandibular dysfunction and trigeminal sensitivity after recent pterional craniotomy: preliminary study.

    Science.gov (United States)

    Brazoloto, Thiago Medina; de Siqueira, Silvia Regina Dowgan Tesseroli; Rocha-Filho, Pedro Augusto Sampaio; Figueiredo, Eberval Gadelha; Teixeira, Manoel Jacobsen; de Siqueira, José Tadeu Tesseroli

    2017-05-01

    Surgical trauma at the temporalis muscle is a potential cause of post-craniotomy headache and temporomandibular disorders (TMD). The aim of this study was to evaluate the prevalence of pain, masticatory dysfunction and trigeminal somatosensory abnormalities in patients who acquired aneurysms following pterional craniotomy. Fifteen patients were evaluated before and after the surgical procedure by a trained dentist. The evaluation consisted of the (1) research diagnostic criteria for TMD, (2) a standardized orofacial pain questionnaire and (3) a systematic protocol for quantitative sensory testing (QST) for the trigeminal nerve. After pterional craniotomy, 80% of the subjects, 12 patients, developed orofacial pain triggered by mandibular function. The pain intensity was measured by using the visual analog scale (VAS), and the mean pain intensity was 3.7. The prevalence of masticatory dysfunction was 86.7%, and there was a significant reduction of the maximum mouth opening. The sensory evaluation showed tactile and thermal hypoesthesia in the area of pterional access in all patients. There was a high frequency of temporomandibular dysfunction, postoperative orofacial pain and trigeminal sensory abnormalities. These findings can help to understand several abnormalities that can contribute to postoperative headache or orofacial pain complaints after pterional surgeries.

  13. Does scope of practice correlate with the outcomes of craniotomy for tumor resection in children?

    Science.gov (United States)

    Missios, Symeon; Bekelis, Kimon

    2017-06-01

    The relationship of scope of practice (predominantly adult, versus predominantly pediatric) with the outcomes of brain tumor surgery in children remains uncertain. We investigated the association of practice focus with the outcomes of neurosurgical oncology operations in pediatric patients. We performed a cohort study of all pediatric patients (younger than 18 years old) who underwent craniotomies for tumor resections from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. In order to control for confounding, we used propensity score conditioning with mixed effects analysis to account for clustering at the hospital level. During the study period, there were 770 pediatric patients who underwent craniotomy for tumor resection and met the inclusion criteria. Of these, 370 (48.1%) underwent treatment by providers with predominantly adult practices and 400 (51.9%) by physicians who operated predominantly on children. Mixed-effects multivariable regression analysis demonstrated lack of association of predominantly adult practice with inpatient mortality (OR, 1.12; 95% CI, 0.48-2.58), and discharge to a facility (OR, 1.25; 95% CI, 0.77-2.03). These associations persisted in propensity-adjusted models. In a cohort of pediatric patients undergoing craniotomy for tumor resection from a comprehensive all-payer database, we did not demonstrate a difference in mortality, and discharge to a facility between providers with predominantly adult and predominantly pediatric practices.

  14. Risk factors for intraoperative allogeneic blood transfusion during craniotomy for brain tumor removal in children.

    Science.gov (United States)

    Vassal, Olivia; Desgranges, François-Pierrick; Tosetti, Sylvain; Burgal, Stéphanie; Dailler, Frédéric; Javouhey, Etienne; Mottolese, Carmine; Chassard, Dominique

    2016-02-01

    Several clinical and surgical factors can influence the occurrence of allogeneic blood transfusion (ABT) during oncologic neurosurgery. To identify the potential predictive factors of ABT during craniotomy for the removal of brain tumors in children and the potential impact of intraoperative ABT on early postoperative outcome. A retrospective study was performed in all pediatric patients younger than 18 years who underwent craniotomy for brain tumor removal from December 2009 to December 2012 in our institution. Pre-, intra-, and postoperative data were collected from medical and stored electronic anesthesia records. The predictors of intraoperative ABT were determined using multivariate logistic regression. A total of 110 patients were included. Twenty-seven patients (25%) received intraoperative ABT with a volume of 16 ± 8 ml·kg(-1) . On multivariate analysis, an age 270 min, and a preoperative hemoglobin craniotomy for brain tumor removal is at risk of intraoperative ABT. An age 270 min, and a preoperative hemoglobin <12.2 g·dl(-1) are the main factors associated with intraoperative ABT during this surgery. © 2015 John Wiley & Sons Ltd.

  15. Successful Insular Glioma Removal in a Deaf Signer Patient During an Awake Craniotomy Procedure.

    Science.gov (United States)

    Metellus, Philippe; Boussen, Salah; Guye, Maxime; Trebuchon, Agnes

    2017-02-01

    Resection of tumors located within the insula of the dominant hemisphere represents a technical challenge because of the complex anatomy, including the surrounding vasculature, and the relationship to functional (motor and language) structures. We report here the case of a successful resection of a left insular glioma in a native deaf signer during an awake craniotomy. The patient, a congenitally deaf right-handed patient who is a native user of sign language, presented with a seizure 1 week before he was referred to our department. Magnetic resonance imaging revealed a left heterogeneous insular tumor enhanced after intravenous gadolinium infusion. Because of its deep and dominant hemisphere location, an awake craniotomy was decided. The patient was evaluated intraoperatively using object naming, text reading, and sign repetition tasks. An isolated inferior frontal gyrus site evoked repeated object naming errors. A transopercular parietal approach was performed and allowed the successful removal of the tumor under direct electric stimulation and electrocorticography. To our knowledge, this is the first report of successful removal of a left insular tumor without any functional sequelae in a native deaf signer using intraoperative direct cerebral stimulation during an awake craniotomy. The methodology used also provides the first evidence of the actual anatomo-functional organization of language in deaf signers. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Awake craniotomy in a developmentally delayed blind man with cognitive deficits.

    Science.gov (United States)

    Burbridge, Mark; Raazi, Mateen

    2013-04-01

    To describe the complex perioperative considerations and anesthetic management of a cognitively delayed blind adult male who underwent awake craniotomy to remove a left anterior temporal lobe epileptic focus. A 28-yr-old left-handed blind cognitively delayed man was scheduled for awake craniotomy to resect a left anterior temporal lobe epileptic focus due to intractable epilepsy despite multiple medications. His medical history was also significant for retinopathy of prematurity that rendered him legally blind in both eyes and an intracerebral hemorrhage shortly after birth that resulted in a chronic brain injury and developmental delay. His cognitive capacity was comparable with that of an eight year old. Since patient cooperation was the primary concern during the awake electrocorticography phase of surgery, careful assessment of the patient's ability to tolerate the procedure was undertaken. There was extensive planning between surgeons and anesthesiologists, and a patient-specific pharmacological strategy was devised to facilitate surgery. The operation proceeded without complication, the patient has remained seizure-free since the procedure, and his quality of life has improved dramatically. This case shows that careful patient assessment, effective interdisciplinary communication, and a carefully tailored anesthetic strategy can facilitate an awake craniotomy in a potentially uncooperative adult patient with diminished mental capacity and sensory deficits.

  17. Awake craniotomy for trapping a giant fusiform aneurysm of the middle cerebral artery.

    Science.gov (United States)

    Passacantilli, Emiliano; Anichini, Giulio; Cannizzaro, Delia; Fusco, Francesca; Pedace, Francesca; Lenzi, Jacopo; Santoro, Antonio

    2013-01-01

    Giant fusiform aneurysms of the distal middle cerebral artery (MCA) are rare lesions that, because of the absence of an aneurysm neck and the presence of calcified walls and partial thrombosis, can be difficult to clip without sacrificing the parent vessel. Moreover, when the aneurysm is located in the dominant hemisphere, it is not possible to test language and cognitive functions during surgical intervention, making the closure of the parent vessel extremely dangerous. A 46-year-old woman presented with a one-year history of frontal headache without neurological deficit. A magnetic resonance imaging and an angiography showed a giant fusiform aneurysm of the left M2 tract. Because of the location and the absence of a neck, the aneurysm was considered difficult to coil and not amenable to preoperative balloon occlusion; thus, the patient was a candidate for surgical treatment. After a preoperative psychological evaluation, patient underwent awake craniotomy with the asleep-awake-asleep technique. A standard left pterional approach was performed to expose the internal carotid artery, the MCA and the aneurysm originating from the frontal branch of the MCA. Neurological examination responses remained unchanged during temporary parent artery occlusion, and trapping was successfully performed. Awake craniotomy is a useful option in intracranial aneurysm surgery because it permits neurological testing before vessels are permanently clipped or sacrificed. With the asleep-awake-asleep technique, it is possible to perform a standard pterional craniotomy, which allows good exposure of the vascular structures without cerebral retraction.

  18. [Effect of transcutaneous acupoint electrical stimulation on lipid peroxidation and cognitive function in patients experiencing craniotomy].

    Science.gov (United States)

    Ni, Jian-wu; Meng, Yi-nan; Xiang, Hai-fei; Ren, Qiu-sheng; Wang, Jun-lu

    2009-02-01

    To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on serum superoxide dismutase (SOD) activity, malondialdehyde (MDA) and S100beta contents in craniotomy patients for studying its cerebral protection mechanism. Fifty patients scheduled for neurosurgery were randomly divided into TAES group (n = 25) and control group (n=25) with randomized block method. For patients of TAES group, TAES was applied to bilateral Hegu (LI 4) and Quchi (LI 11), Zusanli (ST 36) and Sanyinjiao (SP 6) from 30 minutes on before anesthesia to the end of operation. Patients of control group were anesthetized with sevoflurane inhalation and intermittent (i.v.) of sulfenany and vecurnium bromide. Blood samples were taken for assaying serum SOD activity, MDA and S100beta contents with purinase oxydasis, biochemiluminescence and enzyme linked immunosorbent assay separately. Scores of cognitive ability were given by using Mini Mental State Examination (MMSE). In comparison with pre-anesthesia, serum SOD activity decreased significantly 1 h after craniotomy in control group, at the end of operation in both control and TAES groups (Pcraniotomy and 48 h after operation were markedly lower in TAES group (Pcognitive function scores (P>0.05). TAES can increase serum SOD activity and reduce MDA and S100beta levels in patients undergoing craniotomy, which may contribute to its effect in reducing lipid peroxidation induced cerebral injury. But its impact on the patient's cognitive function needs study further.

  19. Prospective randomized controlled study on small-window craniotomy versus ordinary large-window craniotomy in the evacuation of epidural hematoma

    Directory of Open Access Journals (Sweden)

    Lian-shui HU

    2014-05-01

    Full Text Available There is still controversy on the clinical efficacy of small-window craniotomy (SWCT for acute epidural hematoma with concurrent early-phase cerebral herniation. This study compared multiple surgical and prognostic parameters of SWCT versus ordinary large-window craniotomy (LWCT, which aimed at providing evidences for surgical decision. Compared with LWCT (N = 51, SWCT (N = 44 displayed shortened average operation time (P = 0.000, reduced intraoperative blood loss (P = 0.000 and lessened intraoperative blood transfusion (P = 0.031. Moreover, there was no differences of postoperative residual hematoma (P = 0.141, postoperative palinesthesia time (P = 0.201, the ratio of postoperative secondary ischemia (P = 0.865 or cerebral edema (P = 0.879, and 6-month Glasgow Outcome Scale (GOS score (P = 0.603 between the two surgical approaches.  Results suggested that, for patients with acute epidural hematoma and concurrent early-phase cerebral herniation, SWCT could effectively evacuate hematoma and relief brain herniation without significant differences of effect and prognosis from LWCT. In addition, SWCT has several advantages such as significantly reduced operation time, intraoperative blood loss and blood transfusion. doi: 10.3969/j.issn.1672-6731.2014.05.013

  20. Acute Kidney Injury After Craniotomy Is Associated With Increased Mortality: A Cohort Study.

    Science.gov (United States)

    Kovacheva, Vesela P; Aglio, Linda S; Boland, Torrey A; Mendu, Mallika L; Gibbons, Fiona K; Christopher, Kenneth B

    2016-09-01

    Acute kidney injury (AKI) is a serious postoperative complication. To determine whether AKI in patients after craniotomy is associated with heightened 30-day mortality. We performed a 2-center, retrospective cohort study of 1656 craniotomy patients who received critical care between 1998 and 2011. The exposure of interest was AKI defined as meeting RIFLE (Risk, Injury, Failure, Loss of Kidney Function, and End-stage Kidney Disease) class risk, injury, and failure criteria, and the primary outcome was 30-day mortality. Adjusted odds ratios were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both AKI and mortality. Additionally, mortality in craniotomy patients with AKI was analyzed with a risk-adjusted Cox proportional hazards regression model and propensity score matching as a sensitivity analysis. The incidences of RIFLE class risk, injury, and failure were 5.7%, 2.9%, and 1.3%, respectively. The odds of 30-day mortality in patients with RIFLE class risk, injury, or failure fully adjusted were 2.79 (95% confidence interval [CI], 1.76-4.42), 7.65 (95% CI, 4.16-14.07), and 14.41 (95% CI, 5.51-37.64), respectively. Patients with AKI experienced a significantly higher risk of death during follow-up; hazard ratio, 1.82 (95% CI, 1.34-2.46), 3.37 (95% CI, 2.36-4.81), and 5.06 (95% CI, 2.99-8.58), respectively, fully adjusted. In a cohort of propensity score-matched patients, RIFLE class remained a significant predictor of 30-day mortality. Craniotomy patients who suffer postoperative AKI are among a high-risk group for mortality. The severity of AKI after craniotomy is predictive of 30-day mortality. AKI, acute kidney injuryAPACHE II, Acute Physiology and Chronic Health Evaluation IICI, confidence intervalCPT, Current Procedural TerminologyICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical ModificationRIFLE, risk, injury, failure, loss of kidney function, and end

  1. Coconut Model for Learning First Steps of Craniotomy Techniques and Cerebrospinal Fluid Leak Avoidance.

    Science.gov (United States)

    Drummond-Braga, Bernardo; Peleja, Sebastião Berquó; Macedo, Guaracy; Drummond, Carlos Roberto S A; Costa, Pollyana H V; Garcia-Zapata, Marco T; Oliveira, Marcelo Magaldi

    2016-12-01

    Neurosurgery simulation has gained attention recently due to changes in the medical system. First-year neurosurgical residents in low-income countries usually perform their first craniotomy on a real subject. Development of high-fidelity, cheap, and largely available simulators is a challenge in residency training. An original model for the first steps of craniotomy with cerebrospinal fluid leak avoidance practice using a coconut is described. The coconut is a drupe from Cocos nucifera L. (coconut tree). The green coconut has 4 layers, and some similarity can be seen between these layers and the human skull. The materials used in the simulation are the same as those used in the operating room. The coconut is placed on the head holder support with the face up. The burr holes are made until endocarp is reached. The mesocarp is dissected, and the conductor is passed from one hole to the other with the Gigli saw. The hook handle for the wire saw is positioned, and the mesocarp and endocarp are cut. After sawing the 4 margins, mesocarp is detached from endocarp. Four burr holes are made from endocarp to endosperm. Careful dissection of the endosperm is done, avoiding liquid albumen leak. The Gigli saw is passed through the trephine holes. Hooks are placed, and the endocarp is cut. After cutting the 4 margins, it is dissected from the endosperm and removed. The main goal of the procedure is to remove the endocarp without fluid leakage. The coconut model for learning the first steps of craniotomy and cerebrospinal fluid leak avoidance has some limitations. It is more realistic while trying to remove the endocarp without damage to the endosperm. It is also cheap and can be widely used in low-income countries. However, the coconut does not have anatomic landmarks. The mesocarp makes the model less realistic because it has fibers that make the procedure more difficult and different from a real craniotomy. The model has a potential pedagogic neurosurgical application for

  2. Re-do Craniotomy for Recurrent Grade IV Glioblastomas: Impact and Outcomes from the National Neuroscience Institute Singapore.

    Science.gov (United States)

    Chen, Min Wei; Morsy, Ahmed A; Liang, Sai; Ng, Wai Hoe

    2016-03-01

    We hypothesize that re-do craniotomy for recurrent grade IV glioblastomas improves survival while preserving outcome in selected patients. A retrospective analysis was conducted of 141 patients, from a prospectively collected database from 2004-2014, with grade IV glioblastomas who underwent craniotomy and excision. Sixty-five patients were included in our analysis. Twenty patients underwent re-do craniotomy at recurrence and were compared with 45 patients who received nonsurgical therapy for recurrences. Primary end point was overall survival from time of diagnosis. Demographic and disease factors were analyzed using Cox regression analysis for significance. The median survival for those with re-do craniotomy was 25.4 months compared with 11.6 months (P craniotomy were significant for positive outcomes. Our results show that in a select group of patients with recurrent grade IV glioblastomas, repeated excision, aiming for gross total resection where safely possible, has significant survival benefit without severely compromising functionality and should be considered. Copyright © 2016. Published by Elsevier Inc.

  3. Surgical Evacuation of Spontaneous Supratentorial Lobar Intracerebral Hemorrhage: Comparison of Safety and Efficacy of Stereotactic Aspiration, Endoscopic Surgery, and Craniotomy.

    Science.gov (United States)

    Li, Yuqian; Yang, Ruixin; Li, Zhihong; Yang, Yanping; Tian, Bo; Zhang, Xingye; Wang, Bao; Lu, Dan; Guo, Shaochun; Man, Minghao; Yang, Yang; Luo, Tao; Gao, Guodong; Li, Lihong

    2017-09-01

    The safety and efficacy of craniotomy, endoscopic surgery, and stereotactic aspiration for surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage (ICH) is yet uncertain. The present study analyzed the clinical and radiographic data from 99 patients with spontaneous supratentorial lobar ICH, retrospectively, to address this issue. Patients who underwent craniotomy, endoscopy surgery, or stereotactic aspiration were assigned to the craniotomy group (n = 31), endoscopy surgery group (n = 32), or stereotactic aspiration group (n = 36), respectively. The characteristics of all the enrolled patients at the time of admission were assimilated. Also, the therapeutic effects of the three surgical procedures were evaluated based on short-term outcomes within 30 days and long-term outcomes at 6 months after the ictus. The results showed that stereotactic aspiration and endoscopic surgery were associated with a superior clinical therapeutic effect in both short-term and long-term outcomes than craniotomy for the treatment of spontaneous supratentorial lobar ICH. Notably, severely affected patients with hematoma volume > 60 mL or Glasgow Coma Scale score 4-8 may benefit more from endoscopic surgery than the two other surgical procedures. The current findings demonstrate that both stereotactic aspiration and endoscopic surgery possess an apparent advantage over craniotomy for the evacuation of spontaneous supratentorial lobar ICH. The endoscopic surgery might be more safe and effective with higher evacuation rate, better functional neurological outcomes, and lower complication and mortality rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Routine early CT scanning after craniotomy: is it effective for the early detection of postoperative intracranial hematoma?

    Science.gov (United States)

    Wen, Liang; Yang, Xiao-Feng; Jiang, Hao; Wang, Hao; Zhan, Ren-Ya

    2016-08-01

    Postoperative intracranial hematoma (POIH) is a frequent sequela secondary to cranial surgery. The role of routine early postoperative computed tomography (CT) scanning in the detection of POIH remains controversial. The study was aimed at analyzing the effect of routine early CT scanning after craniotomy for the early detection of POIH. Routine early postoperative CT scanning was performed at our institute, and a retrospective study was conducted to analyze the data. POIH was defined as an intracranial hematoma requiring surgical management. A total of 1,148 patients undergoing craniotomy were included in this study; 28 of these patients developed POIH. The majority of POIH cases (15/28, 54 %) were detected during the first 6 h following craniotomy. A routine CT scan was performed on all included patients but two; however, CT scans detected only 16 POIH cases. During the first 6 h, the rate at which CT scans detected POIH was 1.9 % (15/786); subsequently, the rate decreased to only 0.3 % (1/360; p craniotomy CT scan detected POIH was only 0.7 % (5/721) (p craniotomy. However, if the strategy for routine scanning can be improved, its effect may be beneficial.

  5. Haemodynamic changes during craniotomy monitored by a bioimpedance plethysmographic noninvasive cardiac output monitor.

    Science.gov (United States)

    Ali, Zulfiqar; Umamaheswara Rao, G S; Jaganath, A

    2009-06-01

    Profound cardiovascular changes may occur at various stages during a craniotomy. These changes require a detailed haemodynamic analysis including cardiac output. In the present study, we used a monitor based on electrical bioimpedance method for noninvasive cardiac output measurement. In 17 ASA I and II patients undergoing elective craniotomies for supratentorial tumours, the following haemodynamic parameters were measured noninvasively: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR). Haemodynamic changes in response to the following events were studied: (a) induction of anaesthesia with thiopentone, (b) 15 min of air-O(2)-isoflurane anaesthesia, (c) infiltration of the scalp with lidocaine adrenaline mixture, and (d) change of inspired gas mixture to N(2)O-O(2)-isoflurane. HR increased (P < 0.001) and SV decreased (P < 0.001) while CO remained unchanged, one min after administration of thiopentone. After 15 min of isoflurane anaesthesia, HR increased (P < 0.001) and, SBP (P = 0.02), DBP (P = 0.002) and SV (P = 0.003) decreased significantly without change in CO. Three minutes after infiltration of the scalp with lidocaine-adrenaline mixture, there was an increase in SBP (P = 0.001), DBP (P = 0.007), SV (P = 0.007) and CO (P = 0.001) and a decrease in SVR (P < 0.001). Addition of nitrous oxide (60%) to the inspired gas mixture decreased SBP (P = 0.003) and DBP (P = 0.001) with a trend for decrease in CO (P < 0.1). The changes recorded in the present study conform to those that have been documented earlier by using invasive monitoring. Bioimpedance plethysmography is a useful noninvasive technique for monitoring and detailed analysis of the rapidly changing systemic haemodynamics during a craniotomy. The device could be useful for investigating important haemodynamic changes in specific neurosurgical settings.

  6. The Cost of Brain Surgery: Awake vs Asleep Craniotomy for Perirolandic Region Tumors.

    Science.gov (United States)

    Eseonu, Chikezie I; Rincon-Torroella, Jordina; ReFaey, Karim; Quiñones-Hinojosa, Alfredo

    2017-08-01

    Cost effectiveness has become an important factor in the health care system, requiring surgeons to improve efficacy of procedures while reducing costs. An awake craniotomy (AC) with direct cortical stimulation (DCS) presents one method to resect eloquent region tumors; however, some authors assert that this procedure is an expensive alternative to surgery under general anesthesia (GA) with neuromonitoring. To evaluate the cost effectiveness and clinical outcomes between AC and GA patients. Retrospective analysis of a cohort of 17 patients with perirolandic gliomas who underwent an AC with DCS were case-control matched with 23 patients with perirolandic gliomas who underwent surgery under GA with neuromonitoring (ie, motor-evoked potentials, somatosensory-evoked potentials, phase reversal). Inpatient costs, quality-adjusted life years (QALY), extent of resection, and neurological outcome were compared between the groups. Total inpatient expense per patient was $34 804 in the AC group and $46 798 in the GA group ( P = .046). QALY score for the AC group was 0.97 and 0.47 for the GA group ( P = .041). The incremental cost per QALY for the AC group was $82 720 less than the GA group. Postoperative Karnofsky performance status was 91.8 in the AC group and 81.3 in the GA group (P = .047). Length of hospitalization was 4.12 days in the AC group and 7.61 days in the GA group ( P = .049). The total inpatient costs for awake craniotomies were lower than surgery under GA. This study suggests better cost effectiveness and neurological outcome with awake craniotomies for perirolandic gliomas. Copyright © 2017 by the Congress of Neurological Surgeons

  7. Awake Craniotomy Anesthesia: A Comparison of the Monitored Anesthesia Care and Asleep-Awake-Asleep Techniques.

    Science.gov (United States)

    Eseonu, Chikezie I; ReFaey, Karim; Garcia, Oscar; John, Amballur; Quiñones-Hinojosa, Alfredo; Tripathi, Punita

    2017-08-01

    Commonly used sedation techniques for an awake craniotomy include monitored anesthesia care (MAC), using an unprotected airway, and the asleep-awake-asleep (AAA) technique, using a partially or totally protected airway. We present a comparative analysis of the MAC and AAA techniques, evaluating anesthetic management, perioperative outcomes, and complications in a consecutive series of patients undergoing the removal of an eloquent brain lesion. Eighty-one patients underwent awake craniotomy for an intracranial lesion over a 9-year period performed by a single-surgeon and a team of anesthesiologists. Fifty patients were treated using the MAC technique, and 31 were treated using the AAA technique. A retrospective analysis evaluated anesthetic management, intraoperative complications, postoperative outcomes, pain management, and complications. The MAC and AAA groups had similar preoperative patient and tumor characteristics. Mean operative time was shorter in the MAC group (283.5 minutes vs. 313.3 minutes; P = 0.038). Hypertension was the most common intraoperative complication seen (8% in the MAC group vs. 9.7% in the AAA group; P = 0.794). Intraoperative seizure occurred at a rate of 4% in the MAC group and 3.2% in the AAA group (P = 0.858). Awake cases were converted to general anesthesia in no patients in the MAC group and in 1 patient (3.2%) in the AAA group (P = 0.201). No cases were aborted in either group. The mean hospital length of stay was 3.98 days in the MAC group and 3.84 days in the AAA group (P = 0.833). Both the MAC and AAA sedation techniques provide an efficacious and safe method for managing awake craniotomy cases and produce similar perioperative outcomes, with the MAC technique associated with shorter operative time. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Continuous physical examination during subcortical resection in awake craniotomy patients: Its usefulness and surgical outcome.

    Science.gov (United States)

    Bunyaratavej, Krishnapundha; Sangtongjaraskul, Sunisa; Lerdsirisopon, Surunchana; Tuchinda, Lawan

    2016-08-01

    To evaluate the value of physical examination as a monitoring tool during subcortical resection in awake craniotomy patients and surgical outcomes. Authors reviewed medical records of patients underwent awake craniotomy with continuous physical examination for pathology adjacent to the eloquent area. Between January 2006 and August 2015, there were 37 patients underwent awake craniotomy with continuous physical examination. Pathology was located in the left cerebral hemisphere in 28 patients (75.7%). Thirty patients (81.1%) had neuroepithelial tumors. Degree of resections were defined as total, subtotal, and partial in 16 (43.2%), 11 (29.7%) and 10 (27.0%) patients, respectively. Median follow up duration was 14 months. The reasons for termination of subcortical resection were divided into 3 groups as follows: 1) by anatomical landmark with the aid of neuronavigation in 20 patients (54%), 2) by reaching subcortical stimulation threshold in 8 patients (21.6%), and 3) by abnormal physical examination in 9 patients (24.3%). Among these 3 groups, there were statistically significant differences in the intraoperative (p=0.002) and early postoperative neurological deficit (p=0.005) with the lowest deficit in neuronavigation group. However, there were no differences in neurological outcome at later follow up (3-months p=0.103; 6-months p=0.285). There were no differences in the degree of resection among the groups. Continuous physical examination has shown to be of value as an additional layer of monitoring of subcortical white matter during resection and combining several methods may help increase the efficacy of mapping and monitoring of subcortical functions. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. [Emergency Decompressive Craniotomy in the Emergency Room was Effective in Severe Acute Subdural Hematoma Treatment:Two Case Reports].

    Science.gov (United States)

    Shiomi, Naoto; Echigo, Tadashi; Oka, Hideki; Nozawa, Masahiro; Okada, Michiko; Hiraizumi, Shiho; Kato, Fumitaka; Koseki, Hirokazu; Hashimoto, Yoichi; Hino, Akihiko

    2017-02-01

    The outcome of severe acute subdural hematoma is unfavorable. In particular, patients with levels of consciousness of Glasgow Coma Scale(GCS)3 or 4 tend to be refractory to treatment. Decompressive craniotomy should be promptly performed to remove hematoma. However, if an operating room is not immediately available, emergency burr hole surgery is sometimes performed in the emergency room(primary care room)prior to craniotomy. A previous study has reported that the interval from injury to surgery influences the outcome of severe acute subdural hematoma. Therefore, emergency decompression is important to effectively treat patients with severe acute subdural hematoma. We present the cases of two patients with acute subdural hematomas. In both cases, emergency decompressive craniotomy(hematoma removal after craniotomy and external decompression)was performed in the emergency room of the Emergency and Critical Care Center. In both cases, the surgery was followed by favorable outcomes. Case 1 was a 36-year-old female. The patient's level of consciousness upon arrival was GCS 3. The interval from injury to diagnosis on the basis of CT findings was 75 minutes. Surgery began 20 minutes after diagnosis. Case 2 was a 25-year-old male. The second patient's level of consciousness upon arrival was GCS 4. The interval from injury to diagnosis on the basis of CT findings was 60 minutes. Surgery was begun 40 minutes after diagnosis. In both patients, we observed anisocoria and the loss of the light reflex. However, the postoperative course was favorable, and both patients were discharged. In summary, to treat severe acute subdural hematomas, early emergency decompressive craniotomy is optimal. Emergency decompressive surgery in the emergency room is independent of operating room or staff. Therefore, emergency decompressive craniotomy may improve the outcome of patients with severe acute subdural hematomas.

  10. Small shifts in craniotomy position in the lateral fluid percussion injury model are associated with differential lesion development.

    Science.gov (United States)

    Vink, R; Mullins, P G; Temple, M D; Bao, W; Faden, A I

    2001-08-01

    Previous studies have shown that location and direction of injury may affect outcome in experimental models of traumatic brain injury. Significant variability in outcome data has also been noted in studies using the lateral fluid percussion brain injury model (FPI) in rats. In recent studies from our laboratory, we observed considerable variability in localization and severity of tissue damage as a function of small changes in craniotomy position. To further address this issue, we examined the relationship between craniotomy position and brain lesion size/location in rats subjected to moderate FPI (2.28 +/- 0.18 atmospheres). With placement of a 5-mm craniotomy adjacent to the sagittal suture, there was both ipsilateral and contralateral damage as detected at 3 weeks posttrauma using T2-weighted magnetic resonance imaging (MRI). The MRI lesions were generally restricted to the hippocampus and subcortical layers. Shifting of the craniotomy site laterally was associated with increased ipsilateral tissue damage and a greater cortical component that correlated with distance from the sagittal suture. In contrast, the contralateral MRI lesion did not change significantly in size or location unless the center of the craniotomy was placed more than 3.5 mm from the sagittal suture, under which condition contralateral damage could no longer be detected. Ipsilateral tissue damage as determined from the MRI scans was linearly correlated to motor outcome but not with cognitive outcome as assessed by the Morris Water Maze. We conclude that craniotomy position is critical in determining extent and location of tissue injury produced during the lateral FPI model in rats. Addressing such potential variability is essential for studies that address either injury mechanisms or therapeutic treatments.

  11. Anaesthetic Management of Supratentorial Tumor Craniotomy Using Awake-Throughout Approach.

    Science.gov (United States)

    Shafiq, Faraz; Salim, Fahad; Enam, Ather; Parkash, Jai; Faheem, Mohammad

    2017-12-01

    The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length of stay in hospital.

  12. Intraoperative Rupture of Unruptured Cerebral Aneurysm during Craniotomy: A Case Report

    Directory of Open Access Journals (Sweden)

    Kenji Yoshiki

    2017-11-01

    Full Text Available An unruptured aneurysm was incidentally found in the right middle cerebral artery in a 67-year-old woman. During an attempt to turn the temporalis muscle for surgical clipping, systolic blood pressure suddenly increased. After opening the dura mater, we found a subarachnoid hemorrhage and severe brain swelling. We promptly expanded the craniotomy area to reach the aneurysm while pulling part of the frontal lobe to apply a clip. We retrospectively analyzed the aneurysm using computational fluid dynamics. Our analysis suggests that the rupture of the aneurysm occurred at a location with very low wall shear stress.

  13. Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury

    Science.gov (United States)

    Tawfik, Mohamed Mohamed; Badran, Basma Abed; Eisa, Ahmed Amin; Barakat, Rafik Ibrahim

    2015-01-01

    The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery. Her fetus was viable with no signs of distress and no detected placental abnormalities. Cesarean delivery was performed followed by craniotomy in the same setting under general anesthesia with good outcome of the patient and her baby. PMID:25829914

  14. The Gap Within the Gap

    Directory of Open Access Journals (Sweden)

    Katherine Michelmore

    2017-02-01

    Full Text Available Gaps in educational achievement between high- and low-income children are growing. Administrative data sets maintained by states and districts lack information about income but do indicate whether a student is eligible for subsidized school meals. We leverage the longitudinal structure of these data sets to develop a new measure of economic disadvantage. Half of eighth graders in Michigan are eligible for a subsidized meal, but just 14% have been eligible for subsidized meals in every grade since kindergarten. These children score 0.94 standard deviations below those who are never eligible for meal subsidies and 0.23 below those who are occasionally eligible. There is a negative, linear relationship between grades spent in economic disadvantage and eighth-grade test scores. This is not an exposure effect; the relationship is almost identical in third-grade, before children have been exposed to varying years of economic disadvantage. Survey data show that the number of years that a child will spend eligible for subsidized lunch is negatively correlated with her or his current household income. Years eligible for subsidized meals can therefore be used as a reasonable proxy for income. Our proposed measure can be used to estimate heterogeneous effects in program evaluations, to improve value-added calculations, and to better target resources.

  15. Anaesthetic management for combined emergency caesarean section and craniotomy tumour removal

    Directory of Open Access Journals (Sweden)

    Dewi Y Bisri

    2017-01-01

    Full Text Available Presentation of primary intracranial tumour during pregnancy is extremely rare. Symptoms of brain tumour include nausea, vomiting, headache and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. In very few cases, craniotomy tumour removal is performed earlier or even simultaneously with foetal delivery. A 40-year-old woman at 32 weeks of gestation in foetal distress presented to the emergency room with decreased level of consciousness Glasgow Coma Scale 6 (E2M2V2. Computed tomographic scan revealed a mass lesion over the left temporoparietal region with midline shift and intratumoural bleeding. In view of high risk of herniation and foetal distress, she underwent emergency caesarean section followed by craniotomy tumour removal. In parturient with brain tumour, combined surgery of tumour removal and caesarean section is decided based on clinical symptoms, type of tumour and foetal viability. Successful anaesthetic management requires a comprehensive knowledge of physiology and pharmacology, individually tailored to control intracranial pressure while ensuring the safety of mother and foetus.

  16. A Comparison of Pain Scales in Patients with Disorders of Consciousness Following Craniotomy.

    Science.gov (United States)

    Suraseranivongse, Suwannee; Yuvapoositanont, Pensook; Srisakkrapikoop, Paphatsorn; Pommul, Ruetaichanok; Phaka, Waraporn; Itthimathin, Parunut

    2015-07-01

    Evaluate the validity, reliability, and practicality of pain assessment tools in patients with disorders of consciousness who underwent craniotomy. This prospective observational study cross-validated three pain scales, FLACC (Face, Legs, Activity, Cry, Consolability), rFLACC (Revised FLA CC), and NCS (Nociception Coma Scale), based on validity, reliability, and practicality. After translation, the three pain scales were tested for concurrent validity, construct validity, and interrater reliability in patients who experienced disorders of consciousness within 24 hours following craniotomy. Opinions regarding practicality were elicited via questionnaire from nurses who have used and are familiar with these pain scales. Fifty-eight patients were enrolled in the present study. Concurrent validity was supported by positive correlations among all scales, which ranged from r = 0.638 to r = 0.978. All scales yielded fair to moderate agreement (K = 0.380-0.626) with routine clinical decision to treat postoperative pain. Concurrent validity was much improved in the assessment of intubated patients. Construct validity was demonstrated by high scores (3-5) in higher pain situations before analgesic was given and low pain scores (0) in pain-free situations after analgesic was given. All scales had good interrater reliability (intraclass correlation = 0.7506-0.8810). All pain scales were found to be valid and reliable, especially in intubated patients. In terms ofpracticality, NCS was found to be the most acceptable by practitioners.

  17. Tumefactive multiple sclerosis requiring emergency craniotomy: case report and literature review.

    Science.gov (United States)

    Munarriz, Pablo M; Castaño-Leon, Ana M; Martinez-Perez, Rafael; Hernandez-Lain, Aurelio; Ramos, Ana; Lagares, Alfonso

    2013-01-01

    Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by focal neurological dysfunction with a relapsing and remitting course. Tumor-like presentation of MS (or "tumefactive"/"pseudotumoral" presentation) has been described before with a certain frequency; it consists of a large single plaque (>2cm) with presence of edema and mass effect and it is hard to distinguish from a brain tumor. However, we present a very rare case of a 53-year-old woman with a right temporal mass that turned out to be a MS plaque, who deteriorated within hours (brain herniation with loss of consciousness and unilateral mydriasis) and required an emergency craniotomy. We also present a review of the literature. It appears that only 4 cases of emergency craniotomy/craniectomy required in a patient with a tumor-like MS plaque have been reported before. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  18. Preserving the Facial Nerve During Orbitozygomatic Craniotomy: Surgical Anatomy Assessment and Stepwise Illustration.

    Science.gov (United States)

    Tayebi Meybodi, Ali; Lawton, Michael T; Yousef, Sonia; Sánchez, J J González; Benet, Arnau

    2017-09-01

    Surgical safety and efficiency during an orbitozygomatic (OZ) osteotomy rely on thorough knowledge of the surgical anatomy of the facial nerve. Although the anatomy of the facial nerve and its relation to the pterional craniotomy are described, a thorough assessment of facial nerve preservation techniques during the OZ approach and its variations is lacking. We assessed the surgical anatomy of the facial nerve related to the OZ approach and provided a thorough stepwise description on how to preserve it. The OZ approach was performed bilaterally in 15 cadaveric heads. The interfascial and subfascial techniques were performed to study their nuances in preserving the facial nerve. We compared the 2 techniques and provided a thorough description on how to preserve the facial nerve during each step of the OZ approach. At the zygomatic arch, the facial nerve was found between the galea and the superficial temporal fascia. A cut in the fascia at the posterior end of the zygomatic arch did not cross any facial nerve branches. The subfascial technique was simpler, more efficient, and provided more structural protection of the facial nerve branches than the interfascial technique. The frontal division of the facial nerve is related directly to dissection over the zygomatic bone and may be injured during fascial dissection or osteotomies. Both interfascial and subfascial techniques are feasible to use during the OZ craniotomy and provide ample exposure of the OZ unit. Regarding the preservation of the facial nerve branches, we favor the subfascial method. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Awake Craniotomy for Tumor Resection: Further Optimizing Therapy of Brain Tumors.

    Science.gov (United States)

    Mehdorn, H Maximilian; Schwartz, Felix; Becker, Juliane

    2017-01-01

    In recent years more and more data have emerged linking the most radical resection to prolonged survival in patients harboring brain tumors. Since total tumor resection could increase postoperative morbidity, many methods have been suggested to reduce the risk of postoperative neurological deficits: awake craniotomy with the possibility of continuous patient-surgeon communication is one of the possibilities of finding out how radical a tumor resection can possibly be without causing permanent harm to the patient.In 1994 we started to perform awake craniotomy for glioma resection. In 2005 the use of intraoperative high-field magnetic resonance imaging (MRI) was included in the standard tumor therapy protocol. Here we review our experience in performing awake surgery for gliomas, gained in 219 patients.Patient selection by the operating surgeon and a neuropsychologist is of primary importance: the patient should feel as if they are part of the surgical team fighting against the tumor. The patient will undergo extensive neuropsychological testing, functional MRI, and fiber tractography in order to define the relationship between the tumor and the functionally relevant brain areas. Attention needs to be given at which particular time during surgery the intraoperative MRI is performed. Results from part of our series (without and with ioMRI scan) are presented.

  20. Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

    Science.gov (United States)

    Vacas, Susana; Van de Wiele, Barbara

    2017-01-01

    Background: Craniotomy is a relatively common surgical procedure with a high incidence of postoperative pain. Development of standardized pain management and enhanced recovery after surgery (ERAS) protocols are necessary and crucial to optimize outcomes and patient satisfaction and reduce health care costs. Methods: This work is based upon a literature search of published manuscripts (between 1996 and 2017) from Pubmed, Cochrane Central Register, and Google Scholar. It seeks to both synthesize and review our current scientific understanding of postcraniotomy pain and its part in neurosurgical ERAS protocols. Results: Strategies to ameliorate craniotomy pain demand interventions during all phases of patient care: preoperative, intraoperative, and postoperative interventions. Pain management should begin in the perioperative period with risk assessment, patient education, and premedication. In the intraoperative period, modifications in anesthesia technique, choice of opioids, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), regional techniques, dexmedetomidine, ketamine, lidocaine, corticosteroids, and interdisciplinary communication are all strategies to consider and possibly deploy. Opioids remain the mainstay for pain relief, but patient-controlled analgesia, NSAIDs, standardization of pain management, bio/behavioral interventions, modification of head dressings as well as patient-centric management are useful opportunities that potentially improve patient care. Conclusions: Future research on mechanisms, predictors, treatments, and pain management pathways will help define the combinations of interventions that optimize pain outcomes. PMID:29285407

  1. Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms.

    Science.gov (United States)

    Figueiredo, Eberval Gadelha; Welling, Leonardo C; Preul, Mark C; Sakaya, Gabriel Reis; Neville, Iuri; Spetzler, Robert F; Teixeira, Manoel Jacobsen

    2016-05-01

    The pterional approach was described in the 1970s and has become the most utilized cranial approach with many variations described, including the minipterional technique. Although described recently as an alternative to the pterional approach for anterior circulation aneurysms, to our knowledge a large series of cases using the minipterional approach in both ruptured and unruptured aneurysms has not been described. We present our clinical experience with the minipterional craniotomy in more than 100 ruptured and unruptured anterior circulation aneurysms. The results of 86 consecutive patients with 102 ruptured non-giant, anterior circulation aneurysms treated with early surgery utilizing the minipterional craniotomy were analyzed. Postoperative angiography was carried out in all cases. Outcome results were classified as excellent in 67 (77.9%), and good in seven (8.1%), while 16 (13.9%) patients died. The minipterional technique provides adequate surgical exposure and excellent outcomes for both ruptured and unruptured anterior circulation aneurysm clipping. It constitutes a safe and effective alternative to the pterional approach, with equivalent or potentially better aesthetic and functional outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Herpes Simplex Type 2 Encephalitis After Craniotomy: Case Report and Literature Review.

    Science.gov (United States)

    Berger, Assaf; Shahar, Tal; Margalit, Nevo

    2016-04-01

    Herpes simplex encephalitis (HSE) after neurosurgical procedures is extremely uncommon, and the few published case reports mainly described herpes simplex virus type 1 (HSV-1) as being culpable. We present a rare case of HSV-2 encephalitis after craniotomy and describe its pathophysiology and optimal management. A 70-year-old woman underwent an elective resection of a recurrent left sphenoid wing meningioma and clipping of a left middle cerebral artery aneurysm, the latter having been found incidentally. She returned to our department with clinical findings suggestive of meningitis 12 days after the operation. Her lack of response to empiric antibiotic treatment, taken together with the lymphocyte-predominant initial cerebrospinal fluid obtained by lumbar puncture and the electroencephalographic indications of encephalopathy, led to the suspicion of a diagnosis of HSE, which was later confirmed by a polymerase chain reaction test positive for HSV-2. The patient was then successfully treated with intravenous acyclovir for 2 weeks followed by another week of oral acyclovir treatment before being discharged. The present case stresses the importance of recognizing the relatively rare entity of HSE after craniotomy. Timely correct diagnosis will expedite the initiation of appropriate treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Skull Subsidence due to Periosteum Defect following Craniotomy in a Child.

    Science.gov (United States)

    Arishima, Hidetaka; Akazawa, Ayumi; Kikuta, Ken-Ichiro

    2017-01-01

    We report a case of a 7-year-old child with a cranial deformity secondary to a craniotomy for an intracranial hematoma. He suffered from an acute epidural hematoma with a lineal fracture of the right temporal bone following a severe head injury. A large question mark-shaped skin flap with the periosteum and temporal muscle was created for a decompressive craniectomy; however, neither the acute epidural hematoma nor brain swelling was severe, and we performed a small craniotomy compared with the skin flap without a decompressive craniectomy. Eighteen months after the operation, he complained of skull deformity with a mild depression of the forehead. Axial and 3-dimensional computed tomography showed thinness and subsidence of the frontoparietal bone around the replaced bone flap, corresponding to the skin flap with the periosteum defect. We suggest that the periosteum defect following creation of the skin flap during surgery prevented normal growth of the skull, which caused the thinness and subsidence of the frontoparietal bone. Preservation and cooptation of the periosteum should be performed during neurological surgeries in babies and children to prevent skull deformity. © 2016 S. Karger AG, Basel.

  4. Remifentanil-propofol vs dexmedetomidine-propofol--anesthesia for supratentorial craniotomy.

    Science.gov (United States)

    Turgut, Namigar; Turkmen, Aygen; Ali, Achmet; Altan, Aysel

    2009-02-01

    The aim of the present study was to compare the perioperative hemodynamics, propofol consumption and recovery profiles of remifentanil and dexmedetomidine when used with air-oxygen and propofol, in order to evaluate a postoperative analgesia strategy and explore undesirable side-effects (nausea, vomiting, shivering). In a prospective randomized double-blind study 50 ASAI-III patients scheduled for supratentorial craniotomy, were allocated into two equal Groups. Group D patients (n = 25), received i.v. dexmedetomidine 1 microg kg(-1) as preinduction over a 15-min period and 0.2-1 microg kg(-1) hr(-1) by continuous i.v. infusion during the operation period. Group R patients (n = 25), received remifentanil 1 microg kg(-1) as induction i.v. over a 15-min period and 0.05-1 microg kg(-1) min(-1) as maintenance. The propofol infusion was started at a rate of 10 mg kg(-1) h(-1) and titrated to maintain BIS in the range 40-50. Propofol doses for induction and maintenance of anesthesia was lower with dexmedetomidine (respectively p craniotomy and provide similar intraoperative hemodynamic responses and postoperative adverse events. Propofol-remifentanil allows earlier cognitive recovery; however, it leads to earlier demand for postoperative analgesics. Undesirable side-effects were similar in two Groups.

  5. Surgical planning for retrosigmoid craniotomies improved by 3D computed tomography venography.

    Science.gov (United States)

    Gharabaghi, A; Rosahl, S K; Feigl, G C; Samii, A; Liebig, T; Heckl, S; Mirzayan, J M; Safavi-Abbasi, S; Koerbel, A; Löwenheim, H; Nägele, T; Shahidi, R; Samii, M; Tatagiba, M

    2008-02-01

    It is impossible to precisely anticipate the crooked course of the transverse and sigmoid sinuses and their individual relationship to superficial landmarks such as the asterion during retrosigmoid approaches. This study was designed to evaluate this anatomical relationship with the help of a surgical planning system and to analyze the impact of these in vivo findings on trepanation placement in retrosigmoid craniotomies. In a consecutive series of 123 patients with pathologies located in the cerebellopontine angle, 72 patients underwent surgical planning for retrosigmoid craniotomies based on 3D volumetric renderings of computed tomography venography. By opacity modulation of surfaces in 3D images the position of the asterion was assessed in relationship to the transverse-sigmoid sinus transition (TST) and compared to its intraoperative localization. We evaluated the impact of this additional information on trepanation placement. The spatial relationship of the asterion and the underlying TST complex could be identified and recorded in 66 out of 72 cases. In the remaining 6 cases the sutures were ossified and not visible in the 3D CT reconstructions. The asterion was located on top of the TST in 51 cases, above the TST in 4 cases, and below the TST in 11 cases. The location of the trepanation was modified in 27 cases due to the preoperative imaging findings with major and minor modifications in 10 and 17 cases, respectively. Volume-rendered images provide reliable 3D visualization of complex and hidden anatomical structures in the posterior fossa and thereby increase the precision in retrosigmoid approaches.

  6. [Presurgical evaluaton for lateral suboccipital craniotomy using contrast-enhanced CT volumetric imaging].

    Science.gov (United States)

    Oishi, Makoto; Fukuda, Masafumi; Saito, Akihiko; Hiraishi, Tetsuya; Fuji, Yukihiko

    2009-05-01

    To safely and precisely accomplish lateral suboccipital craniotomy (LSOC), we have presurgically evaluated the three-dimensional (3-D) relationships of various vascular structures and cranial landmarks in the occipito-cervical region by volumetric imaging of 3-D contrast enhanced computed tomography (CECT). The 3-D anatomies visualized by adjusting the window width, window level, and opacity level of the specific CT value for each structure were an occpital artery (OA), mastoid and posterior condylar emissary veins (MEV and PCEV), which were useful in dissecting muscles and exposing the cranial surface, and the relationship of the transverse-sigmoid sinus CTSS) and the asterion, which was necessary and decisive for making a key burr hole to perform craniotomy. The morphologic analysis for our 48 cases with cerebello-pontine angle tumor or neurovascular compression syndrome showed running patterns of OA, varieties of MEV and PCEV in their sizes and connections, right dominance of TSS, and the various relationship between the TSS and the asterion. Especially, the exact location of the TSS compared to the astenon was found to be inferior in 56%, right below in 38%, and superior in 6%. In conclusion, presurgical evaluation using volumetric imaging of 3-D CECT is a convenient and valuable method for obtaining the anatomic information required for performing LSOC safely and precisely in individual patients.

  7. The incidence and risk factors of meningitis after major craniotomy in China: a retrospective cohort study.

    Science.gov (United States)

    Chen, Chen; Zhang, Bingyan; Yu, Shenglei; Sun, Feng; Ruan, Qiaoling; Zhang, Wenhong; Shao, Lingyun; Chen, Shu

    2014-01-01

    Meningitis after neurosurgery can result in severe morbidity and high mortality. Incidence varies among regions and limited data are focused on meningitis after major craniotomy. This retrospective cohort study aimed to determine the incidence, risk factors and microbiological spectrum of postcraniotomy meningitis in a large clinical center of Neurosurgery in China. Patients who underwent neurosurgeries at the Department of Neurosurgery in Huashan Hospital, the largest neurosurgery center in Asia and the Pacific, between 1st January and 31st December, 2008 were selected. Individuals with only shunts, burr holes, stereotactic surgery, transsphenoidal or spinal surgery were excluded. The complete medical records of each case were reviewed, and data on risk factors were extracted and evaluated for meningitis. A total of 65 meningitides were identified among 755 cases in the study, with an incidence of 8.60%. The risk of meningitis was increased by the presence of diabetes mellitus (odds ratio [OR], 6.27; P = 0.009), the use of external ventricular drainage (OR, 4.30; P = 0.003) and the use of lumbar drainage (OR, 17.23; PMeningitis remains an important source of morbidity and mortality after major craniotomy. Diabetic patients or those with cerebral spinal fluid shunts carry significant high risk of infection. Thus, identification of the risk factors as soon as possible will help physicians to improve patient care.

  8. Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration.

    Science.gov (United States)

    Akcil, Eren Fatma; Dilmen, Ozlem Korkmaz; Vehid, Hayriye; Ibısoglu, Lutfiye Serap; Tunali, Yusuf

    2017-03-01

    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. 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. 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. The scalp block may provide better analgesia in infratentorial craniotomies than local anesthetic infiltration. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Post-craniotomy intracranial infection in patients with brain tumors: a retrospective analysis of 5723 consecutive patients.

    Science.gov (United States)

    Shi, Zhong-Hua; Xu, Ming; Wang, Yong-Zhi; Luo, Xu-Ying; Chen, Guang-Qiang; Wang, Xin; Wang, Tao; Tang, Ming-Zhong; Zhou, Jian-Xin

    2017-02-01

    To determine the risk factors for and the incidence, outcomes, and causative pathogens of post-craniotomy intracranial infection (PCII) in patients with brain tumors. A retrospective study was performed of 5723 patients with brain tumors who were surgically treated between January 2012 and December 2013 in Beijing Tiantan Hospital. The patients' demographics, pathohistological diagnoses, surgical procedures, postoperative variables, causative pathogens, and outcomes were evaluated. The overall incidence of PCII was 6.8%, and 82.1% of all cases were diagnosed within two weeks after the craniotomy. Postoperative administration of antibiotics reduced the incidence of PCII. Independent risk factors included clean-contaminated craniotomy, prolonged operation (> 7 h), external cerebrospinal fluid (CSF) drainage/monitoring device placement, and postoperative CSF leakage. Patients ≤ 45 years old were more susceptible to infection. Compared with supratentorial tumors, tumors located in the infratentorial or intraventricular regions were more vulnerable to PCII. Gram-positive bacteria were the most common causative pathogens isolated from the CSF samples, accounting for 82.0% of the PCII cases. Risk factors for PCII can be identified early in the perioperative period. These findings raise the possibility of improving the clinical outcomes of patients with brain tumors who undergo craniotomy.

  10. Localization of transverse-sigmoid sinus junction using preoperative 3D computed tomography: application in retrosigmoid craniotomy.

    Science.gov (United States)

    Xia, Lei; Zhang, Mingshan; Qu, Yanming; Ren, Ming; Wang, Haoran; Zhang, Hongwei; Yu, Chunjiang; Zhu, Mingwang; Li, Jianhua

    2012-10-01

    In retrosigmoid craniotomy, neurosurgeons usually depend on surface landmarks and their experience to evaluate the position of transverse-sigmoid sinus junction (TSSJ) and place an appropriate initial burr-hole, which is not accurate each time because of variability in different craniums. The authors introduce a simple procedure based on 3D computed tomography (CT) to localize the TSSJ in retrosigmoid craniotomy. Eighteen patients who underwent retrosigmoid craniotomy were analyzed. On the internal view of skull in 3D CT image, a simulative burr-hole was placed on the margin of transverse-sigmoid sinus groove junction. Then, on the external view of skull in 3D CT image, the center of the simulative burr-hole was marked and a coordinate system was established based on a line connected the digastric point and the asterion. Then the coordinate of the burr-hole's center was measured in this coordinate system. In operation, the burr-hole was placed according to the coordinate measured previously and craniotomy was performed. The margin of TSSJ was exposed in each case. No damage of venous sinus was encountered. Post-operative skull base CT demonstrated a good match between the actual and predicted burr-hole and bone defects only existed along the cut line. This simple method could help in localizing the TSSJ and avoiding the risk of sinus injury and reducing the bone defect. It is sufficiently precise for practical application at surgical planning.

  11. A Superior Cerebellar Convexity Two-Part Craniotomy to Access the Paramedian Supra and Infratentorial Space: Technical Note.

    Science.gov (United States)

    Cage, Tene; Benet, Arnau; Golfinos, John; McDermott, Michael W

    2016-06-30

    A craniotomy over the superior cerebellar convexity for approaches to this region typically involves a small infratentorial craniotomy and then drilling down of the bone to expose some portion of the transverse/sigmoid sinuses. The authors describe the anatomy of the region and the method for a two-part paramedian occipital and suboccipital craniotomy (supra and infratentorial) that may have time-saving, safety, and cosmetic advantages. For this technique, a supratentorial craniotomy is used to expose the transverse sinus from above, and subsequently, dissection across the sinus over the cerebellar convexity can be done under direct vision. The two bone pieces are joined on the inner table side while plates for fixation above the superior nuchal line can be counter-sunk to avoid post-operative pain from the prominence of screws. There is no need for cranioplasty materials since there is no burring down of bone for adequate exposure of the transverse sinus. The technique has been used by two senior surgeons over the years convincing them of the speed, safety, and utility of the technique. Here, the authors present a single example of the technique.

  12. [Mini-orbitozygomatic craniotomy in surgery for supratentorial aneurysms and tumors of the anterior and middle cranial fossae].

    Science.gov (United States)

    Dzhindzhikhadze, R S; Dreval', O N; Lazarev, V A; Kambiev, R L

    2016-01-01

    Progress in microneurosurgical techniques, neuroanesthesiology, and intraoperative imaging enables surgery using small incisions and craniotomy, in accordance with the keyhole surgery concept. Supraorbital craniotomy is the most widespread minimally invasive approach. There are a number of supraorbital craniotomy modifications, regarding different soft tissue incisions and the extent of craniotomy. We present the first results of using mini-orbitozygomatic craniotomy for aneurysms of the anterior circle of Willis and space-occupying lesions of the anterior and middle cranial fossae performed through an eyebrow incision. Forty five patients were operated on using mini-orbitozygomatic (MOZ) craniotomy in the period between March 2014 and December 2015. Fifteen supratentorial aneurysms were clipped, and 30 space-occupying lesions were resected. Most patients had unruptured aneurysms (10 patients). Five patients had a history of SAH. The aneurysm localization was as follows: 8 anterior communicating artery aneurysms, 4 aneurysms of the internal carotid artery in the area of the posterior communicating artery orifice, and 3 ophthalmic aneurysms. The Hunt-Hess scale was used to evaluate the patients' condition, and the Fisher scale was used to quantify SAH volume. Surgery was performed 14 days after SAH, on average. Contrast-enhanced MRI of the brain was the diagnostic method of choice in a group of patients with space-occupying lesions within the anterior and middle cranial fossae. In some cases, patients underwent CT with reconstruction for assessment of the skull base bone structures. The mean age of patients was 58.3 years. All aneurysms were completely excluded from the cerebral blood flow. No serious complications and deaths in a group of aneurysm patients occurred. Complete tumor removal was performed in 28 patients. Two patients having pituitary macroadenomas with supra- and parasellar spread underwent subtotal resection due to adenoma invasion into the cavernous

  13. Flurbiprofen and hypertension but not hydroxyethyl starch are associated with post-craniotomy intracranial haematoma requiring surgery.

    Science.gov (United States)

    Jian, M; Li, X; Wang, A; Zhang, L; Han, R; Gelb, A W

    2014-11-01

    Post-craniotomy intracranial haematoma is one of the most serious complications after neurosurgery. We examined whether post-craniotomy intracranial haematoma requiring surgery is associated with the non-steroidal anti-inflammatory drugs flurbiprofen, hypertension, or hydroxyethyl starch (HES). A case-control study was conducted among 42 359 patients who underwent elective craniotomy procedures at Beijing Tiantan Hospital between January 2006 and December 2011. A one-to-one control group without post-craniotomy intracranial haematoma was selected matched by age, pathologic diagnosis, tumour location, and surgeon. Perioperative blood pressure records up to the diagnosis of haematoma, the use of flurbiprofen and HES were examined. The incidence of post-craniotomy intracranial haematoma and the odds ratios for the risk factors were determined. A total of 202 patients suffered post-craniotomy intracranial haematoma during the study period, for an incidence of 0.48% (95% CI=0.41-0.55). Haematoma requiring surgery was associated with an intraoperative systolic blood pressure of >160 mm Hg (OR=2.618, 95% CI=2.084-2.723, P=0.007), an intraoperative mean blood pressure of >110 mm Hg (OR=2.600, 95% CI=2.312-3.098, P=0.037), a postoperative systolic blood pressure of >160 mm Hg (OR=2.060, 95% CI= 1.763-2.642, P=0.022), a postoperative mean blood pressure of >110 mm Hg (OR=3.600, 95% CI= 3.226-4.057, P=0.001), and the use of flurbiprofen during but not after the surgery (OR=2.256, 95% CI=2.004-2.598, P=0.005). The intraoperative infusion of HES showed no significant difference between patients who had a haematoma and those who did not. Intraoperative and postoperative hypertension and the use of flurbiprofen during surgery are risk factors for post-craniotomy intracranial haematoma requiring surgery. The intraoperative infusion of HES was not associated with a higher incidence of haematoma. © The Author 2014. Published by Oxford University Press on behalf of the British

  14. Visualization of the electric field evoked by transcranial electric stimulation during a craniotomy using the finite element method.

    Science.gov (United States)

    Tomio, Ryosuke; Akiyama, Takenori; Horikoshi, Tomo; Ohira, Takayuki; Yoshida, Kazunari

    2015-12-30

    Transcranial MEP (tMEP) monitoring is more readily performed than cortical MEP (cMEP), however, tMEP is considered as less accurate than cMEP. The craniotomy procedure and changes in CSF levels must affect current spread. These changes can impair the accuracy. The aim of this study was to investigate the influence of skull deformation and cerebrospinal fluid (CSF) decrease on tMEP monitoring during frontotemporal craniotomy. We used the finite element method to visualize the electric field in the brain, which was generated by transcranial electric stimulation, using realistic 3-dimensional head models developed from T1-weighted images. Surfaces of 5 layers of the head were separated as accurately as possible. We created 3 brain types and 5 craniotomy models. The electric field in the brain radiates out from the cortex just below the electrodes. When the CSF layer is thick, a decrease in CSF volume and depression of CSF surface level during the craniotomy has a major impact on the electric field. When the CSF layer is thin and the distance between the skull and brain is short, the craniotomy has a larger effect on the electric field than the CSF decrease. So far no report in the literature the electric field during intraoperative tMEP using a 3-dimensional realistic head model. Our main finding was that the intensity of the electric field in the brain is most affected by changes in the thickness and volume of the CSF layer. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Drug concentrations in the serum and cerebrospinal fluid of patients treated with norvancomycin after craniotomy.

    Science.gov (United States)

    Wu, Y; Kang, J; Wang, Q

    2017-02-01

    Intracranial infection by gram-positive cocci is commonly found after craniotomy. Norvancomycin was independently developed in China, and had demonstrated therapeutic capability against gram-positive infection. This study investigated the serum and cerebrospinal fluid (CSF) concentrations in patients that received intravenous injection of norvancomycin after craniotomy. Patients with an indwelling catheter in the operational area/ventricle after craniotomy were administered norvancomycin by two approaches: (1) The conventional group consisted of 14 cases that were infused with 0.8 g norvancomycin for 1 h, every 12 h; (2) The continuous administration group consisted of 14 cases that were infused with 0.8 g norvancomycin for 1 h, and then another 0.4 g for 11 h with extended infusion, followed by continuous infusion of 0.4 g norvancomycin for 12 h. Samples of serum and CSF were collected at different time-points to measure norvancomycin levels after administration. In the conventional and continuous administration groups, the peak serum concentrations of norvancomycin were 55.52 ± 26.04 and 59.22 ± 41.88 mg/L, respectively, while those at 24 h were 8.21 ± 6.04 and 8.01 ± 4.17 mg/L, respectively. Meanwhile, peak CSF concentrations were 16.31 ± 11.15 and 8.82 ± 8.91 mg/L, respectively, while those at 24 h were 6.12 ± 2.34 and 6.24 ± 4.38 mg/L, respectively. This preliminary study showed that for the early administration of standard doses of norvancomycin post-neurosurgery, the CSF concentration in both the conventional and continuous administration groups reached or exceeded the 90 % minimum inhibitory concentration (MIC 90 , 2 mg/L) of target bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).

  16. Decompressive craniotomy for the treatment of malignant infarction of the middle cerebral artery: mortality and outcome

    Directory of Open Access Journals (Sweden)

    Gianise Toboliski Bongiorni

    Full Text Available ABSTRACT Objective To assess, by Rankin scale, the functional disability of patients who had a malignant middle cerebral artery (MCA ischemic stroke, who underwent decompressive craniotomy (DC within the first 30 days. Methods A cross-sectional study in a University hospital. Between June 2007 and December 2014, we retrospectively analyzed the records of all patients submitted to DC due to a malignant MCA infarction. The mortality rate was defined during the hospitalization period. The modified outcome Rankin score (mRS was measured 30 days after the procedure, for stratification of the quality of life. Results The DC mortality rate was 30% (95% CI 14.5 to 51.9 for the 20 patients reported. The mRS 30 days postoperatively was ≥ 4 [3.3 to 6] for all patients thereafter. Conclusion DC is to be considered a real alternative for the treatment of patients with a malignant ischemic MCA infarction.

  17. Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice.

    Science.gov (United States)

    Szelényi, Andrea; Bello, Lorenzo; Duffau, Hugues; Fava, Enrica; Feigl, Guenther C; Galanda, Miroslav; Neuloh, Georg; Signorelli, Francesco; Sala, Francesco

    2010-02-01

    There is increasing evidence that the extent of tumor removal in low-grade glioma surgery is related to patient survival time. Thus, the goal of resecting the largest amount of tumor possible without leading to permanent neurological sequelae is a challenge for the neurosurgeon. Electrical stimulation of the brain to detect cortical and axonal areas involved in motor, language, and cognitive function and located within the tumor or along its boundaries has become an essential tool in combination with awake craniotomy. Based on a literature review, discussions within the European Low-Grade Glioma Group, and illustrative clinical experience, the authors of this paper provide an overview for neurosurgeons, neurophysiologists, linguists, and anesthesiologists as well as those new to the field about the stimulation techniques currently being used for mapping sensorimotor, language, and cognitive function in awake surgery for low-grade glioma. The paper is intended to help the understanding of these techniques and facilitate a comparison of results between users.

  18. Stereotactic aspiration versus craniotomy for primary intracerebral hemorrhage: a meta-analysis of randomized controlled trials.

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    Jia-Wei Wang

    Full Text Available BACKGROUND: A wealth of evidence based on the randomized controlled trials (RCTs has indicated that surgery may be a better choice in the management of primary intracerebral hemorrhage (ICH compared to conservative treatment. However, there is considerable controversy over selecting appropriate surgical procedures for ICH. Thus, this meta-analysis was performed to assess the effects of stereotactic aspiration compared to craniotomy in patients with ICH. METHODS: According to the study strategy, we searched PUBMED, EMBASE and Cochrane Central Register of Controlled Trials. Other sources such as the internet-based clinical trial registries, relevant journals and the lists of references were also searched. After literature searching, two investigators independently performed literature screening, assessment of quality of the included trials and data extraction. The outcome measures included death or dependence, total risk of complication, and the risk of rebleeding, gastrointestinal hemorrhage and systematic infection. RESULTS: Four RCTs with 2996 participants were included. The quality of the included trials was acceptable. Stereotactic aspiration significantly decreased the odds of death or dependence at the final follow-up (odds ratio (OR: 0.80, 95% confidence interval (CI: 0.69-0.93; P = 0.004 and the risk of intracerebral rebleeding (OR: 0.44, 95% CI: 0.26-0.74; P = 0.002 compared to craniotomy with no significant heterogeneity among the study results. CONCLUSIONS: The present meta-analysis provides evidence that the stereotactic aspiration may be associated with a reduction in the odds of being dead or dependent in primary ICH, which should be interpreted with caution. Further trials are needed to identify those patients most likely to benefit from the stereotactic aspiration.

  19. One-piece Orbitozygomatic Craniotomy for Resection of Rathke's Cleft Cyst: Operative Video.

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    Dossani, Rimal H; Patra, Devi P; Storey, Christopher; Kalakoti, Piyush; Sun, Hai

    2018-02-01

    Objective  The video stars orbitozygomatic resection of Rathke's cleft cyst with suprasellar extension in a 37-year-old male patient presenting with severe headaches and bitemporal hemianopia. Clinical and radiological characteristics along with surgical technique (positioning, bony opening, surgical dissection and debulking, closure), histopathology, and postoperative course are described. Methods  Preoperative MRI demonstrated a noncontrast-enhancing cystic lesion in the sella with suprasellar extension causing compression of both optic nerves. A one-piece orbitozygomatic craniotomy was performed. The tumor was encountered in the interoptic space. First, the cyst was decompressed and fluid appearing like motor oil was aspirated. Both optic nerves were decompressed and dissected free from the cyst wall. Intraoperatively, the most challenging aspect was separating the tumor from surrounding vascular structures, including bilateral A1 arteries and the left carotid bifurcation. A combination of sharp and blunt dissection was utilized to free the tumor from adhesions to critical neurovascular structures. Once freed, the suprasellar aspect of the tumor was mobilized into the operative cavity and debulked. Finally, the sellar component of the tumor was removed all the way down to the sellar floor. Postoperative MRI demonstrated decompressed bilateral optic nerves with an intact pituitary stalk with preservation of normal pituitary gland. Histopathology identified pathognomonic features consistent with diagnosis of Rathke's cleft cyst, including flattened ciliated epithelium and presence of Rathke's cleft remnants. Results  Postoperatively, bilateral improvement in vision was noted with transient diabetes insipidus. Patient was discharged home on postoperative day 4. Conclusion  A one-piece orbitozygomatic craniotomy is an effective and safe strategy for resection of Rathke's cleft cysts with suprasellar extension. The link to the video can be found at: https

  20. Effect of propofol and sevoflurane on the inflammatory response of patients undergoing craniotomy.

    Science.gov (United States)

    Markovic-Bozic, Jasmina; Karpe, Blaz; Potocnik, Iztok; Jerin, Ales; Vranic, Andrej; Novak-Jankovic, Vesna

    2016-03-22

    The purpose of this randomised, single-centre study was to prospectively investigate the impact of anaesthetic techniques for craniotomy on the release of cytokines IL-6, IL-8, IL-10, and to determine whether intravenous anaesthesia compared to inhalational anaesthesia attenuates the inflammatory response. The study enroled 40 patients undergoing craniotomy, allocated into two equal groups to receive either sevoflurane (n = 20) or propofol (n = 20) in conjunction with remifentanil and rocuronium. The lungs were ventilated mechanically to maintain normocapnia. Remifentanil infusion was adjusted according to the degree of surgical manipulation and increased when mean arterial pressure and the heart rate increased by more than 30 % from baseline. The depth of anaesthesia was adjusted to maintain a bispectral index (BIS) of 40-60. Invasive haemodynamic monitoring was used. Serum levels of IL-6, IL-8 and IL-10 were measured before surgery and anaesthesia, during tumour removal, at the end of surgery, and at 24 and 48 h after surgery. Postoperative complications (pain, vomiting, changes in blood pressure, infection and pulmonary, cardiovascular and neurological events) were monitored during the first 15 days after surgery. Compared with patients anaesthetised with sevoflurane, patients who received propofol had higher levels of IL-10 (p = 0.0001) and lower IL-6/IL-10 concentration ratio during and at the end of surgery (p = 0.0001). Both groups showed only a minor response of IL- 8 during and at the end of the surgery (p = 0.57). Patients who received propofol had higher levels of IL-10 during surgery. Neither sevoflurane nor propofol had any significant impact on the occurrence of postoperative complications. Our findings should incite future studies to prove a potential medically important anti-inflammatory role of propofol in neuroanaesthesia. Identified as NCT02229201 at www.clinicaltrials.gov.

  1. Stereotactic Aspiration versus Craniotomy for Primary Intracerebral Hemorrhage: A Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Wang, Jia-Wei; Li, Jin-Ping; Song, Ying-Lun; Tan, Ke; Wang, Yu; Li, Tao; Guo, Peng; Li, Xiong; Wang, Yan; Zhao, Qi-Huang

    2014-01-01

    Background A wealth of evidence based on the randomized controlled trials (RCTs) has indicated that surgery may be a better choice in the management of primary intracerebral hemorrhage (ICH) compared to conservative treatment. However, there is considerable controversy over selecting appropriate surgical procedures for ICH. Thus, this meta-analysis was performed to assess the effects of stereotactic aspiration compared to craniotomy in patients with ICH. Methods According to the study strategy, we searched PUBMED, EMBASE and Cochrane Central Register of Controlled Trials. Other sources such as the internet-based clinical trial registries, relevant journals and the lists of references were also searched. After literature searching, two investigators independently performed literature screening, assessment of quality of the included trials and data extraction. The outcome measures included death or dependence, total risk of complication, and the risk of rebleeding, gastrointestinal hemorrhage and systematic infection. Results Four RCTs with 2996 participants were included. The quality of the included trials was acceptable. Stereotactic aspiration significantly decreased the odds of death or dependence at the final follow-up (odds ratio (OR): 0.80, 95% confidence interval (CI): 0.69–0.93; P = 0.004) and the risk of intracerebral rebleeding (OR: 0.44, 95% CI: 0.26–0.74; P = 0.002) compared to craniotomy with no significant heterogeneity among the study results. Conclusions The present meta-analysis provides evidence that the stereotactic aspiration may be associated with a reduction in the odds of being dead or dependent in primary ICH, which should be interpreted with caution. Further trials are needed to identify those patients most likely to benefit from the stereotactic aspiration. PMID:25237813

  2. Hyperammonemic coma after craniotomy: Hepatic encephalopathy from upper gastrointestinal hemorrhage or valproate side effect?

    Science.gov (United States)

    Guo, Xiaopeng; Wei, Junji; Gao, Lu; Xing, Bing; Xu, Zhiqin

    2017-01-01

    Abstract Rationale: Postoperative coma is not uncommon in patients after craniotomy. It generally presents as mental state changes and is usually caused by intracranial hematoma, brain edema, or swelling. Hyperammonemia can also result in postoperative coma; however, it is rarely recognized as a potential cause in coma patients. Hyperammonemic coma is determined through a complicated differential diagnosis, and although it can also be induced as a side effect of valproate (VPA), this cause is frequently unrecognized or confused with upper gastrointestinal hemorrhage (UGH)-induced hepatic encephalopathy. We herein present a case of valproate-induced hyperammonemic encephalopathy (VHE) to illustrate the rarity of such cases and emphasize the importance of correct diagnosis and proper treatment. Patient concerns and diagnoses: A 61-year-old woman with meningioma was admitted into our hospital. Radical resection of the tumor was performed, and the patient recovered well as expected. After administration of valproate for 7 days, the patient was suddenly found in a deep coma, and her mental state deteriorated rapidly. The diagnoses of hepatic encephalopathy was confirmed. However, whether it origins from upper gastrointestinal hemorrhage or valproate side effect is uncertain. Interventions and outcomes: The patient's condition fluctuated without improvement during the subsequent 3 days under the treatment of reducing ammonia. With the discontinuation of valproate treatment, the patient regained complete consciousness within 48 hours, and her blood ammonia decreased to the normal range within 4 days. Lessons subsections: VHE is a rare but serious complication in patients after craniotomy and is diagnosed by mental state changes and elevated blood ammonia. Thus, the regular perioperative administration of VPA, which is frequently neglected as a cause of VHE, should be emphasized. In addition, excluding UGH prior to providing a diagnosis and immediately discontinuing VPA

  3. Comparison of Dexmedetomidine and Remifentanil on Airway Reflex and Hemodynamic Changes during Recovery after Craniotomy

    Science.gov (United States)

    Kim, Hyunzu; Min, Kyeong Tae; Lee, Jeong Rim; Ha, Sang Hee; Lee, Woo Kyung; Seo, Jae Hee

    2016-01-01

    Purpose During emergence from anesthesia for a craniotomy, maintenance of hemodynamic stability and prompt evaluation of neurological status is mandatory. The aim of this prospective, randomized, double-blind study was to compare the effects of dexmedetomidine and remifentanil on airway reflex and hemodynamic change in patients undergoing craniotomy. Materials and Methods Seventy-four patients undergoing clipping of unruptured cerebral aneurysm were recruited. In the dexmedetomidine group, patients were administered dexmedetomidine (0.5 µg/kg) for 5 minutes, while the patients of the remifentanil group were administered remifentanil with an effect site concentration of 1.5 ng/mL until endotracheal extubation. The incidence and severity of cough and hemodynamic variables were measured during the recovery period. Hemodynamic variables, respiration rate, and sedation scale were measured after extubation and in the post-anesthetic care unit (PACU). Results The incidence of grade 2 and 3 cough at the point of extubation was 62.5% in the dexmedetomidine group and 53.1% in the remifentanil group (p=0.39). Mean arterial pressure (p=0.01) at admission to the PACU and heart rate (p=0.04 and 0.01, respectively) at admission and at 10 minutes in the PACU were significantly lower in the dexmedetomidine group. Respiration rate was significantly lower in the remifentanil group at 2 minutes (p<0.01) and 5 minutes (p<0.01) after extubation. Conclusion We concluded that a single bolus of dexmedetomidine (0.5 µg/kg) and remifentanil infusion have equal effectiveness in attenuating coughing and hemodynamic changes in patients undergoing cerebral aneurysm clipping; however, dexmedetomidine leads to better preservation of respiration. PMID:27189295

  4. Differential Effects of Intraoperative Positive End-expiratory Pressure (PEEP) on Respiratory Outcome in Major Abdominal Surgery Versus Craniotomy

    Science.gov (United States)

    Vidal Melo, Marcos F.; Staehr-Rye, Anne Kathrine; Bittner, Edward A.; Kurth, Tobias; Eikermann, Matthias

    2016-01-01

    Objectives In this study, we examined whether (1) positive end-expiratory pressure (PEEP) has a protective effect on the risk of major postoperative respiratory complications in a cohort of patients undergoing major abdominal surgeries and craniotomies, and (2) the effect of PEEP is differed by surgery type. Background Protective mechanical ventilation with lower tidal volumes and PEEP reduces compounded postoperative complications after abdominal surgery. However, data regarding the use of intraoperative PEEP is conflicting. Methods In this observational study, we included 5915 major abdominal surgery patients and 5063 craniotomy patients. Analysis was performed using multivariable logistic regression. The primary outcome was a composite of major postoperative respiratory complications (respiratory failure, reintubation, pulmonary edema, and pneumonia) within 3 days of surgery. Results Within the entire study population (major abdominal surgeries and craniotomies), we found an association between application of PEEP ≥5cmH2O and a decreased risk of postoperative respiratory complications compared with PEEP 5cmH2O was associated with a significant lower odds of respiratory complications in patients undergoing major abdominal surgery (odds ratio 0.53, 95% confidence interval 0.39 – 0.72), effects that translated to deceased hospital length of stay [median hospital length of stay : 6 days (4–9 days), incidence rate ratios for each additional day: 0.91 (0.84 - 0.98)], whereas PEEP >5cmH2O was not significantly associated with reduced odds of respiratory complications or hospital length of stay in patients undergoing craniotomy. Conclusions The protective effects of PEEP are procedure specific with meaningful effects observed in patients undergoing major abdominal surgery. Our data suggest that default mechanical ventilator settings should include PEEP of 5–10cmH2O during major abdominal surgery. PMID:26496082

  5. Proliferation Index Predicts Survival after Second Craniotomy within 6 Months of Adjuvant Radiotherapy for High-grade Glioma.

    Science.gov (United States)

    Gzell, C; Wheeler, H; Huang, D; Gaur, P; Chen, J; Kastelan, M; Back, M

    2016-03-01

    To determine pathological features that predict survival in patients having repeat craniotomy within 6 months of radiotherapy for high-grade glioma (HGG). HGG patients (World Health Organization grade 3/4) managed with repeat craniotomy within 6 months of completing radiotherapy between 2008 and 2012 were included. Based on the presence of residual tumour cells, the pathology was reported as pathological progression or pathological pseudoprogression. The proliferation index (Ki67) was reported and compared with initial pathology as a percentage change. Tumour necrosis was estimated as a percentage of the specimen. Overall survival was calculated in months. Of 327 patients managed with HGG, 27 patients underwent repeat craniotomy within 6 months of radiotherapy. The median survival after reoperation was 11 months (95% confidence interval 1-22). Ki67 at reoperation of 0%, 1-9% and >10% was associated with survival with a median survival of 13, 13 and 3 months, respectively (P = 0.007). Change in Ki67 was also associated with median survival, with 80% reduction median survival 13 months, P = 0.02. Widespread treatment-related necrosis improved outcome, with >80% necrosis having a median survival of 13 months versus 3 months in those with craniotomy within 6 months of radiotherapy is not an independent indicator of prognosis. Patients with residual tumour that had a low Ki67 had a similar median survival as those with only treatment necrosis. Reduced proliferation of residual tumour cells and widespread necrosis may be more important indicators for future outcome. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  6. Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy

    OpenAIRE

    Dube, Surya Kumar; Pandia, Mihir Prakash; Chaturvedi, Arvind; Bithal, Parmod; Dash, Hari Hara

    2015-01-01

    Background: Post operative recovery has been reported to be faster with desflurane than sevoflurane anesthesia in previous studies. The use of desflurane is often criticized in neurosurgery due to the concerns of cerebral vasodilation and increase in ICP and studies comparing desflurane and sevoflurane in neurosurgey are scarce. So we compared the intraoperative brain condition, hemodynamics and postoperative recovery in patients undergoing elective supratentorial craniotomy receiving either ...

  7. Correlation of measured and calculated serum osmolality during mannitol or hypertonic saline infusion in patients after craniotomy: a study protocol and statistical analysis plan for a randomised controlled trial

    Science.gov (United States)

    Li, Qian; Xu, Ming; Zhou, Jian-Xin

    2014-01-01

    Introduction Brain oedema is a major complication after craniotomy. Hyperosmolar agents have been used as the medical treatment for this condition. Measurement and estimation of serum osmolality during hyperosmolar agent infusion is of clinical importance to evaluate clinical efficacy, adjust dosage and avoid side effects. However, several studies have shown that calculated serum osmolality may lead to a systematic bias compared with direct measurement. In the present study, mannitol or hypertonic saline (HS) will be used in patients after elective craniotomy. We aim to determine the accuracy of serum osmolality estimation during the application of hyperosmolar agent. Methods and analysis The study is a prospective, randomised, double-blinded, controlled, parallel-group design. Adult patients requiring the use of hyperosmolar agents for the prevention or treatment of postoperative brain oedema are enrolled and assigned randomly to one of the two treatment study groups, labelled as ‘M group’ and ‘HS group’. Patients in the M and HS groups receive intravenous infusion of 125 mL of either 20% mannitol or 3.1% sodium chloride solution, respectively. Data will be collected immediately before the infusion of study agents, 15, 30, 60, 120, 240 and 360 min after the start of infusion of experimental agents, which includes serum osmolality, concentration of serum sodium, potassium, urea and glucose. Serum osmolality will be measured by means of freezing point depression. Estimated serum osmolality will also be calculated by using four formulas published previously. Osmole gap is calculated as the difference between the measured and the estimated values. The primary endpoint is the correlation of measured and estimated serum osmolality during hyperosmolar agent infusion. Ethics and dissemination The study was approved by the International Review Board (IRB) of Beijing Tiantan Hospital, Capital Medical University. Study findings will be disseminated through peer

  8. Diagnostic work up for language testing in patients undergoing awake craniotomy for brain lesions in language areas.

    Science.gov (United States)

    Bilotta, Federico; Stazi, Elisabetta; Titi, Luca; Lalli, Diana; Delfini, Roberto; Santoro, Antonio; Rosa, Giovanni

    2014-06-01

    Awake craniotomy is the technique of choice in patients with brain tumours adjacent to primary and accessory language areas (Broca's and Wernicke's areas). Language testing should be aimed to detect preoperative deficits, to promptly identify the occurrence of new intraoperative impairments and to establish the course of postoperative language status. Aim of this case series is to describe our experience with a dedicated language testing work up to evaluate patients with or at risk for language disturbances undergoing awake craniotomy for brain tumour resection. Pre- and intra operative testing was accomplished with 8 tests. Intraoperative evaluation was accomplished when patients were fully cooperative (Ramsey language testings were normal in 9 patients (45%), showed mild to moderate language deficit in 8 (40%) and severe language deficit or aphasic disorders in 3 (15%). Broca's area was identified in 15 patients, in all cases by counting arrest during stimulation and in 12 cases by naming arrest. In this article we describe our experience using a language testing work up to evaluate - pre, intra and postoperatively - patients undergoing awake craniotomy for brain tumour resection with preoperative language disturbances or at risk for postoperative language deficits. This approach allows a systematic evaluation and recording of language function status and can be accomplished even when a neuropsychologist or speech therapist are not involved in the operation crew.

  9. Specificities of Awake Craniotomy and Brain Mapping in Children for Resection of Supratentorial Tumors in the Language Area.

    Science.gov (United States)

    Delion, Matthieu; Terminassian, Aram; Lehousse, Thierry; Aubin, Ghislaine; Malka, Jean; N'Guyen, Sylvie; Mercier, Philippe; Menei, Philippe

    2015-12-01

    In the pediatric population, awake craniotomy began to be used for the resection of brain tumor located close to eloquent areas. Some specificities must be taken into account to adapt this method to children. The aim of this clinical study is to not only confirm the feasibility of awake craniotomy and language brain mapping in the pediatric population but also identify the specificities and necessary adaptations of the procedure. Six children aged 11 to 16 were operated on while awake under local anesthesia with language brain mapping for supratentorial brain lesions (tumor and cavernoma). The preoperative planning comprised functional magnetic resonance imaging (MRI) and neuropsychologic and psychologic assessment. The specific preoperative preparation is clearly explained including hypnosis conditioning and psychiatric evaluation. The success of the procedure was based on the ability to perform the language brain mapping and the tumor removal without putting the patient to sleep. We investigated the pediatric specificities, psychological experience, and neuropsychologic follow-up. The children experienced little anxiety, probably in large part due to the use of hypnosis. We succeeded in doing the cortical-subcortical mapping and removing the tumor without putting the patient to sleep in all cases. The psychological experience was good, and the neuropsychologic follow-up showed a favorable evolution. Preoperative preparation and hypnosis in children seemed important for performing awake craniotomy and contributing language brain mapping with the best possible psychological experience. The pediatrics specificities are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Rapid and low-invasive functional brain mapping by realtime visualization of high gamma activity for awake craniotomy.

    Science.gov (United States)

    Kamada, K; Ogawa, H; Kapeller, C; Prueckl, R; Guger, C

    2014-01-01

    For neurosurgery with an awake craniotomy, the critical issue is to set aside enough time to identify eloquent cortices by electrocortical stimulation (ECS). High gamma activity (HGA) ranging between 80 and 120 Hz on electrocorticogram (ECoG) is assumed to reflect localized cortical processing. In this report, we used realtime HGA mapping and functional magnetic resonance imaging (fMRI) for rapid and reliable identification of motor and language functions. Three patients with intra-axial tumors in their dominant hemisphere underwent preoperative fMRI and lesion resection with an awake craniotomy. All patients showed significant fMRI activation evoked by motor and language tasks. After the craniotomy, we recorded ECoG activity by placing subdural grids directly on the exposed brain surface. Each patient performed motor and language tasks and demonstrated realtime HGA dynamics in hand motor areas and parts of the inferior frontal gyrus. Sensitivity and specificity of HGA mapping were 100% compared to ECS mapping in the frontal lobe, which suggested HGA mapping precisely indicated eloquent cortices. The investigation times of HGA mapping was significantly shorter than that of ECS mapping. Specificities of the motor and language-fMRI, however, did not reach 85%. The results of HGA mapping was mostly consistent with those of ECS mapping, although fMRI tended to overestimate functional areas. This novel technique enables rapid and accurate functional mapping.

  11. Keyhole craniotomy through retrosigmoid approach followed by microvascular decompression for primary trigeminal neuralgia:a report of 23 cases

    Directory of Open Access Journals (Sweden)

    Gang-ge CHENG

    2011-03-01

    Full Text Available Objective To explore the surgical technique,effects,and complications of keyhole craniotomy through retrosigmoid approach followed by microvascular decompression for primary trigeminal neuralgia.Methods The craniotomy with a keyhole incision above postauricular hairline followed by microvascular decompression was performed in 23 patients with primary trigeminal neuralgia.Dissection of intracranial part of trigeminal nerve under microscope was done to search for the offending vessels,which were thereby freed and between which and the root entry zone(REZ of trigeminal nerve the Teflon grafts were placed.Effects and complications were observed in follow-up,ranging from 1 month to 2 years.Results Out of 23 patients who were all found compression in REZ of trigeminal nerves by the offending vessels in operation,disappearance of symptoms post-surgery was found in 22 cases,face numbness on the surgical side in 3 cases and no effects in 1 case.Recurrence of pain was not observed in patients who had initially benefited from the surgery at the follow-up.Conclusion The keyhole craniotomy through retrosigmoid approach followed by microvascular decompression is safe and effective for primary trigeminal neuralgia,in which accurate technique during operation plays a vital role in the decrease of complications and the outcome post-surgery.

  12. Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study.

    Science.gov (United States)

    Sneh-Arbib, O; Shiferstein, A; Dagan, N; Fein, S; Telem, L; Muchtar, E; Eliakim-Raz, N; Rubinovitch, B; Rubin, G; Rappaport, Z H; Paul, M

    2013-12-01

    Neurosurgery is characterized by a prolonged risk period for surgical site infection (SSI), mainly related to the presence of cerebrospinal fluid (CSF) drains. We aimed to examine factors associated with post-neurosurgical SSIs, focusing on post-operative factors. A prospective cohort study was conducted in a single center over a period of 18 months in Israel. Included were adult patients undergoing clean or clean-contaminated craniotomy, including craniotomies with external CSF drainage or shunts. SSIs were defined by the Centers for Disease Control and Prevention (CDC) criteria for healthcare-associated infections. All patients were followed up for 90 days and those with foreign body insertion for 1 year. We compared patients with and without SSI. A multivariable regression analysis for SSI was conducted including uncorrelated variables significantly associated with SSI. A total of 502 patients were included, with 138 (27.5%) undergoing emergent or urgent craniotomy. The overall SSI rate was 5.6% (28 patients), of which 3.2% (16 patients) were intracerebral. Non-elective surgery, external CSF drainage/monitoring devices, re-operation, and post-operative respiratory failure were independently associated with subsequent SSI. External CSF devices was the only significant risk factor for intracerebral SSIs (p operative infection acquisition through external CSF devices. Standard operating procedures for their maintenance are necessary.

  13. Anaesthetic management for awake craniotomy in brain glioma resection: initial experience in Military Hospital Mohamed V of Rabat.

    Science.gov (United States)

    Meziane, Mohammed; Elkoundi, Abdelghafour; Ahtil, Redouane; Guazaz, Miloudi; Mustapha, Bensghir; Haimeur, Charki

    2017-01-01

    The awake brain surgery is an innovative approach in the treatment of tumors in the functional areas of the brain. There are various anesthetic techniques for awake craniotomy (AC), including asleep-awake-asleep technique, monitored anesthesia care, and the recent introduced awake-awake-awake method. We describe our first experience with anesthetic management for awake craniotomy, which was a combination of these techniques with scalp nerve block, and propofol/rémifentanil target controlled infusion. A 28-year-oldmale underwent an awake craniotomy for brain glioma resection. The scalp nerve block was performed and a low sedative state was maintained until removal of bone flap. During brain glioma resection, the patient awake state was maintained without any complications. Once, the tumorectomy was completed, the level of anesthesia was deepened and a laryngeal mask airway was inserted. A well psychological preparation, a reasonable choice of anesthetic techniques and agents, and continuous team communication were some of the key challenges for successful outcome in our patient.

  14. A comparison of equivolume, equiosmolar solutions of hypertonic saline and mannitol for brain relaxation during elective supratentorial craniotomy.

    Science.gov (United States)

    Hernández-Palazón, Joaquín; Fuentes-García, Diego; Doménech-Asensi, Paloma; Piqueras-Pérez, Claudio; Falcón-Araña, Luis; Burguillos-López, Sebastián

    2016-01-01

    Hyperosmolar solutions have been used in neurosurgery to reduce brain volume and facilitate surgical exposure. The purpose of this study was to compare the effects of equivolume, equiosmolar solutions of mannitol and hypertonic saline (HS) on brain relaxation, intensive care unit (ICU) and hospital stay, postoperative outcomes and incidence of side-effects in patients undergoing elective supratentorial craniotomy. In a randomised, prospective, double-blind study, 60 patients undergoing elective supratentorial craniotomy were randomised 1:1 to receive 3 ml/kg of either 20% mannitol or 3% HS. The primary outcome was the surgical condition of the brain assessed by the neurosurgeon using a 4-point scale after opening the dura (1 = relaxed, 2 = satisfactory, 3 = firm and 4 = bulging). Secondary outcomes were electrolytes, blood gases, plasma osmolality and haemodynamic variables measured at 0 min, 30 min, 2 h and 6 h after infusion. Also, predefined postoperative complications, length of ICU and hospital stay were recorded. Appropriate statistical tests were used for comparison; p craniotomy, but less effective in patients with pre-existing mass effect and midline shift.

  15. The Use of the Target Cancellation Task to Identify Eloquent Visuospatial Regions in Awake Craniotomies: Technical Note.

    Science.gov (United States)

    Conner, Andrew K; Glenn, Chad; Burks, Joshua D; McCoy, Tressie; Bonney, Phillip A; Chema, Ahmed A; Case, Justin L; Brunner, Scott; Baker, Cordell; Sughrue, Michael

    2016-11-17

    The success of awake craniotomies relies on the patient's performance of function-specific tasks that are simple, quick, and reproducible. Intraoperative identification of visuospatial function through cortical and subcortical mapping has utilized a variety of intraoperative tests, each with its own benefits and drawbacks. In light of this, we developed a simple software program that aids in preventing neglect by simulating a target-cancellation task on a portable electronic device. In this report, we describe the interactive target cancellation task and have reviewed seven consecutive patients who underwent awake craniotomy for parietal and/or posterior temporal infiltrating brain tumors of the non-dominant hemisphere. Each of these patients performed target cancellation and line bisection tasks intraoperatively. The outcomes of each patient and testing scenario are described. Positive intraoperative cortical and subcortical sites involved with visuospatial processing were identified in three of the seven patients using the target cancellation and confirmed utilizing the line-bisection task. No identification of visuospatial function was accomplished utilizing the line-bisection task alone. Complete visuospatial function mapping was completed in less than 10 minutes in all patients. No patients had preoperative or postoperative hemineglect. Our findings highlight the feasibility of the target cancellation technique for use during awake craniotomy to aid in avoiding postoperative hemineglect. Target cancellation may offer an alternative method of cortical and subcortical visuospatial mapping in patients unable to perform other commonly used modalities.

  16. Intraventricular administration of tigecycline for the treatment of multidrug-resistant bacterial meningitis after craniotomy: a case report.

    Science.gov (United States)

    Wu, Yuanxing; Chen, Kai; Zhao, Jingwei; Wang, Qiang; Zhou, Jianxin

    2018-02-01

    Intracranial infections, especially multidrug-resistant (MDR) bacterial meningitis, are one of the most severe complications after craniotomy and may greatly impact patient outcomes. We report a case of severe MDR Klebsiella pneumonia meningitis after craniotomy that was treated with three different dosages of tigecycline (Pfizer, New York, NY, U.S.A.)via a combined intravenous (IV) and intracerebroventricular (ICV) administration. Here, we discuss the pharmacokinetics (PK) of a combined IV and ICV tigecycline administration for a patient with an intracranial infection after craniotomy. In the present case, three different dosages of tigecycline were administered: 49 mg IV plus 1 mg ICV q12 h, 45 mg IV plus 5 mg ICV q12 h, 40 mg IV plus 10 mg ICV q12 h. The combined IV and ICV administration might improve CSF tigecycline concentrations, and in this case, the methods of administration were safe and effective.

  17. Charting service quality gaps

    OpenAIRE

    Cândido, Carlos; Morris, D. S.

    2000-01-01

    Some of the most influential models in the service management literature (Parasuraman et al., 1985; Grönroos, 1990) focus on the concept of service quality gap (SQG). Parasuraman et al. (1985) define a pioneering model with five SQGs, the concepts of which are amplified in Brogowicz et al.’s (1990) model. The latter has five types of encompassing gaps: information and feedback-related gaps; design-related gaps; implementation-related gaps; communication-related gaps; and customers’ perception...

  18. A comparison between sevoflurane and desflurane anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery.

    Science.gov (United States)

    Magni, Giuseppina; Rosa, Italia La; Melillo, Guido; Savio, Angela; Rosa, Giovanni

    2009-08-01

    Desflurane in neurosurgery may be beneficial because it facilitates postoperative early neurologic evaluation. However, its use has been debated because of its capacity to promote cerebral vasodilatation. Sevoflurane has been extensively used in neurosurgical patients. In this prospective clinical trial, we compared early postoperative recovery and cognitive function in patients undergoing craniotomy for supratentorial expanding lesions and receiving sevoflurane or desflurane anesthesia. One hundred twenty patients, ASA physical status I-III (66 men), Glascow Coma Scale 15, undergoing craniotomy for supratentorial expanding lesions were enrolled in the study. Patients were randomly allocated to two anesthetic regimens. In Group S (60 patients, 52 +/- 16 yr), anesthesia was maintained using sevoflurane with end-tidal of 1.5%-2% and was age adjusted to obtain approximately 1.2 minimum alveolar anesthetic concentration. In Group D (60 patients, 60 +/- 14 yr), anesthesia was maintained using desflurane with end-tidal of 6%-7% and was age adjusted to obtain approximately 1.2 minimum alveolar concentration. Emergence time was measured as the time from drug discontinuation to the time at which patients opened their eyes; tracheal extubation time was measured as the time from anesthetic discontinuation and tracheal extubation. Recovery time was measured as the time elapsing from discontinuation of anesthetic and the time when patients were able to recall their name and date of birth. Cognitive behavior was evaluated with the Short Orientation Memory Concentration Test. In the postanesthesia care unit, a blinded observer monitored the patients for 3 h; the incidence of hemodynamic events, pain, nausea, and shivering requiring rescue medication was recorded. The mean emergence time (12.2 +/- 4.9 min in Group S vs 10.8 +/- 7.2 min in Group D; P = ns) was similar in the two groups, whereas the mean extubation time and recovery time were longer in Group S (15.2 +/- 3.0 min in

  19. Anti-inflammatory and immune regulatory effects of acupuncture after craniotomy: study protocol for a parallel-group randomized controlled trial.

    Science.gov (United States)

    Cho, Seung-Yeon; Yang, Seung-Bo; Shin, Hee Sup; Lee, Seung Hwan; Koh, Jun Seok; Kwon, Seungwon; Jung, Woo-Sang; Moon, Sang-Kwan; Park, Jung-Mi; Ko, Chang-Nam; Park, Seong-Uk

    2017-01-10

    Despite recent advances in the medical and surgical fields, complications such as infection, pneumonia, or brain swelling may occur after a craniotomy. In some patients, perioperative antibiotic prophylaxis causes adverse effects such as itching, rash, or digestive conditions. Certain patients still develop infections severe enough to require a repeat operation despite antibiotic prophylaxis. Acupuncture has been used to treat inflammatory conditions, and many basic and clinical studies have provided evidence of its anti-inflammatory and immune regulatory effects. The aim of this study is to explore the effects of acupuncture on inflammation and immune function after craniotomy. This trial will be a single-center, parallel-group clinical trial. Forty patients who underwent craniotomy for an unruptured aneurysm, facial spasm, or a brain tumor will be allocated to either the study or the control group. The study group will receive conventional management as well as acupuncture, electroacupuncture, and intradermal acupuncture, which will start within 48 h of the craniotomy. The patients will receive a total of six sessions within 8 days. The control group will only receive conventional management. The primary outcome measure will be the C-reactive protein levels, while the secondary outcomes will be the serum erythrocyte sedimentation rate and the tumor necrosis factor-α, interleukin (IL)-1β, and IL-6 levels measured at four different time points: within 48 h prior to the craniotomy and on days 2, 4, and 7 after surgery. The presence of fever and infection, the use of additional antibiotics, the presence of infection, including pneumonia or urinary tract infection, and safety will also be investigated. In this trial, we will observe whether acupuncture has anti-inflammatory and immune regulatory effects after a craniotomy. If our study yields positive results and a placebo-controlled study also finds favorable results following our study, acupuncture could be

  20. Behind the Pay Gap

    Science.gov (United States)

    Dey, Judy Goldberg; Hill, Catherine

    2007-01-01

    Women have made remarkable gains in education during the past three decades, yet these achievements have resulted in only modest improvements in pay equity. The gender pay gap has become a fixture of the U.S. workplace and is so ubiquitous that many simply view it as normal. "Behind the Pay Gap" examines the gender pay gap for college graduates.…

  1. A novel craniotomy simulation system for evaluation of stereo-pair reconstruction fidelity and tracking

    Science.gov (United States)

    Yang, Xiaochen; Clements, Logan W.; Conley, Rebekah H.; Thompson, Reid C.; Dawant, Benoit M.; Miga, Michael I.

    2016-03-01

    Brain shift compensation using computer modeling strategies is an important research area in the field of image-guided neurosurgery (IGNS). One important source of available sparse data during surgery to drive these frameworks is deformation tracking of the visible cortical surface. Possible methods to measure intra-operative cortical displacement include laser range scanners (LRS), which typically complicate the clinical workflow, and reconstruction of cortical surfaces from stereo pairs acquired with the operating microscopes. In this work, we propose and demonstrate a craniotomy simulation device that permits simulating realistic cortical displacements designed to measure and validate the proposed intra-operative cortical shift measurement systems. The device permits 3D deformations of a mock cortical surface which consists of a membrane made of a Dragon Skin® high performance silicone rubber on which vascular patterns are drawn. We then use this device to validate our stereo pair-based surface reconstruction system by comparing landmark positions and displacements measured with our systems to those positions and displacements as measured by a stylus tracked by a commercial optical system. Our results show a 1mm average difference in localization error and a 1.2mm average difference in displacement measurement. These results suggest that our stereo-pair technique is accurate enough for estimating intra-operative displacements in near real-time without affecting the surgical workflow.

  2. The Incidence and Risk Factors of Meningitis after Major Craniotomy in China: A Retrospective Cohort Study

    Science.gov (United States)

    Yu, Shenglei; Sun, Feng; Ruan, Qiaoling; Zhang, Wenhong; Shao, Lingyun; Chen, Shu

    2014-01-01

    Background Meningitis after neurosurgery can result in severe morbidity and high mortality. Incidence varies among regions and limited data are focused on meningitis after major craniotomy. Aim This retrospective cohort study aimed to determine the incidence, risk factors and microbiological spectrum of postcraniotomy meningitis in a large clinical center of Neurosurgery in China. Methods Patients who underwent neurosurgeries at the Department of Neurosurgery in Huashan Hospital, the largest neurosurgery center in Asia and the Pacific, between 1stJanuary and 31st December, 2008 were selected. Individuals with only shunts, burr holes, stereotactic surgery, transsphenoidal or spinal surgery were excluded. The complete medical records of each case were reviewed, and data on risk factors were extracted and evaluated for meningitis. Results A total of 65 meningitides were identified among 755 cases in the study, with an incidence of 8.60%. The risk of meningitis was increased by the presence of diabetes mellitus (odds ratio [OR], 6.27; P = 0.009), the use of external ventricular drainage (OR, 4.30; P = 0.003) and the use of lumbar drainage (OR, 17.23; Pcraniotomy. Diabetic patients or those with cerebral spinal fluid shunts carry significant high risk of infection. Thus, identification of the risk factors as soon as possible will help physicians to improve patient care. PMID:25003204

  3. Comparison of Conscious Sedation and Asleep-Awake-Asleep Techniques for Awake Craniotomy.

    Science.gov (United States)

    Dilmen, Ozlem Korkmaz; Akcil, Eren Fatma; Oguz, Abdulvahap; Vehid, Hayriye; Tunali, Yusuf

    2017-01-01

    Since awake craniotomy (AC) has become a standard of care for supratentorial tumour resection, especially in the motor and language cortex, determining the most appropriate anaesthetic protocol is very important. The aim of this retrospective study is to compare the effectiveness of conscious sedation (CS) to "awake-asleep-awake" (AAA) techniques for supratentorial tumour resection. Forty-two patients undergoing CS and 22 patients undergoing AAA were included in the study. The primary endpoint was to compare the CS and AAA techniques with respect to intraoperative pain and agitation in patients undergoing supratentorial tumour resection. The secondary endpoint was comparison of the other intraoperative complications. This study results show that the incidence of intraoperative agitation and seizure were lower in the AAA group than in the CS group. Intraoperative blood pressures were significantly higher in the CS group than in the AAA group during the pinning and incision, but the level of blood pressures did not need antihypertensive treatment. Otherwise, blood pressures were significantly higher in the AAA group than in the CS group during the neurological examination and the severity of hypertension needed statistically significant more antihypertensive treatment in the AAA group. As a result of hypertension, the amount of intraoperative bleeding was higher in the AAA group than in the CS group. In conclusion, the AAA technique may provide better results with respect to agitation and seizure, but intraoperative hypertension needed a vigilant follow-up especially in the wake-up period. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Is a wake-up call in order? Review of the evidence for awake craniotomy.

    Science.gov (United States)

    Paldor, Iddo; Drummond, Katharine J; Awad, Mohammed; Sufaro, Yuval Z; Kaye, Andrew H

    2016-01-01

    Awake craniotomy (AC) has been used in increasing frequency in the past few decades. It has mainly been used for resection of intrinsic tumors, but also, rarely, for other pathologies. The vast majority of reports specific to one pathology, however, have focused on resection of low grade glioma in the awake setting. Tumors in eloquent areas have mainly been resected when the patient is awake for the purpose of preservation of function. Motor function is the most documented, and most successfully preserved function. Other functions are harder to localize with direct electrical stimulation (DES), and thus more difficult to preserve. The success rate of DES localization correlates to the rate of function preservation. The effect of AC on extent of resection is inconsistent in the literature. Other functions, such as sensory and visuospatial recognition, have been protected during AC, but this is best performed in large, referral centers that have experience with the procedure. Other benefits to AC, such as cost-effectiveness and reduction in patient pain and anxiety, have also been reported. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. [Long-term cognitive deficits in patients operated on for cerebral aneurysm by craniotomy and clipping].

    Science.gov (United States)

    Perea Bartolomé, M Victoria; Ladera Fernández, V; Maíllo Sánchez, A

    2009-01-01

    An important number of patients continue to present cognitive disorders after cerebral aneurysm surgeries, not only within the acute phase but also years after the subarachnoid hemorrhage and in spite of their good functional recovery. The percentage of patients who continues to present cognitive alterations after 4 years of cerebral aneurysm surgery is studied within a sample of people who had pterional craniotomy and ICA clipping (Intracranial Aneurysm Clips). The repercussions on their daily life activities and quality of life are also considered and we analyze how are these deficits related to the cerebral location of the aneurysm. Twenty-nine adults of both sexes, without cognitive disorder or psychiatric precedents who had an aneurysm surgery in different cerebral locations. All the patients were independent in their daily life activities. The majority of the patients had good neurological resolution four years after the surgery and their cognitive performances were within the normality. Nevertheless, there is a small group that continues to present cognitive performances below what was expected for their age and educational level. The performances in cognitive tasks of attention, temporalspatial orientation, visual naming, memory, auditory verbal learning, visual-constructive skills and executive function do not depend on the cerebral location of the aneurysm.

  6. Robot- and computer-assisted craniotomy (CRANIO): from active systems to synergistic man-machine interaction.

    Science.gov (United States)

    Cunha-Cruz, V; Follmann, A; Popovic, A; Bast, P; Wu, T; Heger, S; Engelhardt, M; Schmieder, K; Radermacher, K

    2010-01-01

    Computer and robot assistance in craniotomy/craniectomy procedures is intended to increase precision and efficiency of the removal of calvarial tumours, enabling the preoperative design and manufacturing of the corresponding implant. In the framework of the CRANIO project, an active robotic system was developed to automate the milling processes based on a predefined resection planning. This approach allows for a very efficient milling process, but lacks feedback of the intra-operative process to the surgeon. To better integrate the surgeon into the process, a new teleoperated synergistic architecture was designed. This enables the surgeon to realize changes during the procedure and use their human cognitive capabilities. The preoperative planning information is used as guidance for the user interacting with the system through a master-slave architecture. In this article, the CRANIO system is presented together with this new synergistic approach. Experiments have been performed to evaluate the accuracy of the system in active and synergistic modes for the bone milling procedure. The laboratory studies showed the general feasibility of the new concept for the selected medical procedure and determined the accuracy of the system. Although the integration of the surgeon partially reduces the efficiency of the milling process compared with a purely active (automatic) milling, it provides more feedback and flexibility to the user during the intra-operative procedure.

  7. Effects of Anesthetic Management on Early Postoperative Recovery, Hemodynamics and Pain After Supratentorial Craniotomy.

    Science.gov (United States)

    Ayrian, Eugenia; Kaye, Alan David; Varner, Chelsia L; Guerra, Carolina; Vadivelu, Nalini; Urman, Richard D; Zelman, Vladimir; Lumb, Philip D; Rosa, Giovanni; Bilotta, Federico

    2015-10-01

    Various clinical trials have assessed how intraoperative anesthetics can affect early recovery, hemodynamics and nociception after supratentorial craniotomy. Whether or not the difference in recovery pattern differs in a meaningful way with anesthetic choice is controversial. This review examines and compares different anesthetics with respect to wake-up time, hemodynamics, respiration, cognitive recovery, pain, nausea and vomiting, and shivering. When comparing inhalational anesthetics to intravenous anesthetics, either regimen produces similar recovery results. Newer shorter acting agents accelerate the process of emergence and extubation. A balanced inhalational/intravenous anesthetic could be desirable for patients with normal intracranial pressure, while total intravenous anesthesia could be beneficial for patients with elevated intracranial pressure. Comparison of inhalational anesthetics shows all appropriate for rapid emergence, decreasing time to extubation, and cognitive recovery. Comparison of opioids demonstrates similar awakening and extubation time if the infusion of longer acting opioids was ended at the appropriate time. Administration of local anesthetics into the skin, and addition of corticosteroids, NSAIDs, COX-2 inhibitors, and PCA therapy postoperatively provided superior analgesia. It is also important to emphasize the possibility of long-term effects of anesthetics on cognitive function. More research is warranted to develop best practices strategies for the future that are evidence-based.

  8. Post craniotomy extra-ventricular drain (EVD) associated nosocomial meningitis: CSF diagnostic criteria.

    Science.gov (United States)

    Muñoz-Gómez, Sigridh; Wirkowski, Elizabeth; Cunha, Burke A

    2015-01-01

    Because external ventricular drains (EVDs) provide access to cerebrospinal fluid (CSF), there is potential for EVD associated acute bacterial meningitis (EVD-AM). Post-craniotomy, in patients with EVDs, one or more CSF abnormalities are commonly present making the diagnosis of EVD-AM problematic. EVD-AM was defined as elevated CSF lactic acid (>6 nmol/L), plus CSF marked pleocytosis (>50 WBCs/mm(3)), plus a positive Gram stain (same morphology as CSF isolate), plus a positive CSF culture of neuropathogen (same morphology as Gram stained organism). We reviewed 22 adults with EVDs to determine if our four CSF parameters combined accurately identified EVD-AM. No single or combination of <4 CSF parameters correctly diagnosed or ruled out EVD-AM. Combined our four CSF parameters clearly differentiated EVD-AM from one case of pseudomeningitis due to E. cloacae. We conclude that our four CSF criteria combined are useful in diagnosing EVD-AM in adults. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Comparison of Unilateral and Bilateral Craniotomy for the Treatment of Bilateral Middle Cerebral Artery Aneurysms: Anatomic and Clinical Parameters and Surgical Outcomes.

    Science.gov (United States)

    Cho, Min Jai; Oh, Chang Wan; Kwon, O-Ki; Byoun, Hyoung Soo; Lee, Si Un; Kim, Tackeun; Chung, Young Seob; Ban, Seung Pil; Bang, Jae Seung

    2017-12-01

    To compare 2 craniotomy approaches (unilateral and bilateral) in terms of anatomic and clinical parameters and surgical outcomes. Between January 2011 and December 2014, 19 patients with bilateral unruptured middle cerebral artery (MCA) aneurysm were treated with unilateral craniotomy (group 1), and 10 patients were treated with bilateral mini-craniotomy (group 2). We compared demographic data, characteristics of aneurysms, radiologic and clinical parameters, postoperative complications, and surgical outcomes between the 2 groups. No statistically significant differences in aneurysm characteristics were found between the 2 groups. Radiologic parameters did not have any influence on surgical outcomes or the incidence of postoperative complications. Group 1 had a higher incidence of olfactory dysfunction (11 of 19; 58%) and residual neck at the contralateral aneurysm (10 of 19; 53%), whereas no patients in group 2 had olfactory dysfunction or residual neck at the contralateral aneurysm. All patients in group 2 had good surgical outcomes (modified Rankin scale score 0). The length of hospital stay was similar in the 2 groups. Bilateral mini-craniotomy for the treatment of bilateral MCA aneurysms was associated with better surgical outcomes and fewer complications. Bilateral mini-craniotomy does not require as much retraction of the frontal lobe to apply a clip completely at the contralateral aneurysm. Therefore, it represents a safe and effective therapeutic option for unruptured bilateral MCA aneurysms. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study.

    Science.gov (United States)

    Chen, Lu; Xu, Ming; Li, Gui-Yun; Cai, Wei-Xin; Zhou, Jian-Xin

    2014-01-01

    Emergence agitation is a frequent complication that can have serious consequences during recovery from general anesthesia. However, agitation has been poorly investigated in patients after craniotomy. In this prospective cohort study, adult patients were enrolled after elective craniotomy for brain tumor. The sedation-agitation scale was evaluated during the first 12 hours after surgery. Agitation developed in 35 of 123 patients (29%). Of the agitated patients, 28 (80%) were graded as very and dangerously agitated. By multivariate stepwise logistic regression analysis, independent predictors for agitation included male sex, history of long-term use of anti-depressant drugs or benzodiazepines, frontal approach of the operation, method and duration of anesthesia and presence of endotracheal intubation. Total intravenous anesthesia and balanced anesthesia with short duration were protective factors. Emergence agitation was associated with self-extubation (8.6% vs 0%, P = 0.005). Sedatives were administered more in agitated patients than non-agitated patients (85.7% vs 6.8%, Pcraniotomy for brain tumors. The clarification of risk factors could help to identify the high-risk patients, and then to facilitate the prevention and treatment of agitation. For patients undergoing craniotomy, greater attention should be paid to those receiving a frontal approach for craniotomy and those anesthetized under balanced anesthesia with long duration. More researches are warranted to elucidate whether total intravenous anesthesia could reduce the incidence of agitation after craniotomy. ClinicalTrials.gov NCT00590499.

  11. A prospective, randomized, double-blind, and multicenter trial of prophylactic effects of ramosetronon postoperative nausea and vomiting (PONV) after craniotomy: comparison with ondansetron.

    Science.gov (United States)

    Ryu, Jung-Hee; Lee, Ji-Eun; Lim, Young-Jin; Hong, Deok-Man; Park, Hee-Pyoung; Han, Jong-In; Baik, Hee-Jung; Kim, Hyun-Zu; Min, Kyeong-Tae; Do, Sang-Hwan

    2014-01-01

    Craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). This prospective, randomized, double-blind, multi-center study was performed to evaluate the efficacy of prophylactic ramosetron in preventing PONV compared with ondansetron after elective craniotomy in adult patients. A total of 160 American Society of Anesthesiologists physical status I-II patients aged 19-65 years who were scheduled to undergo elective craniotomy for various intracranial lesions were enrolled in this study. All patients received total intravenous anesthesia (TIVA) with propofol and remifentanil. Patients were randomly allocated into three groups to receive ondansetron (4 mg; group A, n  =  55), ondansetron (8 mg; group B, n  =  54), or ramosetron (0.3 mg; group C, n  =  51) intravenously at the time of dural closure. The incidence of PONV, the need for rescue antiemetics, pain score, patient-controlled analgesia (PCA) consumption, and adverse events were recorded 48 h postoperatively. Among the initial 160 patients, 127 completed the study and were included in the final analysis. The incidences of PONV were lower (nausea, 14% vs. 59% and 41%, respectively; P  craniotomy patients. Ramosetron at 0.3 mg was more effective than ondansetron at 4 or 8 mg for preventing PONV in adult craniotomy patients. CLINICAL RESEARCH INFORMATION SERVICE (CRIS) IDENTIFIER: KCT0000320. Registered 9 January 2012.

  12. Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study

    Science.gov (United States)

    Chen, Lu; Xu, Ming; Li, Gui-Yun; Cai, Wei-Xin; Zhou, Jian-Xin

    2014-01-01

    Emergence agitation is a frequent complication that can have serious consequences during recovery from general anesthesia. However, agitation has been poorly investigated in patients after craniotomy. In this prospective cohort study, adult patients were enrolled after elective craniotomy for brain tumor. The sedation-agitation scale was evaluated during the first 12 hours after surgery. Agitation developed in 35 of 123 patients (29%). Of the agitated patients, 28 (80%) were graded as very and dangerously agitated. By multivariate stepwise logistic regression analysis, independent predictors for agitation included male sex, history of long-term use of anti-depressant drugs or benzodiazepines, frontal approach of the operation, method and duration of anesthesia and presence of endotracheal intubation. Total intravenous anesthesia and balanced anesthesia with short duration were protective factors. Emergence agitation was associated with self-extubation (8.6% vs 0%, P = 0.005). Sedatives were administered more in agitated patients than non-agitated patients (85.7% vs 6.8%, Pcraniotomy for brain tumors. The clarification of risk factors could help to identify the high-risk patients, and then to facilitate the prevention and treatment of agitation. For patients undergoing craniotomy, greater attention should be paid to those receiving a frontal approach for craniotomy and those anesthetized under balanced anesthesia with long duration. More researches are warranted to elucidate whether total intravenous anesthesia could reduce the incidence of agitation after craniotomy. Trial Registration ClinicalTrials.gov NCT00590499. PMID:25493435

  13. Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study.

    Science.gov (United States)

    Jeswani, Sunil; Nuño, Miriam; Wu, Arthur; Bonert, Vivien; Carmichael, John D; Black, Keith L; Chu, Ray; King, Wesley; Mamelak, Adam N

    2016-03-01

    Craniopharyngiomas and similar midline suprasellar tumors have traditionally been resected via transcranial approaches. More recently, expanded endoscopic endonasal transsphenoidal approaches have gained interest. Surgeons have advocated for both approaches, and at present there is no consensus whether one approach is superior to the other. The authors therefore compared surgical outcomes between craniotomy and endoscopic endonasal transsphenoidal surgery (EETS) for suprasellar tumors treated at their institution. A retrospective review of patients undergoing resection of suprasellar lesions at Cedars-Sinai Medical Center between 2000 and 2013 was performed. Patients harboring suspected craniopharyngioma were selected for extensive review. Other pathologies or predominantly intrasellar masses were excluded. Cases were separated into 2 groups, based on the surgical approach taken. One group underwent EETS and the other cohort underwent craniotomy. Patient demographic data, presenting symptoms, and previous therapies were tabulated. Preoperative and postoperative tumor volume was calculated for each case based on MRI. Student t-test and the chi-square test were used to evaluate differences in patient demographics, tumor characteristics, and outcomes between the 2 cohorts. To assess for selection bias, 3 neurosurgeons who did not perform the surgeries reviewed the preoperative imaging studies and clinical data for each patient in blinded fashion and indicated his/her preferred approach. These data were subject to concordance analysis using Cohen's kappa test to determine if factors other than surgeon preference influenced the choice of surgical approach. Complete data were available for 53 surgeries; 19 cases were treated via EETS, and 34 were treated via craniotomy. Patient demographic data, preoperative symptoms, and tumor characteristics were similar between the 2 cohorts, except that fewer operations for recurrent tumor were observed in the craniotomy cohort

  14. Awake craniotomy for cortical language mapping and resection of an arteriovenous malformation adjacent to eloquent areas under general anesthesia — A hybrid approach

    Directory of Open Access Journals (Sweden)

    Pree Nimmannitya

    2015-12-01

    Full Text Available Surgery of arteriovenous malformation (AVM is sometimes challenging and carries a high risk of morbidity, especially when the AVM is located in an eloquent area of the brain. Unlike gliomas, awake craniotomy has not been widely used for resection of AVM. The authors present a case of an AVM in the left frontal lobe which was successfully removed with the aid of awake craniotomy with cortical language mapping. In conclusion, awake craniotomy for functional cortical mapping is beneficial for AVM resection, especially when the lesion is located in or adjacent to eloquent areas of the brain. A hybrid approach with functional mapping in the awake condition and AVM resection under general anesthesia may be useful in selected cases. Furthermore, en bloc resection with the nidus embedded in the brain parenchyma may be a useful means of removal to reduce operation time and intraoperative blood loss if there is no apparent functional cortex surrounding the AVM, as in the present case.

  15. Rapid and minimum invasive functional brain mapping by real-time visualization of high gamma activity during awake craniotomy.

    Science.gov (United States)

    Ogawa, Hiroshi; Kamada, Kyousuke; Kapeller, Christoph; Hiroshima, Satoru; Prueckl, Robert; Guger, Christoph

    2014-11-01

    Electrocortical stimulation (ECS) is the gold standard for functional brain mapping during an awake craniotomy. The critical issue is to set aside enough time to identify eloquent cortices by ECS. High gamma activity (HGA) ranging between 80 and 120 Hz on electrocorticogram is assumed to reflect localized cortical processing. In this report, we used real-time HGA mapping and functional neuronavigation integrated with functional magnetic resonance imaging (fMRI) for rapid and reliable identification of motor and language functions. Four patients with intra-axial tumors in their dominant hemisphere underwent preoperative fMRI and lesion resection with an awake craniotomy. All patients showed significant fMRI activation evoked by motor and language tasks. During the craniotomy, we recorded electrocorticogram activity by placing subdural grids directly on the exposed brain surface. Each patient performed motor and language tasks and demonstrated real-time HGA dynamics in hand motor areas and parts of the inferior frontal gyrus. Sensitivity and specificity of HGA mapping were 100% compared with ECS mapping in the frontal lobe, which suggested HGA mapping precisely indicated eloquent cortices. We found different HGA dynamics of language tasks in frontal and temporal regions. Specificities of the motor and language-fMRI did not reach 85%. The results of HGA mapping was mostly consistent with those of ECS mapping, although fMRI tended to overestimate functional areas. This novel technique enables rapid and accurate identification of motor and frontal language areas. Furthermore, real-time HGA mapping sheds light on underlying physiological mechanisms related to human brain functions. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Comparing the Effect of Labetalol versus Morphine on Controlling Blood Pressure and Pulse Rate During Emergence from Anesthesia after Craniotomy

    Directory of Open Access Journals (Sweden)

    Mohammadali Attari

    2017-01-01

    Full Text Available Background: Emergence from anesthesia is associated with sympathetic stimulation, increase in pulse and blood pressure. There are different methods, but the most appropriate method should be selected regarding the differences in nationalities. This study aimed to compare the efficacy of morphine and labetalol in controlling blood pressure and pulse during emergence from anesthesia in brain tumors craniotomy. Materials and Methods: This study was conducted at Al-Zahra Hospital of Isfahan - Iran on 60 patients suffering from brain tumor candidated for craniotomy and randomly classified into two groups of 30. One group received labetalol with dose of 10 mg over 10 min from 45 min before finishing dressing and then 0.75 mg/min until 35 min later; another group received morphine in bolus dose of 0.1 mg/kg during 2–3 min. Blood pressure and pulse were measured every 10 min over 40 min. After operation, they were measured every 5 min over 15 min. Results: The morphine group had higher systolic (133.3 ± 18.8 and diastolic blood pressure (87.1 ± 13.6 (P = 0.021 and 0.028, respectively at extubation and during 45 min before dressing, the diastolic blood pressure was significantly higher in compares with labetalol (75.3 ± 10.5 (P < 0.05. And extubation time was significantly shorter in labetalol group (7.7 ± 0.84 (P < 0.001. Pulse had no significant difference in both groups. In labetalol group, blood pressure and pulse fluctuations were more stable. Conclusion: Administration of labetalol 45 min before finishing dressing can significantly control blood pressure during emergence from anesthesia and also shorten the time of extubation during emergence in patients undergoing craniotomy.

  17. Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects.

    Science.gov (United States)

    Beenen, L F; Lindeboom, J; Kasteleijn-Nolst Trenité, D G; Heimans, J J; Snoek, F J; Touw, D J; Adèr, H J; van Alphen, H A

    1999-10-01

    To determine the efficacy, tolerability, and impact on quality of life and cognitive functioning of anticonvulsant prophylaxis with phenytoin or sodium valproate in patients after craniotomy. A prospective, stratified, randomised, double blind single centre clinical trial was performed, comparing two groups of 50 patients each, who underwent craniotomy for different pathological conditions and who were treated for 1 year after surgery with either 300 mg phenytoin/day or 1500 mg sodium valproate/day. During the study period patients were seen in the outpatient clinic at 1.5, 3, 6, and 12 months, when medical history, adverse events, and drug plasma concentrations were evaluated. Neuropsychological functioning and quality of life were assessed on the last three visits. In cases of a seizure an EEG was performed, drug plasma concentration assessed, and medication subsequently increased. Of the 100 included patients 14 (seven in each group) experienced one or more postoperative seizures. Severity of the seizures was comparable in the two groups. In all patients, drug plasma concentrations were in the low or subtherapeutic ranges at the time of the first postoperative seizure. Five patients in the phenytoin group and two in the valproate group had to stop their treatment due to drug related adverse events. Sixty patients completed the 12 month period. Analysis of neuropsychological and quality of life data showed no significant differences. For efficacy, tolerability, impact on cognitive functioning, and quality of life, no major differences were found between phenytoin and valproate prophylaxis. Valproate is an alternative for anticonvulsant prophylaxis in patients after craniotomy.

  18. Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy.

    Science.gov (United States)

    Dube, Surya Kumar; Pandia, Mihir Prakash; Chaturvedi, Arvind; Bithal, Parmod; Dash, Hari Hara

    2015-01-01

    Post operative recovery has been reported to be faster with desflurane than sevoflurane anesthesia in previous studies. The use of desflurane is often criticized in neurosurgery due to the concerns of cerebral vasodilation and increase in ICP and studies comparing desflurane and sevoflurane in neurosurgey are scarce. So we compared the intraoperative brain condition, hemodynamics and postoperative recovery in patients undergoing elective supratentorial craniotomy receiving either desflurane or sevoflurane. Fifty three patients between 18-60yr undergoing elective supratentorial craniotomy receiving N2O and oxygen (60%:40%) and 0.8-1.2 MAC of either desflurane or sevoflurane were randomized to group S (Sevoflurane) or group D (Desflurane). Subdural intra cranial pressure (ICP) was measured and brain condition was assessed.. Emergence time, tracheal extubation time and recovery time were recorded. Cognitive behavior was evaluated with Short Orientation Memory Concentration Test (SOMCT) and neurological outcome (at the time of discharge) was assessed using Glasgow Outcome Score (GOS) between the two groups. The emergence time [Group D 7.4 ± 2.7 minutes vs. Group S 7.8 ± 3.7 minutes; P = 0.65], extubation time [Group D 11.8 ± 2.8 minutes vs. Group S 12.9 ± 4.9 minutes; P = 0.28] and recovery time [Group D 16.4 ± 2.6 minutes vs. Group S 17.1 ± 4.8 minutes; P = 0.50] were comparable between the two groups. There was no difference in ICP [Group D; 9.1 ± 4.3 mmHg vs. Group S; 10.9 ± 4.2 mmHg; P = 0.14] and brain condition between the two groups. Both groups had similar post-operative complications, hospital and ICU stay and GOS. In patients undergoing elective supratentorial craniotomy both sevoflurane and desflurane had similar intra-operative brain condition, hemodynamics and post operative recovery profile.

  19. The Impact of Race on Discharge Disposition and Length of Hospitalization After Craniotomy for Brain Tumor.

    Science.gov (United States)

    Muhlestein, Whitney E; Akagi, Dallin S; Chotai, Silky; Chambless, Lola B

    2017-08-01

    Racial disparities exist in health care, frequently resulting in unfavorable outcomes for minority patients. Here, we use guided machine learning (ML) ensembles to model the impact of race on discharge disposition and length of stay (LOS) after brain tumor surgery from the Healthcare Cost and Utilization Project National Inpatient Sample. We performed a retrospective cohort study of 41,222 patients who underwent craniotomies for brain tumors from 2002 to 2011 and were registered in the National Inpatient Sample. Twenty-six ML algorithms were trained on prehospitalization variables to predict non-home discharge and extended LOS (>7 days) after brain tumor resection, and the most predictive algorithms combined to create ensemble models. Partial dependence analysis was performed to measure the independent impact of race on the ensembles. The guided ML ensembles predicted non-home disposition (area under the curve, 0.796) and extended LOS (area under the curve, 0.824) with good discrimination. Partial dependence analysis showed that black race increases the risk of non-home discharge and extended LOS over white race by 6.9% and 6.5%, respectively. Other, nonblack race increases the risk of extended LOS over white race by 6.0%. The impact of race on these outcomes is not seen when analyzing the general inpatient or general operative population. Minority race independently increases the risk of extended LOS and black race increases the risk of non-home discharge in patients undergoing brain tumor resection, a finding not mimicked in the general inpatient or operative population. Recognition of the influence of race on discharge and LOS could generate interventions that may improve outcomes in this population. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms

    Science.gov (United States)

    Deshaies, Eric M; Villwock, Mark R; Singla, Amit; Toshkezi, Gentian; Padalino, David J

    2015-01-01

    Less invasive surgical approaches for intracranial aneurysm clipping may reduce length of hospital stay, surgical morbidity, treatment cost, and improve patient outcomes. We present our experience with a minimally invasive pterional approach for anterior circulation aneurysms performed in a major tertiary cerebrovascular center and compare the results with an aged matched dataset from the Nationwide Inpatient Sample (NIS). From August 2008 to December 2012, 22 elective aneurysm clippings on patients ≤55 years of age were performed by the same dual fellowship-trained cerebrovascular/endovascular neurosurgeon. One patient (4.5%) experienced transient post-operative complications. 18 of 22 patients returned for follow-up imaging and there were no recurrences through an average duration of 22 months. A search in the NIS database from 2008 to 2010, also for patients aged ≤55 years of age, yielded 1,341 hospitalizations for surgical clip ligation of unruptured cerebral aneurysms. Inpatient length of stay and hospital charges at our institution using the minimally invasive thumb-sized pterional technique were nearly half that of NIS (length of stay: 3.2 vs 5.7 days; hospital charges: $52,779 vs. $101,882). The minimally invasive thumb-sized pterional craniotomy allows good exposure of unruptured small and medium-sized supraclinoid anterior circulation aneurysms. Cerebrospinal fluid drainage from key subarachnoid cisterns and constant bimanual microsurgical techniques avoid the need for retractors which can cause contusions, localized venous infarctions, and post-operative cerebral edema at the retractor sites. Utilizing this set of techniques has afforded our patients with a shorter hospital stay at a lower cost compared to the national average. PMID:26325337

  1. Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms.

    Science.gov (United States)

    Deshaies, Eric M; Villwock, Mark R; Singla, Amit; Toshkezi, Gentian; Padalino, David J

    2015-08-11

    Less invasive surgical approaches for intracranial aneurysm clipping may reduce length of hospital stay, surgical morbidity, treatment cost, and improve patient outcomes. We present our experience with a minimally invasive pterional approach for anterior circulation aneurysms performed in a major tertiary cerebrovascular center and compare the results with an aged matched dataset from the Nationwide Inpatient Sample (NIS). From August 2008 to December 2012, 22 elective aneurysm clippings on patients ≤55 years of age were performed by the same dual fellowship-trained cerebrovascular/endovascular neurosurgeon. One patient (4.5%) experienced transient post-operative complications. 18 of 22 patients returned for follow-up imaging and there were no recurrences through an average duration of 22 months. A search in the NIS database from 2008 to 2010, also for patients aged ≤55 years of age, yielded 1,341 hospitalizations for surgical clip ligation of unruptured cerebral aneurysms. Inpatient length of stay and hospital charges at our institution using the minimally invasive thumb-sized pterional technique were nearly half that of NIS (length of stay: 3.2 vs 5.7 days; hospital charges: $52,779 vs. $101,882). The minimally invasive thumb-sized pterional craniotomy allows good exposure of unruptured small and medium-sized supraclinoid anterior circulation aneurysms. Cerebrospinal fluid drainage from key subarachnoid cisterns and constant bimanual microsurgical techniques avoid the need for retractors which can cause contusions, localized venous infarctions, and post-operative cerebral edema at the retractor sites. Utilizing this set of techniques has afforded our patients with a shorter hospital stay at a lower cost compared to the national average.

  2. Comparison between Modified Neuroendoscopy and Craniotomy Evacuation of Spontaneous Intra-Cerebral Hemorrhages: Study of Clinical Outcome and Glasgow Outcome Score

    Directory of Open Access Journals (Sweden)

    Arie Ibrahim

    2016-08-01

    Full Text Available Background and Purposes: Stroke is still one of a leading health-care problem in industrial country and in the developing country. Spontaneous Intra-cerebral Hemorrhage accounts for 30–60% of all stroke admissions into a hospital. Presence of intra-cerebral hemorrhage is considered a poor prognostic factor due to the resultant obstruction to the mass effect following the presence of blood resulting in raised intracranial pressure. While the craniotomy procedure failed to show more benefits over functional outcome, a less invasive and quicker surgical decompression might improve the outcome. Neuroendoscopy is one of promising optional  on minimal invasive  treatment  for spontaneous intra-cerebral hemorrhage. Material and Methods: We evaluated Glasgow Outcome Score and clinical outcome of patients with Spontaneous Intra-cerebral Hemorrhage who underwent modified neuroendoscopic surgery and craniotomy. Randomized control trial was performed during 27 months in 43 patients. Twenty-five patients treated with neuroendoscopy surgery and 18 patients with craniotomy. The removal of intra-cerebral hemorrhage was done by a modified neuroendoscopic transparent sheath made of silastic material, derived from pieces of thoracic tube No. 21F as a conduit working channel. Results: We analyzed statistically, clinical outcome assessment and Glasgow Outcome Scale 6 months post operative follow-up period. The mortality rate was significantly higher by Pearson chi-square methods, in craniotomy group n=12 (63.2% compared with neuroendoscopy group, n=7 (36.8% (p<.005. Patients with Glasgow Outcome Scale score 3–5 was higher in neuroendoscopy group, n=18 (75% compared with craniotomy group n=6 (25%. The survival rate analyzed by Kaplan Meier methods, found that patients in the neuroendoscopy group were a significantly longer survival rate compare with the craniotomy group during 6 months post operative follow-up period. Conclusions: Treatment of spontaneous

  3. Endoscopic Evacuation of Basal Ganglia Hemorrhage via Keyhole Approach Using an Adjustable Cannula in Comparison with Craniotomy

    Science.gov (United States)

    Zhang, Heng-Zhu; Li, Yu-Ping; Yan, Zheng-cun; Wang, Xing-dong; She, Lei; Wang, Xiao-dong; Dong, Lun

    2014-01-01

    Neuroendoscopic (NE) surgery as a minimal invasive treatment for basal ganglia hemorrhage is a promising approach. The present study aims to evaluate the efficacy and safety of NE approach using an adjustable cannula to treat basal ganglia hemorrhage. In this study, we analysed the clinical and radiographic outcomes between NE group (21 cases) and craniotomy group (30 cases). The results indicated that NE surgery might be an effective and safe approach for basal ganglia haemorrhage, and it is also suggested that NE approach may improve good functional recovery. However, NE approach only suits the selected patient, and the usefulness of NE approach needs further randomized controlled trials (RCTs) to evaluate. PMID:24949476

  4. Bridging the Gap

    DEFF Research Database (Denmark)

    Kramer Overgaard, Majken; Broeng, Jes; Jensen, Monika Luniewska

    Bridging the Gap (BtG) is a 2-year project funded by The Danish Industry Foundation. The goal of Bridging the Gap has been to create a new innovation model which will increase the rate at which Danish universities can spinout new technology ventures.......Bridging the Gap (BtG) is a 2-year project funded by The Danish Industry Foundation. The goal of Bridging the Gap has been to create a new innovation model which will increase the rate at which Danish universities can spinout new technology ventures....

  5. Bridging a Cultural Gap

    Science.gov (United States)

    Leviatan, Talma

    2008-01-01

    There has been a broad wave of change in tertiary calculus courses in the past decade. However, the much-needed change in tertiary pre-calculus programmes--aimed at bridging the gap between high-school mathematics and tertiary mathematics--is happening at a far slower pace. Following a discussion on the nature of the gap and the objectives of a…

  6. Anaesthesiological strategies in elective craniotomy: randomized, equivalence, open trial – The NeuroMorfeo trial

    Directory of Open Access Journals (Sweden)

    Guzzetti Stefano

    2009-04-01

    Full Text Available Abstract Background Many studies have attempted to determine the "best" anaesthetic technique for neurosurgical procedures in patients without intracranial hypertension. So far, no study comparing intravenous (IA with volatile-based neuroanaesthesia (VA has been able to demonstrate major outcome differences nor a superiority of one of the two strategies in patients undergoing elective supratentorial neurosurgery. Therefore, current practice varies and includes the use of either volatile or intravenous anaesthetics in addition to narcotics. Actually the choice of the anaestesiological strategy depends only on the anaesthetists' preferences or institutional policies. This trial, named NeuroMorfeo, aims to assess the equivalence between volatile and intravenous anaesthetics for neurosurgical procedures. Methods/Design NeuroMorfeo is a multicenter, randomized, open label, controlled trial, based on an equivalence design. Patients aged between 18 and 75 years, scheduled for elective craniotomy for supratentorial lesion without signs of intracranial hypertension, in good physical state (ASA I-III and Glasgow Coma Scale (GCS equal to 15, are randomly assigned to one of three anaesthesiological strategies (two VA arms, sevoflurane + fentanyl or sevoflurane + remifentanil, and one IA, propofol + remifentanil. The equivalence between intravenous and volatile-based neuroanaesthesia will be evaluated by comparing the intervals required to reach, after anaesthesia discontinuation, a modified Aldrete score ≥ 9 (primary end-point. Two statistical comparisons have been planned: 1 sevoflurane + fentanyl vs. propofol + remifentanil; 2 sevoflurane + remifentanil vs. propofol + remifentanil. Secondary end-points include: an assessment of neurovegetative stress based on (a measurement of urinary catecholamines and plasma and urinary cortisol and (b estimate of sympathetic/parasympathetic balance by power spectrum analyses of electrocardiographic tracings recorded

  7. Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

    Science.gov (United States)

    Rossaint, Rolf; Veldeman, Michael

    2016-01-01

    Background Awake craniotomy (AC) renders an expanded role in functional neurosurgery. Yet, evidence for optimal anaesthesia management remains limited. We aimed to summarise the latest clinical evidence of AC anaesthesia management and explore the relationship of AC failures on the used anaesthesia techniques. Methods Two authors performed independently a systematic search of English articles in PubMed and EMBASE database 1/2007-12/2015. Search included randomised controlled trials (RCTs), observational trials, and case reports (n>4 cases), which reported anaesthetic approach for AC and at least one of our pre-specified outcomes: intraoperative seizures, hypoxia, arterial hypertension, nausea and vomiting, neurological dysfunction, conversion into general anaesthesia and failure of AC. Random effects meta-analysis was used to estimate event rates for four outcomes. Relationship with anaesthesia technique was explored using logistic meta-regression, calculating the odds ratios (OR) and 95% confidence intervals [95%CI]. Results We have included forty-seven studies. Eighteen reported asleep-awake-asleep technique (SAS), twenty-seven monitored anaesthesia care (MAC), one reported both and one used the awake-awake-awake technique (AAA). Proportions of AC failures, intraoperative seizures, new neurological dysfunction and conversion into general anaesthesia (GA) were 2% [95%CI:1–3], 8% [95%CI:6–11], 17% [95%CI:12–23] and 2% [95%CI:2–3], respectively. Meta-regression of SAS and MAC technique did not reveal any relevant differences between outcomes explained by the technique, except for conversion into GA. Estimated OR comparing SAS to MAC for AC failures was 0.98 [95%CI:0.36–2.69], 1.01 [95%CI:0.52–1.88] for seizures, 1.66 [95%CI:1.35–3.70] for new neurological dysfunction and 2.17 [95%CI:1.22–3.85] for conversion into GA. The latter result has to be interpreted cautiously. It is based on one retrospective high-risk of bias study and significance was

  8. Wide-Gap Chalcopyrites

    CERN Document Server

    Siebentritt, Susanne

    2006-01-01

    Chalcopyrites, in particular those with a wide band gap, are fascinating materials in terms of their technological potential in the next generation of thin-film solar cells and in terms of their basic material properties. They exhibit uniquely low defect formation energies, leading to unusual doping and phase behavior and to extremely benign grain boundaries. This book collects articles on a number of those basic material properties of wide-gap chalcopyrites, comparing them to their low-gap cousins. They explore the doping of the materials, the electronic structure and the transport through interfaces and grain boundaries, the formation of the electric field in a solar cell, the mechanisms and suppression of recombination, the role of inhomogeneities, and the technological role of wide-gap chalcopyrites.

  9. Mini-Craniotomy Under Local Anesthesia for Chronic Subdural Hematoma: An Effective Choice for Elderly Patients and for Patients in a Resource-Strained Environment.

    Science.gov (United States)

    Mahmood, Shaikh Danish; Waqas, Muhammad; Baig, Mirza Zain; Darbar, Aneela

    2017-10-01

    Mini-craniotomy for chronic subdural hematoma (CSDH) is associated with lower rates of recurrence. However, the procedure is performed mostly with the patient under general anesthesia (GA) and therefore frequently requires an intensive care unit (ICU) facility, especially in the elderly population. Because of the unavailability of ICU beds, and to avoid GA, we started to perform this procedure with the patient under local anesthesia (LA). This was a retrospective medical chart review conducted in the section of Neurosurgery at the Aga Khan Hospital in Karachi, Pakistan. The study duration was 1 year. We included patients aged 55 years or older undergoing surgery for CSDH. Clinical characteristics, hospital stay, and recurrence rates were compared between 2 groups, local versus general anesthesia. Thirty-five patients underwent mini-craniotomy for CSDH in the study period. Sixteen patients underwent mini-craniotomy under LA versus 19 patients for GA. Median age for the LA group was 67 years compared with 70 years in the GA group. Four patients from the LA group experienced postoperative complications versus 7 from the GA group. Only one patient in the LA group required an ICU bed in the postoperative period. There was no recurrence in LA group. The overall recurrence was 2.86%. Mini-craniotomy for CSDH under LA is an equally effective procedure compared with mini-craniotomy under GA. In addition, it minimizes the risks of GA in the elderly population and obviates the need of a postoperative ICU bed. It also reduces operative time and hospital stay as compared with GA. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Resection of Gliomas with and without Neuropsychological Support during Awake Craniotomy-Effects on Surgery and Clinical Outcome.

    Science.gov (United States)

    Kelm, Anna; Sollmann, Nico; Ille, Sebastian; Meyer, Bernhard; Ringel, Florian; Krieg, Sandro M

    2017-01-01

    During awake craniotomy for tumor resection, a neuropsychologist (NP) is regarded as a highly valuable partner for neurosurgeons. However, some centers do not routinely involve an NP, and data to support the high influence of the NP on the perioperative course of patients are mostly lacking. The aim of this study was to investigate whether there is a difference in clinical outcomes between patients who underwent awake craniotomy with and without the attendance of an NP. Our analysis included 61 patients, all operated on for resection of a presumably language-eloquent glioma during an awake procedure. Of these 61 cases, 47 surgeries were done with neuropsychological support (NP group), whereas 14 surgeries were performed without an NP (non-NP group) due to a language barrier between the NP and the patient. For these patients, neuropsychological assessment was provided by a bilingual resident. Both groups were highly comparable regarding age, gender, preoperative language function, and tumor grades (glioma WHO grades 1-4). Gross total resection (GTR) was achieved more frequently in the NP group (NP vs. non-NP: 61.7 vs. 28.6%, P  = 0.04), which also had shorter durations of surgery (NP vs. non-NP: 240.7 ± 45.7 vs. 286.6 ± 54.8 min, P  vs. postoperative imaging) was lower in the NP group (NP vs. non-NP: 19.1 vs. 42.9%, P  = 0.09), but no difference was observed in terms of permanent surgery-related language deterioration (NP vs. non-NP: 6.4 vs. 14.3%, P  = 0.48). We need professional neuropsychological evaluation during awake craniotomies for removal of presumably language-eloquent gliomas. Although these procedures are routinely carried out with an NP, this is one of the first studies to provide data supporting the NP's crucial role. Despite the small group size, our study shows statistically significant results, with higher rates of GTR and shorter durations of surgery among patients of the NP group. Moreover, our data emphasize the common

  11. Use of Dexmedetomidine for Prophylactic Analgesia and Sedation in Patients With Delayed Extubation After Craniotomy: A Randomized Controlled Trial

    Science.gov (United States)

    Zhao, Li-Hong; Shi, Zhong-Hua; Chen, Guang-Qiang; Yin, Ning-Ning; Chen, Han; Yuan, Yuan; Cao, Wei; Xu, Ming; Hao, Jing-Jing

    2017-01-01

    Background: We conducted a randomized trial to evaluate the efficacy and safety of dexmedetomidine for prophylactic analgesia and sedation in patients with delayed extubation after craniotomy. Methods: From June 2012 to July 2014, 150 patients with delayed extubation after craniotomy were randomized 1:1 and were assigned to the dexmedetomidine group that received a continuous infusion of 0.6 μg/kg/h (10 μg/mL) or the control group that received a maintenance infusion of 0.9% sodium chloride for injection. The mean percentage of time under optimal sedation (SAS3-4), the percentage of patients who required rescue with propofol/fentanyl, and the total dose of propofol/fentanyl required throughout the course of drug infusion, as well as VAS, HR, MAP, and SpO2 were recorded. Results: The percentage of time under optimal sedation was significantly higher in the dexmedetomidine group than in the control group (98.4%±6.7% vs. 93.0%±16.2%, P=0.008). The VAS was significantly lower in the dexmedetomidine group than in the control group (1.0 vs. 4.0, P=0.000). The HR and mean BP were significantly lower in the dexmedetomidine group than in the control group at all 3 time points (before endotracheal suctioning, immediately after extubation, and 30 min after extubation). No significant difference in SpO2 was observed between the 2 groups. For hemodynamic adverse events, patients in the dexmedetomidine group were more likely to develop bradycardia (5.3% vs. 0%, P=0.043) but had a lower likelihood of tachycardia (2.7% vs. 18.7%, P=0.002). Conclusions: Dexmedetomidine may be an effective prophylactic agent to induce sedation and analgesia in patients with delayed extubation after craniotomy. The use of dexmedetomidine (0.6 μg/kg/h) infusion does not produce respiratory depression, but may increase the incidence of bradycardia. PMID:26641648

  12. Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy

    Directory of Open Access Journals (Sweden)

    Surya Kumar Dube

    2015-01-01

    Full Text Available Background: Post operative recovery has been reported to be faster with desflurane than sevoflurane anesthesia in previous studies. The use of desflurane is often criticized in neurosurgery due to the concerns of cerebral vasodilation and increase in ICP and studies comparing desflurane and sevoflurane in neurosurgey are scarce. So we compared the intraoperative brain condition, hemodynamics and postoperative recovery in patients undergoing elective supratentorial craniotomy receiving either desflurane or sevoflurane. Materials and Methods: Fifty three patients between 18-60yr undergoing elective supratentorial craniotomy receiving N 2 O and oxygen (60%:40% and 0.8-1.2 MAC of either desflurane or sevoflurane were randomized to group S (Sevoflurane or group D (Desflurane. Subdural intra cranial pressure (ICP was measured and brain condition was assessed.. Emergence time, tracheal extubation time and recovery time were recorded. Cognitive behavior was evaluated with Short Orientation Memory Concentration Test (SOMCT and neurological outcome (at the time of discharge was assessed using Glasgow Outcome Score (GOS between the two groups. Results: The emergence time [Group D 7.4 ± 2.7 minutes vs. Group S 7.8 ± 3.7 minutes; P = 0.65], extubation time [Group D 11.8 ± 2.8 minutes vs. Group S 12.9 ± 4.9 minutes; P = 0.28] and recovery time [Group D 16.4 ± 2.6 minutes vs. Group S 17.1 ± 4.8 minutes; P = 0.50] were comparable between the two groups. There was no difference in ICP [Group D; 9.1 ± 4.3 mmHg vs. Group S; 10.9 ± 4.2 mmHg; P = 0.14] and brain condition between the two groups. Both groups had similar post-operative complications, hospital and ICU stay and GOS. Conclusion: In patients undergoing elective supratentorial craniotomy both sevoflurane and desflurane had similar intra-operative brain condition, hemodynamics and post operative recovery profile.

  13. Risk factors for meningitis after craniotomy in patients with subarachnoid hemorrhage due to anterior circulation aneurysms rupture.

    Science.gov (United States)

    Inoue, Takashi; Shimizu, Hiroaki; Fujimura, Miki; Sato, Kenichi; Endo, Hidenori; Niizuma, Kuniyasu; Sakata, Hiroyuki; Tominaga, Teiji

    2015-12-01

    Postoperative meningitis is a serious complication occurring after neurosurgical interventions. However, few investigations have focused specifically on the risk factors that predispose patients to meningitis after major craniotomy. This study identified the risk factors for postoperative meningitis after neurovascular surgery, and investigated the relationship between postoperative meningitis and clinical outcome. A total of 148 consecutive patients with subarachnoid hemorrhage (SAH) who underwent clipping surgery through a pterional approach within 72 h between January 2007 and September 2011 were retrospectively analyzed. The treatment strategy of our hospital for patients with SAH was based on the findings of digital subtraction angiography in the acute phase. Coil embolization was firstly considered, and clipping through craniotomy if indicated was performed as soon as possible. Prophylactic antibiotics were administered before beginning craniotomy and for at least 3 days after. Hydrocortisone was used to prevent hyponatremia if allowed by the medical condition of the patient. Intrathecal administration of nicardipine hydrochloride was given if required for vasospasm treatment. Meningitis was clinically diagnosed from the blood samplings and cerebrospinal fluid (CSF) examinations. Data were collected from the electronic and paper charts. The status of modified Rankin scale (mRS) 0-2 at discharge was defined as favorable outcome. A total of 14 patients (9.5%) had meningitis during this study period. Symptomatic vasospasm was detected in 33 patients (22.3%), and 12 patients (8.1%) had permanent neurological deficits caused by vasospasm. Overall, 109 patients (73.6%) had favorable outcome. The longer duration of drainage placement, presence of CSF leakage, and intrathecal administration of vasodilatory agent showed significantly higher incidence of postoperative meningitis in univariate analysis (p=0.0093, 0.0017, and 0.0090, respectively). The proportion of

  14. Gap length distributions by PEPR

    International Nuclear Information System (INIS)

    Warszawer, T.N.

    1980-01-01

    Conditions guaranteeing exponential gap length distributions are formulated and discussed. Exponential gap length distributions of bubble chamber tracks first obtained on a CRT device are presented. Distributions of resulting average gap lengths and their velocity dependence are discussed. (orig.)

  15. Management of a patient undergoing sitting position craniotomy for acoustic neuroma with co-existing interstitial lung disease

    Directory of Open Access Journals (Sweden)

    Deepa Suvarna

    2015-01-01

    Full Text Available A 38-year-old woman with acoustic neuroma associated with occupational interstitial lung disease (ILD was successfully managed for sitting position craniotomy using carefully titrated desflurane-based anaesthesia. The anaesthetic challenges included maintenance an adequate depth of anaesthesia, reducing perioperative airway events and ensuring smooth recovery. While dealing with ILD patient in sitting position, careful risk assessment is important because it will help us predict the course of the perioperative events. Balanced general anaesthesia using desflurane fulfilled the requirement of good depth and smooth recovery in this patient. Though there are reports of maintenance of anaesthesia with other inhalational agents, there are scanty reports of using desflurane in these cases.

  16. A contrast study on the curative effect between trepanation and drainage and decompressive craniotomy for treating cerebellar hemorrhage

    Directory of Open Access Journals (Sweden)

    Jie ZHUO

    2014-06-01

    Full Text Available Thirty-three cases of hypertensive cerebellar hemorrhage were involved in this survey, with the bleeding volume over 10 ml. All of them were given external ventricular drainage and then taken continuous monitoring of intracranial pressure (ICP after admission. Within 7-24 h after the onset, they all underwent trepanation and drainage under local anesthesia. In the same period, another 33 cases of cerebellar hemorrhage patients were collected as the control, who met the inclusion criteria and were treated with conventional posterior fossa decompressive craniotomy. As results, the total efficiency of the drilling group was 81.82% (27/33, which was much better than the control group (63.64%, 21/33. However, there was no statistical significance between 2 groups (χ2 = 2.750, P = 0.097. doi: 10.3969/j.issn.1672-6731.2014.06.014

  17. Application of Awake Craniotomy and Intraoperative Brain Mapping for Surgical Resection of Insular Gliomas of the Dominant Hemisphere.

    Science.gov (United States)

    Alimohamadi, Maysam; Shirani, Mohammad; Shariat Moharari, Reza; Pour-Rashidi, Ahmad; Ketabchi, Mehdi; Khajavi, Mohammadreza; Arami, Mohamadali; Amirjamshidi, Abbas

    2016-08-01

    Radical resection of dominant insular gliomas is difficult because of their close vicinity with internal capsule, basal ganglia, and speech centers. Brain mapping techniques can be used to maximize the extent of tumor removal and to minimize postoperative morbidities by precise localization of eloquent cortical and subcortical areas. Patients with newly diagnosed gliomas of dominant insula were enrolled. The exclusion criteria were severe cognitive disturbances, communication difficulty, age greater than 75 years, severe obesity, difficult airways for intubation and severe cardiopulmonary diseases. All were evaluated preoperatively with contrast-enhanced brain magnetic resonance imaging (MRI), functional brain MRI, and diffusion tensor tractography of language and motor systems. All underwent awake craniotomy with the same anesthesiology protocol. Intraoperative monitoring included continuous motor-evoked potential, electromyography, electrocorticography, direct electrical stimulation of cortex, and subcortical tracts. The patients were followed with serial neurologic examination and imaging. Ten patients were enrolled (4 men, 6 women) with a mean age of 43.6 years. Seven patients suffered from low-grade glioma, and 3 patients had high-grade glioma. The most common clinical presentation was seizure followed by speech disturbance, hemiparesis, and memory loss. Extent of tumor resection ranged from 73% to 100%. No mortality or new major postoperative neurologic deficit was encountered. Seizure control improved in three fourths of patients with medical refractory epilepsy. In one patient with speech disorder at presentation, the speech problem became worse after surgery. Brain mapping during awake craniotomy helps to maximize extent of tumor resection while preserving neurologic function in patients with dominant insular lobe glioma. Copyright © 2016. Published by Elsevier Inc.

  18. Semantic Gaps Are Dangerous

    DEFF Research Database (Denmark)

    Ejstrup, Michael; le Fevre Jakobsen, Bjarne

    Semantic gaps are dangerous Language adapts to the environment where it serves as a tool to communication. Language is a social agreement, and we all have to stick to both grammaticalized and non-grammaticalized rules in order to pass information about the world around us. As such language develops...... unpolite language and tend to create dangerous relations where specialy language creates problems and trouble that could be avoided if we had better language tools at hand. But we have not these tools of communication, and we are in a situation today where media and specially digital and social media......, supported by new possibilities of migration, create dangerous situations. How can we avoid these accidental gaps in language and specially the gaps in semantic and metaphoric tools. Do we have to keep silent and stop discusing certain isues, or do we have other ways to get acces to sufficient language tools...

  19. Where are the Gaps?

    Science.gov (United States)

    Stoneham, Marshall

    Reading a Handbook like this gives a vivid picture of the enormous vigour and power of materials modelling. One is tempted to believe that we can answer all the questions materials technology might pose. Even if that were partly true, we should be identifying just what we do not know how to do. Some gaps will be depend on new hardware and software, especially when modelling quantum systems. Some gaps will be recognised only after some social or technological change has brought them into focus. Among the developments likely to stimulate innovation could be novel nanoelectronics, or the fields where physics meets biology. Still further gaps exist because we have been slaves to fashion, and have been drawn away from unpopular (roughly translating as "too difficult") fields; examples might include excited state spectroscopy, or electrical breakdown.

  20. The longevity gender gap

    DEFF Research Database (Denmark)

    Aviv, Abraham; Shay, Jerry; Christensen, Kaare

    2005-01-01

    In this Perspective, we focus on the greater longevity of women as compared with men. We propose that, like aging itself, the longevity gender gap is exceedingly complex and argue that it may arise from sex-related hormonal differences and from somatic cell selection that favors cells more...... resistant to the ravages of time. We discuss the interplay of these factors with telomere biology and oxidative stress and suggest that an explanation for the longevity gender gap may arise from a better understanding of the differences in telomere dynamics between men and women....

  1. Bridge the Gap

    DEFF Research Database (Denmark)

    Marselis, Randi

    2017-01-01

    This article focuses on photo projects organised for teenage refugees by the Society for Humanistic Photography (Berlin, Germany). These projects, named Bridge the Gap I (2015), and Bridge the Gap II (2016), were carried out in Berlin and brought together teenagers with refugee and German-majorit...... was produced – and sometimes not produced - within the projects. The importance of memory work in the context of refugee resettlement is often overlooked, but is particularly relevant when cultural encounters are organised in museums and exhibition galleries....

  2. Missing the gap

    DEFF Research Database (Denmark)

    Tanggaard, Lene; Glaveanu, Vlad Petre

    by the premise that difference and gaps are places where creative learning is intensified (Glaveanu & Gillespie, 2015). The public discourse around education is often concerned with minding or avoiding the gap by making education more relevant for or similar to the labour market, but what if facilitating...... creative learning at the borders need not minimize differences, but handle and learn from them? If not, schools and educational institutions risk becoming bad copies of the labour marked instead of enabling students to enter the market with something new, something radically dissimilar from what...

  3. Estimating Gender Wage Gaps

    Science.gov (United States)

    McDonald, Judith A.; Thornton, Robert J.

    2011-01-01

    Course research projects that use easy-to-access real-world data and that generate findings with which undergraduate students can readily identify are hard to find. The authors describe a project that requires students to estimate the current female-male earnings gap for new college graduates. The project also enables students to see to what…

  4. 'Mind the Gap!'

    DEFF Research Database (Denmark)

    Persson, Karl Gunnar

    This paper challenges the widely held view that sharply falling real transport costs closed the transatlantic gap in grain prices in the second half of the 19th century. Several new results emerge from an analysis of a new data set of weekly wheat prices and freight costs from New York to UK mark...

  5. Pre-hospital and intra-hospital temporal intervals in patients requiring emergent trauma craniotomy. A 6-year observational study in a level 1 trauma center.

    Science.gov (United States)

    De Vloo, Philippe; Nijs, Stefaan; Verelst, Sandra; van Loon, Johannes; Depreitere, Bart

    2018-03-13

    According to level 2 evidence, earlier evacuation of acute subdural or epidural hematomas necessitating surgery is associated with better outcome. Hence, guidelines recommend performing these procedures "immediately". Literature on extent and causes of pre- and intra-hospital intervals in trauma patients requiring emergent craniotomies is almost completely lacking. Studies delineating and refining the interval before thrombolytic agent administration in ischemic stroke have dramatically reduced the "door-to-needle time". A similar exercise for "trauma-to-decompression time" might result in comparable reductions. We aim to map intervals in emergent trauma craniotomies in our Level 1 Trauma Center, screen for associated factors, and propose possible ways to reduce these intervals. We analyzed patients who were primarily referred (1R; n=45) and secondarily referred (after CT imaging in a community hospital; 2R; n=22) to our emergency department (ED), and underwent emergent trauma craniotomies between 2010 and 2016. Median pre-hospital interval (between emergency call (EC) and arrival at the ED) was 42min for 1R patients. Median intra-hospital interval (between initial ED arrival and skin incision (SI)) was 140min and 268min for 1R and 2R patients, respectively. In 1R patients, ED-SI interval was positively correlated with GCS (ρ=.49; Ppre-hospital and intra-hospital measures to improve performance. This is the first report on EC-SI interval in emergent trauma craniotomy, with a median of 174min and >297min for 1R and 2R patients, respectively, in our center. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. The efficacy and safety of burr-hole craniotomy without continuous drainage for chronic subdural hematoma and subdural hygroma in children under 2 years of age.

    Science.gov (United States)

    Matsuo, Kazuya; Akutsu, Nobuyuki; Otsuka, Kunitoshi; Yamamoto, Kazuki; Kawamura, Atsufumi; Nagashima, Tatsuya

    2016-12-01

    Various treatment modalities have been used in the management of chronic subdural hematoma and subdural hygroma (CSDH/SDHy) in children. However, few studies have examined burr-hole craniotomy without continuous drainage in such cases. Here, we retrospectively evaluated the efficacy and safety of burr-hole craniotomy without continuous drainage for CSDH/SDHy in children under 2 years old. We also aimed to determine the predictors of CSDH/SDHy recurrence. We conducted a retrospective chart review of 25 children under 2 years old who underwent burr-hole craniotomy without continuous drainage for CSDH/SDHy at a pediatric teaching hospital over a 10-year period. We analyzed the relationship between CSDH/SDHy recurrence and factors such as abusive head trauma, laterality of CSDH/SDHy, and subdural fluid collection type (hematoma or hygroma). CSDH/SDHy recurred in 5 of the 25 patients (20 %), requiring a second operation at an average of 0.92 ± 1.12 months after the initial procedure. The mean follow-up period was 25.1 ± 28.6 months. There were no complications related to either operation. None of the assessed factors were statistically associated with recurrence. Burr-hole craniotomy without continuous drainage for CSDH/SDHy appears safe in children aged under 2 years and results in a relatively low recurrence rate. No predictors of CSDH/SDHy recurrence were identified. Advantages of this method include avoiding external subdural drainage-related complications. However, burr-hole drainage may be more effective for CSDH, which our data suggests is more likely to recur than SDHy, providing the procedure is performed with specific efforts to reduce complications.

  7. Preoperative steroid use and the incidence of perioperative complications in patients undergoing craniotomy for definitive resection of a malignant brain tumor.

    Science.gov (United States)

    Alan, Nima; Seicean, Andreea; Seicean, Sinziana; Neuhauser, Duncan; Benzel, Edward C; Weil, Robert J

    2015-09-01

    We studied the impact of preoperative steroids on 30 day morbidity and mortality of craniotomy for definitive resection of malignant brain tumors. Glucocorticoids are used to treat peritumoral edema in patients with malignant brain tumors, however, prolonged (⩾ 10 days) use of preoperative steroids as a risk factor for perioperative complications following resection of brain tumors has not been studied comprehensively. Therefore, we identified 4407 patients who underwent craniotomy to resect a malignant brain tumor between 2007 and 2012, who were reported in the National Surgical Quality Improvement Program, a prospectively collected clinical database. Metastatic brain tumors constituted 37.5% (n=1611) and primary malignant gliomas 62.5% (n=2796) of the study population. We used logistic regression to assess the association between preoperative steroid use and perioperative complications before and after 1:1 propensity score matching. Patients who received steroids constituted 22.8% of the population (n=1009). In the unmatched cohort, steroid use was associated with decreased length of hospitalization (odds ratio [OR] 0.7; 95% confidence interval [CI] 0.6-0.8), however, the risk for readmission (OR 1.5; 95% CI 1.2-1.8) was increased. In the propensity score matched cohort (n=465), steroid use was not statistically associated with any adverse outcomes. Patients who received steroids were less likely to stay hospitalized for a protracted period of time, but were more likely to be readmitted after discharge following craniotomy. As an independent risk factor, preoperative steroid use was not associated with any observed perioperative complications. The findings of this study suggest that preoperative steroids do not independently compromise the short term outcome of craniotomy for resection of malignant brain tumors. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Large gaps between primes

    OpenAIRE

    Maynard, James

    2014-01-01

    We show that there exists pairs of consecutive primes less than $x$ whose difference is larger than $t(1+o(1))(\\log{x})(\\log\\log{x})(\\log\\log\\log\\log{x})(\\log\\log\\log{x})^{-2}$ for any fixed $t$. Our proof works by incorporating recent progress in sieve methods related to small gaps between primes into the Erdos-Rankin construction. This answers a well-known question of Erdos.

  9. Minding the Gap

    Energy Technology Data Exchange (ETDEWEB)

    Firestone, Millicent Anne [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-02-23

    Neutron & X-ray scattering provides nano- to meso-scale details of complex fluid structure; 1D electronic density maps dervied from SAXS yield molecular level insights; Neutron reflectivity provides substructure details of substrate supported complex fluids; Complex fluids composition can be optimized to support a wide variety of both soluble and membrane proteins; The water gap dimensions can be finely tuned through polymer component.

  10. Mind the Gap

    Science.gov (United States)

    Fairbanks, Terry; Savage, Erica; Adams, Katie; Wittie, Michael; Boone, Edna; Hayden, Andrew; Barnes, Janey; Hettinger, Zach; Gettinger, Andrew

    2016-01-01

    Summary Objective Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders’ perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Materials and Methods Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders’ perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. Results We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical work-flow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Discussion Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Conclusion Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation. PMID:27847961

  11. MV controlled spark gap

    International Nuclear Information System (INIS)

    Evdokimovich, V.M.; Evlampiev, S.B.; Korshunov, G.S.; Nikolaev, V.A.; Sviridov, Yu.F.; Khmyrov, V.V.

    1980-01-01

    A megavolt gas-filled trigatron gap with a sectional gas-discharge chamber having a more than three-fold range of operating voltages is described. The discharge chamber consists of ten sections, each 70 mm thick, made of organic glass. The sections are separated one from another by aluminium gradient rings to which ohmic voltage divider is connected. Insulational sections and gradient rings are braced between themselves by means of metal flanges through gaskets made of oil-resistant rubber with the help of fiberglass-laminate pins. The gap has two electrodes 110 mm in diameter. The trigatron ignition assembly uses a dielectric bushing projecting over the main electrode plane. Use has been made of a gas mixture containing 10% of SF 6 and 90% of air making possible to ensure stable gap operation without readjusting in the voltage range from 0.4 to 1.35 MV. The operation time lag in this range is equal to 10 μs at a spread of [ru

  12. Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy.

    Science.gov (United States)

    Chaki, Tomohiro; Sugino, Shigekazu; Janicki, Piotr K; Ishioka, Yoshiya; Hatakeyama, Yosuke; Hayase, Tomo; Kaneuchi-Yamashita, Miki; Kohri, Naonori; Yamakage, Michiaki

    2016-01-01

    Mixtures of various local anesthetics, such as lidocaine and ropivacaine, have been widely used. However, their efficacy and safety for scalp nerve blocks and local infiltration during awake craniotomy have not been fully elucidated. We prospectively investigated 53 patients who underwent awake craniotomy. Scalp block was performed for the blockade of the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with a mixture containing equal volumes of 2% lidocaine and 0.75% ropivacaine, including 5 μg/mL of epinephrine. Infiltration anesthesia was applied at the site of skin incision using the same mixture. The study outcomes included changes in heart rate and blood pressure after head pinning and skin incision, and incidence of severe pain on emergence from anesthesia. Total doses and plasma concentrations of lidocaine and ropivacaine were measured at different time points after performing the block. The heart rate and blood pressure after head pinning were marginally, but significantly, increased when compared with baseline values. There were no significant differences in heart rate and blood pressure before and after the skin incision. Nineteen percent of the patients (10/53) complained of incisional pain at emergence from anesthesia. The highest observed blood concentrations of lidocaine and ropivacaine were 1.9±0.9 and 1.1±0.4 μg/mL, respectively. No acute anesthetic toxicity symptom was observed. Scalp block with a mixture of lidocaine and ropivacaine seems to provide effective and safe anesthetic management in patients undergoing awake craniotomy.

  13. COMPARATIVE STUDY TO EVALUATE EFFECT THE DEXMEDETOMIDINE IN ATTENUATING THE HAEMODYNAMIC AND NEUROENDOCRINE RESPONSES TO SKULL-PIN HEAD HOLDER APPLICATION DURING CRANIOTOMY

    Directory of Open Access Journals (Sweden)

    T. Renganathan

    2017-04-01

    Full Text Available BACKGROUND Application of skull-pin head holder to stabilise the head in craniotomies causes stress in the haemodynamic response (increase in heart rate and mean arterial pressure and neuroendocrine response (increase in blood glucose, serum cortisol and serum prolactin. In this study, attenuation of haemodynamic and neuroendocrine stress response with dexmedetomidine, an alpha-2 adrenoreceptor agonist versus placebo (normal saline were compared. MATERIALS AND METHODS Forty patients posted for elective craniotomy in the age group of 18 to 60 years of both sexes were divided into two groups of 20 each as dexmedetomidine and placebo (normal saline and the attenuation of haemodynamic response and neuroendocrine response to intravenous dexmedetomidine or placebo to the application of skull-pin head holder were compared. Data of haemodynamic and neuroendocrine responses were analysed statistically by Student’s t-test, independent t-test and paired ttest and the p value of <0.05 was considered statistically significant. RESULTS The results of study showed that the increase in heart rate, mean arterial pressure and increase in blood glucose, serum cortisol and serum prolactin was attenuated by dexmedetomidine. CONCLUSION Concludes that the dexmedetomidine attenuates the haemodynamic and neuroendocrine response to the application of skullpin head holder in craniotomy surgeries.

  14. SUBORDINATE GAPS IN MANDARIN CHINESE

    Directory of Open Access Journals (Sweden)

    Ting-Chi Wei

    2011-06-01

    Full Text Available The existence of subordinate gaps in Mandarin Chinese casts doubt on analyses built on canonical coordinate gapping. We observe that the minimality of contrastive focus and the type of subordinate clause determine the acceptability of a missing gap in subordinate structure. Along this vein, we propose that a semantic-based deletion account can be used to interpret gapping in Mandarin. Such account relies on two violable constraints, AvoidF and Focus condition on gapping (Schwarzchild 1999, Merchant 2001 to compute the acceptability of a gap.

  15. The methodology and pharmacokinetics study of intraventricular administration of vancomycin in patients with intracranial infections after craniotomy.

    Science.gov (United States)

    Chen, Kai; Wu, Yuanxin; Wang, Qiang; Wang, Jiaqing; Li, Xingang; Zhao, Zhigang; Zhou, Jianxin

    2015-02-01

    The purpose of the study was to investigate the pharmacokinetics of combined intravenous (i.v.) and intracerebroventricular (i.c.v.) vancomycin for patients with intracranial infections after craniotomy and to provide the basis for establishing the intracranial local administration criterion. Fourteen postoperative intracranial infection cases with surgical cavity/ventricular drainages were given vancomycin (1.0 g, i.v. drip for 2 hours, quaque 12 h, and a simultaneous i.c.v. injection of 10 mg). Their blood and cerebral spinal fluid (CSF) specimens were collected at each time point before and after administrations. The concentrations and biochemical properties were measured. The 1-hour serum vancomycin concentration reached a peak of 46.38 ± 33.39 mg/L; the trough concentration of 48 hours was 8.10 ± 7.11 mg/L; the CSF vancomycin concentration reached a peak of 382.17 ± 421.00 mg/L at 0.25 hours, and the 48-hour trough concentration was 30.82 ± 29.53 mg/L. The inhibitory quotient was calculated at 15.4 by the minimum inhibitory concentration 2 mg/L of target bacteria and had reached the range of 10 to 20 recommended by Infectious Diseases Society of America guidelines. The pH value and osmotic pressure of CSF were found to have no significant changes before and after administration. There was no increasement of seizures and ototoxicity in our study. Before the drug administration and 1 week later, the changes of creatine had no statistically significant, with P > .05. The combined i.v. and i.c.v. administration may improve CSF vancomycin concentrations without side effects at the same dosage. Our finding suggests that it can be an option for the treatment of severe intracranial infections after craniotomy; however, its safety and effectiveness need to be confirmed by further large-scale studies. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. GapBlaster-A Graphical Gap Filler for Prokaryote Genomes.

    Science.gov (United States)

    de Sá, Pablo H C G; Miranda, Fábio; Veras, Adonney; de Melo, Diego Magalhães; Soares, Siomar; Pinheiro, Kenny; Guimarães, Luis; Azevedo, Vasco; Silva, Artur; Ramos, Rommel T J

    2016-01-01

    The advent of NGS (Next Generation Sequencing) technologies has resulted in an exponential increase in the number of complete genomes available in biological databases. This advance has allowed the development of several computational tools enabling analyses of large amounts of data in each of the various steps, from processing and quality filtering to gap filling and manual curation. The tools developed for gap closure are very useful as they result in more complete genomes, which will influence downstream analyses of genomic plasticity and comparative genomics. However, the gap filling step remains a challenge for genome assembly, often requiring manual intervention. Here, we present GapBlaster, a graphical application to evaluate and close gaps. GapBlaster was developed via Java programming language. The software uses contigs obtained in the assembly of the genome to perform an alignment against a draft of the genome/scaffold, using BLAST or Mummer to close gaps. Then, all identified alignments of contigs that extend through the gaps in the draft sequence are presented to the user for further evaluation via the GapBlaster graphical interface. GapBlaster presents significant results compared to other similar software and has the advantage of offering a graphical interface for manual curation of the gaps. GapBlaster program, the user guide and the test datasets are freely available at https://sourceforge.net/projects/gapblaster2015/. It requires Sun JDK 8 and Blast or Mummer.

  17. GapBlaster-A Graphical Gap Filler for Prokaryote Genomes.

    Directory of Open Access Journals (Sweden)

    Pablo H C G de Sá

    Full Text Available The advent of NGS (Next Generation Sequencing technologies has resulted in an exponential increase in the number of complete genomes available in biological databases. This advance has allowed the development of several computational tools enabling analyses of large amounts of data in each of the various steps, from processing and quality filtering to gap filling and manual curation. The tools developed for gap closure are very useful as they result in more complete genomes, which will influence downstream analyses of genomic plasticity and comparative genomics. However, the gap filling step remains a challenge for genome assembly, often requiring manual intervention. Here, we present GapBlaster, a graphical application to evaluate and close gaps. GapBlaster was developed via Java programming language. The software uses contigs obtained in the assembly of the genome to perform an alignment against a draft of the genome/scaffold, using BLAST or Mummer to close gaps. Then, all identified alignments of contigs that extend through the gaps in the draft sequence are presented to the user for further evaluation via the GapBlaster graphical interface. GapBlaster presents significant results compared to other similar software and has the advantage of offering a graphical interface for manual curation of the gaps. GapBlaster program, the user guide and the test datasets are freely available at https://sourceforge.net/projects/gapblaster2015/. It requires Sun JDK 8 and Blast or Mummer.

  18. Middle latency auditory-evoked potential index monitoring of cerebral function to predict functional outcome after emergency craniotomy in patients with brain damage.

    Science.gov (United States)

    Tsurukiri, Junya; Nagata, Katsuhiro; Hoshiai, Akira; Oomura, Taishi; Jimbo, Hiroyuki; Ikeda, Yukio

    2015-10-20

    At present, no satisfactory reports on the monitoring of cerebral function to predict functional outcomes after brain damage such as traumatic brain injury (TBI) and stroke. The middle latency auditory-evoked potential index (MLAEPi) monitor (aepEX plus®, Audiomex, UK) is a mobile MLAEP monitor measuring the degree of consciousness that is represented by numerical values. Hence, we hypothesized that MLAEPi predicts neurological outcome after emergency craniotomy among patients with disturbance of consciousness (DOC), which was caused by brain damage. The afore-mentioned patients who underwent emergency craniotomy within 12 h of brain damage and were subsequently monitored using MLAEPi were enrolled in this study. DOC was defined as an initial Glasgow Coma Scale score craniotomy. Neurological outcome was evaluated before discharge using a cerebral performance category (CPC) score and classified into three groups: favorable outcome group for a CPC score of 1 or 2, unfavorable outcome group for a score of 3 or 4, and brain dead (BD) group for a score of 5. Thirty-two patients were included in this study (17 with TBIs and 15 with acute stroke). Regarding outcome, 10 patients had a favorable outcome, 15 had an unfavorable outcome, and 7 were pronounced BD. MLAEPi was observed to be significantly higher on day 5 than that observed immediately after craniotomy in cases of favorable or unfavorable outcome (63 ± 3.5 vs. 36 ± 2.5 in favorable outcome; 63 ± 3.5 vs. 34 ± 1.8 in unfavorable outcome). MLAEPi was significantly lower in BD patients than in those with a favorable or unfavorable outcome on day 3 (24 ± 4.2 in BD vs. 52 ± 5.2 and 45 ± 2.7 in favorable and unfavorable outcome, respectively) and after day 4. MLAEPi was significantly higher in patients with a favorable outcome than in those with a favorable or unfavorable outcome after day 6 (68 ± 2.3 in favorable outcome vs. 48 ± 2.3 in unfavorable outcome). We believe that MLAEPi satisfactorily denotes

  19. Closing the stop gap

    International Nuclear Information System (INIS)

    Czakon, Michal; Mitov, Alexander; Papucci, Michele; California Univ., Berkeley, CA; Ruderman, Joshua T.; California Univ., Berkeley, CA; New York Univ., NY; Weiler, Andreas; CERN - European Organization for Nuclear Research, Geneva

    2014-07-01

    Light stops are a hallmark of the most natural realizations of weak-scale supersymmetry. While stops have been extensively searched for, there remain open gaps around and below the top mass, due to similarities of stop and top signals with current statistics. We propose a new fast-track avenue to improve light stop searches for R-parity conserving supersymmetry, by comparing top cross section measurements to the theoretical prediction. Stop masses below ∝180 GeV can now be ruled out for a light neutralino. The possibility of a stop signal contaminating the top mass measurement is also briefly addressed.

  20. Photonic band gap materials

    Science.gov (United States)

    Cassagne, D.

    Photonic band gap materials Photonic band gap materials are periodic dielectric structures that control the propagation of electromagnetic waves. We describe the plane wave method, which allows to calculate the band structures of photonic crystals. By symmetry analysis and a perturbative approach, we predict the appearance of the low energy photonic band gaps of hexagonal structures. We propose new two-dimensional structures called graphite and boron nitride. Using a transfer matrix method, we calculate the transmission of the graphite structure and we show the crucial role of the coupling with external modes. We study the appearance of allowed modes in the photonic band gap by the introduction of localized defects in the periodicity. Finally, we discuss the properties of opals formed by self-organized silica microspheres, which are very promising for the fabrication of three-dimensional photonic crystals. Les matériaux à bandes interdites photoniques sont des structures diélectriques périodiques qui contrôlent la propagation des ondes électromagnétiques. Nous décrivons la méthode des ondes planes qui permet de calculer les structures de bandes des cristaux photoniques. Par une analyse de la symétrie et une approche perturbative, nous précisons les conditions d'existence des bandes interdites de basse énergie. Nous proposons de nouvelles structures bidimensionnelles appelées graphite et nitrure de bore. Grâce à une méthode de matrices de transfert, nous calculons la transmission de la structure graphite et nous mettons en évidence le rôle fondamental du couplage avec les modes extérieurs. Nous étudions l'apparition de modes permis dans la bande interdite grâce à l'introduction de défauts dans la périodicité. Enfin, nous discutons les propriétés des opales constituées de micro-billes de silice auto-organisées, qui sont très prometteuses pour la fabrication de cristaux photoniques tridimensionnels.

  1. gap: Genetic Analysis Package

    Directory of Open Access Journals (Sweden)

    Jing Hua Zhao

    2007-06-01

    Full Text Available A preliminary attempt at collecting tools and utilities for genetic data as an R package called gap is described. Genomewide association is then described as a specific example, linking the work of Risch and Merikangas (1996, Long and Langley (1997 for family-based and population-based studies, and the counterpart for case-cohort design established by Cai and Zeng (2004. Analysis of staged design as outlined by Skol et al. (2006 and associate methods are discussed. The package is flexible, customizable, and should prove useful to researchers especially in its application to genomewide association studies.

  2. Gaps in nonsymmetric numerical semigroups

    International Nuclear Information System (INIS)

    Fel, Leonid G.; Aicardi, Francesca

    2006-12-01

    There exist two different types of gaps in the nonsymmetric numerical semigroups S(d 1 , . . . , d m ) finitely generated by a minimal set of positive integers {d 1 , . . . , d m }. We give the generating functions for the corresponding sets of gaps. Detailed description of both gap types is given for the 1st nontrivial case m = 3. (author)

  3. CBF and CMRo2 during craniotomy for small supratentorial cerebral tumours in enflurane anaesthesia. A dose-response study

    International Nuclear Information System (INIS)

    Madsen, J.B.; Cold, G.E.; Eriksen, H.O.; Eskesen, V.; Blatt-Lyon, B.

    1986-01-01

    In 14 patients with supratentorial cerebral tumours with midline shift ≤ 10 mm, cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRo 2 ) were measured twice on the contralateral side of the craniotomy, using a modification of the Kety and Schmidt method. For induction of anaesthesia, thiopental, fentanyl and pancuronium were used. The anaesthesia was maintained with enflurane 1% in nitrous oxide 67%. Moderate hypocapnia to a level averaging 4.3 kPa was achieved. The patients were divided into two groups. In group 1 (n=7), 1% enflurane was used throughout the anaesthesia, and CBF and CMRo 2 measured about 70 min after induction averaged 30.1 ml 100 g -1 min -1 and 1.98 ml O 2 100 g -1 min -1 , respectively. During the second CBF study 1 h later, CBF and CMRo 2 were unchanged (P>0.05). In group 2 (n=7), the inspiratory enflurane concentration was increased from 1 to 2% after the first CBF measurement. In this group a significant decrease in CMRo 2 was observed, while CBF was unchanged. In six patients EEG was recorded simultaneously with the CBF measurements. In patients subjected to increasing enflurane concentration (Group 2), a suppression in the EEG activity was observed without spike waves. It is concluded that enflurane induces a dose-related decrease in CMRo 2 and suppression in the EEG activity, whereas CBF was unchanged (author)

  4. Double concentric craniotomy: Safe and effective technique to achieve an en bloc resection of tumor involving both skull and duraa

    Science.gov (United States)

    Fornaro, R.; Altieri, R.; Garbossa, D.; Zenga, F.; Tartara, F.; Ducati, A

    2015-01-01

    Introduction Many tumors can involve the skull. Meningiomas are one of the most common intracranial neoplasms and invasion of the bone was described in 49% of cases. Other neoplastic lesions that can arise in bone, or involve it, are metastases, hemangiomas, aggressive cutis carcinomas and sarcomas. Radical excision is the golden standard of treatment but elevating a bone flap when the tumor involves both the skull and the dura could represent a technical challenge. Presentation of case We report the technical details of our approach to remove a meningioma involving both skull and dura in a man aged 45. Patient underwent gross total excision and cranioplasty with PEEK custom made prothesis (Synthes™). Discussion We describe a double concentric craniotomy (DCC) technique where the tumor involving the bone is before left in situ, exposing normal dura, to perform afterwards en-bloc excision with minimal traction of brain surface. Conclusion DCC is a safe and effective technique to remove tumor involving both skull and dural structures under direct vision. PMID:26057993

  5. Controlled Cortical Impact and Craniotomy Induce Strikingly Similar Profiles of Inflammatory Gene Expression, but with Distinct Kinetics

    Science.gov (United States)

    Lagraoui, Mouna; Latoche, Joseph R.; Cartwright, Natalia G.; Sukumar, Gauthaman; Dalgard, Clifton L.; Schaefer, Brian C.

    2012-01-01

    An immediate consequence of traumatic brain injury (TBI) is the induction of an inflammatory response. Mounting data suggest that inflammation is a major contributor to TBI-induced brain damage. However, much remains unknown regarding the induction and regulation of the inflammatory response to TBI. In this study we compared the TBI-induced inflammatory response to severe parenchymal injury (controlled cortical impact) vs. mild brain injury (craniotomy) over a 21-day period. Our data show that both severe and mild brain injury induce a qualitatively similar inflammatory response, involving highly overlapping sets of effector molecules. However, kinetic analysis revealed that the inflammatory response to mild brain injury is of much shorter duration than the response to severe TBI. Specifically, the inflammatory response to severe brain injury persists for at least 21 days, whereas the response to mild brain injury returns to near baseline values within 10 days post-injury. Our data therefore imply that the development of accurate diagnostic tests of TBI severity that are based on imaging or biomarker analysis of the inflammatory response may require repeated measures over at least a 10-day period, post-injury. PMID:23118733

  6. National Variability in Intracranial Pressure Monitoring and Craniotomy for Children With Moderate to Severe Traumatic Brain Injury

    Science.gov (United States)

    Van Cleve, William; Kernic, Mary A.; Ellenbogen, Richard G.; Wang, Jin; Zatzick, Douglas F.; Bell, Michael J.; Wainwright, Mark S.; Groner, Jonathan I.; Mink, Richard B.; Giza, Christopher C.; Boyle, Linda Ng; Mitchell, Pamela H.; Rivara, Frederick P.; Vavilala, Monica S.

    2014-01-01

    BACKGROUND Traumatic brain injury (TBI) is a significant cause of mortality and disability in children. Intracranial pressure monitoring (ICPM) and craniotomy/craniectomy (CRANI) may affect outcomes. Sources of variability in the use of these interventions remain incompletely understood. OBJECTIVE To analyze sources of variability in the use of ICPM and CRANI. METHODS Retrospective cross-sectional study of patients with moderate/severe pediatric TBI with the use of data submitted to the American College of Surgeons National Trauma Databank. RESULTS We analyzed data from 7140 children at 156 US hospitals during 7 continuous years. Of the children, 27.4% had ICPM, whereas 11.7% had a CRANI. Infants had lower rates of ICPM and CRANI than older children. A lower rate of ICPM was observed among children hospitalized at combined pediatric/adult trauma centers than among children treated at adult-only trauma centers (relative risk = 0.80; 95% confidence interval 0.66-0.97). For ICPM and CRANI, 18.5% and 11.6%, respectively, of residual model variance was explained by between-hospital variation in care delivery, but almost no correlation was observed between within-hospital tendency toward performing these procedures. CONCLUSION Infants received less ICPM than older children, and children hospitalized at pediatric trauma centers received less ICPM than children at adult-only trauma centers. In addition, significant between-hospital variability existed in the delivery of ICPM and CRANI to children with moderate-severe TBI. PMID:23863766

  7. Early postoperative cognitive recovery after remifentanil-propofol or sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial.

    Science.gov (United States)

    Bilotta, F; Caramia, R; Paoloni, F P; Favaro, R; Araimo, F; Pinto, G; Rosa, G

    2007-02-01

    This study was designed to evaluate early postoperative cognitive recovery after total intravenous anaesthesia with remifentanil-propofol or sufentanil-propofol in patients undergoing craniotomy for supratentorial expanding lesions. Sixty patients were consecutively enrolled, and randomly assigned to one of two study groups: remifentanil-propofol or sufentanil-propofol anaesthesia. To evaluate cognitive function the Short Orientation Memory Concentration Test (SOMCT) and Rancho Los Amigos Scale (RLAS) were administered to all patients in a double-blind procedure before surgery at 15, 45 min and 3 h after extubation. Mean extubation time was similar in the two groups (13 +/- 5 min vs. 19 +/- 6 min). A significantly larger number of patients in the remifentanil-propofol group than in the sufentanil-propofol group required antihypertensive medication postoperatively to maintain mean arterial pressure within 20% of baseline (18/30 vs. 4/29; P = 0.0004). Intergroup analysis showed no differences in baseline SOMCT scores (28 +/- 1 vs. 28 +/- 1) whereas mean SOMCT scores at 15, 45 min and 3 h after extubation were significantly higher in the remifentanil-propofol group (30 patients) than in the sufentanil-propofol group (29 patients) (22 +/- 3 vs. 16 +/- 3; P cognitive recovery.

  8. Remote hemorrhage from the site of craniotomy Hemorragia à distância da área da craniotomia

    Directory of Open Access Journals (Sweden)

    José Alberto Landeiro

    2004-09-01

    Full Text Available Postoperative intracranial hemorrhage is a serious and sometimes a fatal neurosurgical complication. Hemorrhage occurring at regions remote from the site of intracranial operations comprises an uncommon affection, most ignored by the assistant physicians. It bares a still incomprehensive pathophysiology, despite several theories trying to explain it. Looks like a common sense that the presence of the remote site hemorrhage cannot be related to concomitant presence of hypertension, coagulopathy or undiscovered lesions. We report three cases of postoperative hemorrhages occurring in a remote site of supratentorial craniotomies, two patients presented cavernous sinus meningeoma and one patient was submitted to intracranial vascular surgery.Hemorragia intracraniana de ocorrência em pós-operatório é grave complicação das cirurgias intracranianas. O aparecimento de foco hemorrágico em regiões distantes ao sítio operatório original é considerado incomum, e muitas vezes ignorado pelos médicos assistentes. A fisiopatologia envolvida no processo não é de todo compreendida, apesar das diversas teorias já propostas. São apresentados três casos de hemorragia á distancia da área cirúrgica, no pós-operatório de dois pacientes portadores de meningeoma do seio cavernoso e de um submetido à clipagem de aneurisma intracraniano.

  9. GAP-REACH

    Science.gov (United States)

    Lewis-Fernández, Roberto; Raggio, Greer A.; Gorritz, Magdaliz; Duan, Naihua; Marcus, Sue; Cabassa, Leopoldo J.; Humensky, Jennifer; Becker, Anne E.; Alarcón, Renato D.; Oquendo, María A.; Hansen, Helena; Like, Robert C.; Weiss, Mitchell; Desai, Prakash N.; Jacobsen, Frederick M.; Foulks, Edward F.; Primm, Annelle; Lu, Francis; Kopelowicz, Alex; Hinton, Ladson; Hinton, Devon E.

    2015-01-01

    Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-itemGAP-REACH© checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article. PMID:24080673

  10. Gap Task Force

    CERN Multimedia

    Lissuaer, D

    One of the more congested areas in the ATLAS detector is the GAP region (the area between the Barrel Calorimeter and the End Cap calorimeter) where Inner Detector services, LAr Services and some Tile services all must co-habitat in a very limited area. It has been clear for some time that the space in the GAP region is not sufficient to accommodate all that is needed. In the last few month additional problems of routing all the services to Z=0 have been encountered due to the very limited space between the Tile Calorimeter and the first layer of Muon chambers. The Technical Management Board (TMB) and the Executive Board (EB) decided in the middle of March to establish a Task Force to look at this problem and come up with a solution within well-specified guidelines. The task force consisted of experts from the ID, Muon, Liquid Argon and Tile systems in addition to experts from the Technical Coordination team and the Physics coordinator. The task force held many meetings and in general there were some very l...

  11. Closing the value gap

    International Nuclear Information System (INIS)

    Snyder, A.V.

    1992-01-01

    It's a predicament. For the most part, investor-owned electric utilities trade at a deep discount to the actual (that is, replacement-cost) value to their assets. That's because most utilities fail to earn real returns large enough to justify raising and investing capital. The result is a value gap, where overall market value is significantly lower than the replacement costs of the assets. This gap is wider for utilities than for virtually any other industry in our economy. In addition to providing education and awareness, senior management must determine which businesses and activities create value and which diminish it. Then, management must allocate capital and human resources appropriately, holding down investments in value-diminishing areas until they can improve their profitability, and aggressively investing in value-enhancing businesses while preserving their profitability. But value management must not stop with resource-allocation decisions. To create a lasting transition to a value management philosophy, the utility's compensation system must also change: executives will have motivation to create value when compensation stems from this goal, not from such misleading accounting measures as earnings-per-share growth or ROE. That requires clear value-creation goals, and the organization must continuously evaluate top management's performance in light of the progress made toward those goals

  12. The Adaptation Finance Gap Report

    DEFF Research Database (Denmark)

    UNEP’s Adaptation Gap Report series focuses on Finance, Technology and Knowledge gaps in climate change adaptation. It compliments the Emissions Gap Report series, and explores the implications of failing to close the emissions gap. The report builds on a 2014 assessment by the United Nations...... Environment Programme (UNEP), which laid out the concept of ‘adaptation gaps’ and outlined three such gaps: technology, finance and knowledge. The 2016 Adaptation Gap Report assesses the difference between the financial costs of adapting to climate change in developing countries and the amount of money...... and highlights challenges associated with measuring progress towards fulfilling the adaptation finance gap, while informing national and international efforts to advance adaptation. It analyses the ‘adaptation finance gap’ against the background of the provisions laid out in the Paris Agreement, and benefits...

  13. Minding the gap

    Directory of Open Access Journals (Sweden)

    Mia Carlberg

    2013-12-01

    Full Text Available The plan for the Round table session was to focus on organizational and social/cultural differences between librarians and faculty with the aim to increase our awareness of the differences when we try to find ways to cooperate within the academy or school. This may help us to sort things out, experience acceptance and take adequate actions, saving energy and perhaps be less frustrated.  The questions that the workshop addressed were: What is in the gap between librarians and faculty when dealing with information literacy? How can we fill the gap? Participants discussed this in detail with the aim of together finding ways to understand it better and make it possible to find ways to fill this gap. By defining it and thereby making it easier to work out a strategy for future action to improve the teaching of information literacy, including listing possible, impossible or nearly impossible ways. The springboard to the discussion was extracted from some projects that the workshop leader has been engaged in since 2009. The first example is a research circle where Uppsala University Library used action research to observe and understand the process when we had the opportunity to implement information literacy classes with progression in an undergraduate program. What worked well? What did not? Why? This work was described together with other examples from Uppsala University to an international panel working with quality issues. What did they think of our work? May this change the ways we are working? How? Another example is an ongoing joint project where librarians and faculty members are trying to define ways to increase the cooperation between the library and faculty and make this cooperation sustainable. Recent experience from this was brought to the discussion.   There are an overwhelming number of papers written in this field. A few papers have inspired these ideas. One article in particular: Christiansen, L., Stombler, M. & Thaxton, L. (2004. A

  14. Bridging the Evaluation Gap

    Directory of Open Access Journals (Sweden)

    Paul Wouters

    2017-02-01

    Full Text Available Paul Wouters’ essay is concerned with bridging the gap between what we value in our academic work and how we are assessed in formal evaluation exercises. He reflects on the recent evaluation of his own center, and reminds us that it is productive to see evaluations not as the (obviously impossible attempt to produce a true representation of past work, but rather as the exploration and performance of “who one wants to be.” Reflecting on why STS should do more than just play along to survive in the indicator game, he suggests that our field should contribute to changing its very rules. In this endeavor, the attitude and sensibilities developed in our field may be more important than any specific theoretical concepts or methodologies.

  15. Finding the gaps

    Science.gov (United States)

    Stoneham, A. M.

    Much of the pioneering work on radiation damage was based on very simple potentials. Potentials are now much more sophisticated and accurate. Self-consistent molecular dynamics is routine for adiabatic energy surfaces, at least for modest numbers of atoms and modest timescales. This means that non-equilibrium nuclear processes can be followed dynamically. It might also give the illusion that any damage process can be modelled with success. Sadly, this is not yet so. This paper discusses where the gaps lie, and specifically three groups of challenges. The first challenge concerns electronic excited states. The second challenge concerns timescales, from femtoseconds to tens of years. The third challenge concerns length scales, and the link between microscopic (atomistic) and mesoscopic (microstructural) scales. The context of these challenges is materials modification by excitation: the removal of material, the modification of bulk or surface material, the altering of rates of processes or changing of branching ratios, and damage, good or bad.

  16. Preoperative identification of neurosurgery patients with a high risk of in-hospital complications: a prospective cohort of 418 consecutive elective craniotomy patients.

    Science.gov (United States)

    Reponen, Elina; Korja, Miikka; Niemi, Tomi; Silvasti-Lundell, Marja; Hernesniemi, Juha; Tuominen, Hanna

    2015-09-01

    Patients undergoing craniotomy are routinely assessed preoperatively, yet the role of these assessments in predicting outcome is poorly studied. This study aimed to identify preoperative factors predicting in-hospital outcome after cranial neurosurgery. The study cohort consisted of 418 consecutive adults undergoing elective craniotomy for any intracranial lesion. Apart from the age criteria (≥ 18 years), almost all patients were considered eligible for the study to increase external validity of the results. The studied preoperative assessments included various patient-related data, routine blood tests, American Society of Anesthesiologists (ASA) Physical Status Classification system, and a local modification of the ASA classification (Helsinki ASA classification). Adverse outcomes were in-hospital mortality, in-hospital systemic or infectious complications, and in-hospital CNS deficits. Resource use was defined as length of stay (LOS) in the intensive care unit and overall LOS in the hospital. The in-hospital mortality rate was 1.0%. In-hospital systemic or infectious complications and permanent or transient CNS deficits occurred in 6.7% and 11.2% of the patients, respectively. Advanced age (≥ 60-65 years), elevated C-reactive protein level (> 3 mg/L), and high Helsinki ASA score (Class 4) were associated with in-hospital systemic and infectious complications, and a combination of these could identify one-fourth of the patients with postoperative complications. Moreover, this combination of preoperative assessment parameters was significantly associated with increased resource use. In this first prospective and unselected cohort study of outcome after elective craniotomy, simple preoperative assessments identified patients with a high risk of in-hospital systemic or infectious complications as well as extended resource use. Presented risk assessment methods may be widely applicable, also in low-volume centers, as they are based on composite predictors and

  17. Divergent temporal expression of hyaluronan metabolizing enzymes and receptors with craniotomy vs. controlled cortical impact injury in rat brain: A pilot study

    Directory of Open Access Journals (Sweden)

    Guoqiang eXing

    2014-09-01

    Full Text Available Traumatic brain injury triggers many secondary changes in tissue biology which ultimately determine the extent of injury and clinical outcome. Hyaluronan (hyaluronic acid, HA is a protective cementing gel present in the intercellular spaces whose degradation has been reported as a causative factor in tissue damage. Yet little is known about the expression and activities of genes involved in HA catabolism after TBI. Young adult male Sprague-Dawley rats were assigned to three groups: naïve control, craniotomy and, controlled-cortical impact-induced TBI (CCI-TBI. Four animals per group were sacrificed at 4h, 1d, 3d and 7d post CCI. The mRNA expression of hyaluronan synthases (HAS1-3, hyaluronidases (enzymes for HA degradation, HYAL 1-4 & PH20 and CD44 and RHAMM (membrane receptors for HA signaling and removal were determined using real-time PCR. Compared to the naïve controls, expression of HAS1 and HAS2 mRNA, but not HAS3 mRNA increased significantly following craniotomy alone and following CCI with differential kinetics. Expression of HAS2 mRNA increased significantly in the ipsilateral brain at 1d and 3d post CCI. HYAL1 mRNA expression also increased significantly in the craniotomy group and in the contralateral CCI at 1d and 3d post CCI. CD44 mRNA expression increased significantly in the ipsilateral CCI at 4h, 1d, 3d and 7d post CCI (up to 25 fold increase. These data suggest a dynamic regulation and role for HA metabolism in secondary responses to traumatic brain injury.

  18. “Awake” intraoperative functional MRI (ai-fMRI) for mapping the eloquent cortex: Is it possible in awake craniotomy?☆

    Science.gov (United States)

    Lu, Jun-Feng; Zhang, Han; Wu, Jin-Song; Yao, Cheng-Jun; Zhuang, Dong-Xiao; Qiu, Tian-Ming; Jia, Wen-Bin; Mao, Ying; Zhou, Liang-Fu

    2012-01-01

    As a promising noninvasive imaging technique, functional MRI (fMRI) has been extensively adopted as a functional localization procedure for surgical planning. However, the information provided by preoperative fMRI (pre-fMRI) is hampered by the brain deformation that is secondary to surgical procedures. Therefore, intraoperative fMRI (i-fMRI) becomes a potential alternative that can compensate for brain shifts by updating the functional localization information during craniotomy. However, previous i-fMRI studies required that patients be under general anesthesia, preventing the wider application of such a technique as the patients cannot perform tasks unless they are awake. In this study, we propose a new technique that combines awake surgery and i-fMRI, named “awake” i-fMRI (ai-fMRI). We introduced ai-fMRI to the real-time localization of sensorimotor areas during awake craniotomy in seven patients. The results showed that ai-fMRI could successfully detect activations in the bilateral primary sensorimotor areas and supplementary motor areas for all patients, indicating the feasibility of this technique in eloquent area localization. The reliability of ai-fMRI was further validated using intraoperative stimulation mapping (ISM) in two of the seven patients. Comparisons between the pre-fMRI-derived localization result and the ai-fMRI derived result showed that the former was subject to a heavy brain shift and led to incorrect localization, while the latter solved that problem. Additionally, the approaches for the acquisition and processing of the ai-fMRI data were fully illustrated and described. Some practical issues on employing ai-fMRI in awake craniotomy were systemically discussed, and guidelines were provided. PMID:24179766

  19. A prospective controlled study: Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Tang Yuping

    2011-06-01

    Full Text Available Abstract Background Spontaneous intracerebral hemorrhage (ICH is a devastating form of stroke with the high mortality twofold to sixfold higher than that for ischemic stroke. But the treatment of haematomas within the basal ganglia continues to be a matter of debate among neurologists and neurosurgeons. The purpose of this study is to judge the clinical value of minimally invasive stereotactic puncture therapy (MISPT on acute ICH. Methods A prospective controlled study was undertaken. The clinical trial was in compliance with the WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. According to the enrollment criterion, there were 168 acute ICH cases analyzed, of which 90 cases were performed by MISPT ( MISPT group, MG and 78 cases by Conventional craniotomy (CC group, CG, by means of compare of Glasgow Coma Scale(GCS score, postoperative complications(PC and rebleeding incidence(RI, moreover, long-term outcome of 1 year postoperation judged by Glasgow Outcome Scale (GOS, Barthel Index (BI, modified Rankin Scale (mRS and case fatality(CF. Results MG patients showed obvious amelioration in GCS score compared with that of CG. The total incidence of PC in MG decreased obviously compared with that of CG. The incidences of rebleeding in MG and CG were 10.0% and 15.4% respectively. There was no obvious difference between CFs of MG and CG. For three parameters representing long-term outcome, the GOS, BI and mRS in MG were ameliorated significantly than that of CG. Conclusion These data suggested that the advantage of MISPT was displayed in minute trauma and safety, and seemed to be feasible and to had a trend towards improved long-term outcome. Trial Registration The Australian New Zealand Clinical Trials Registry (ANZCTR, the registration number:ACTRN12610000945022.

  20. Risk factors of aseptic bone resorption: a study after autologous bone flap reinsertion due to decompressive craniotomy.

    Science.gov (United States)

    Dünisch, Pedro; Walter, Jan; Sakr, Yasser; Kalff, Rolf; Waschke, Albrecht; Ewald, Christian

    2013-05-01

    In patients who have undergone decompressive craniectomy, autologous bone flap reinsertion becomes necessary whenever the cerebral situation has consolidated. However, aseptic necrosis of the bone flap remains a concern. The aim of this study was to report possible perioperative complications in patients undergoing autologous bone flap reinsertion and to identify the risk factors that may predispose the bone flap to necrosis. All patients admitted to the authors' neurosurgical department between September 1994 and June 2011 and who received their own cryoconserved bone flap after decompressive craniectomy were studied. The grade of the bone flap necrosis was classified into 2 types. Type II bone necrosis was characterized by aseptic resorption with circumscribed or complete lysis of tabula interna and externa requiring surgical revision. To define predisposing factors, a multivariate analysis was performed using bone necrosis as the dependent variable. Among the 372 patients (mean age 48.6 years, 57.4% males) who received 414 bone flaps during the observation period, 134 (36.0%) had a diffuse traumatic brain injury, 69 (18.5%) had subarachnoid hemorrhage, 58 (15.6%) had cerebral infarction, 56 (15.1%) had extraaxial bleeding, 43 (11.6%) had intracerebral bleeding, and 12 (3.2%) had a neoplasm. Surgical relevant Type II bone flap necrosis occurred in 85 patients (22.8%) and 91 bone flaps, after a median time of 15 months (interquartile range [IQR], 10-33 months). In a multivariate analysis with Type II necrosis as the dependent variable, bone flap fragmentation with 2 (OR 3.35, 95% CI 1.59-7.01, p bone flap necrosis. In patients undergoing bone flap reinsertion after craniotomy, aseptic bone necrosis is an underestimated problem during long-term follow-up. Especially in younger patients with an expected good neurological recovery and a fragmented bone flap, an initial allograft should be considered because of an increased risk for aseptic bone flap necrosis.

  1. Craniotomia sem tricotomia: avaliação de 640 casos Craniotomy without tricotomy: analysis of 640 cases

    Directory of Open Access Journals (Sweden)

    Amylcar E. Dvilevicius

    2004-03-01

    Full Text Available A remoção do cabelo para realização de craniotomia utilizada rotineiramente na maioria dos serviços de neurocirurgia para procedimentos cranianos diversos questionada em sua necessidade a partir da avaliação retrospectiva de 640 pacientes submetidos a cirurgias cranianas, em que foi observada uma porcentagem de infecção de ferida cirúrgica de 1,09 %, não superior àquelas com tricotomia revisadas na literatura. Nos 7 casos com infecção, 3 pacientes foram submetidos a derivações liquóricas, 3 pacientes eram vítimas de traumatismo crânio-encefálico e uma paciente substituida a craniotomia para tratamento de tumor cerebral. A técnica para preservação e manuseio do cabelo, suas vantagens e desvantagens são descritas e discutidas.The hair shaving in preparation for neurosurgeris frequently used in most of neurosurgical centers to perform craniotomy. We question about its necessity after our retrospective analysis of 640 patients undergoing cranial procedures without previous hair shaving. We had the overall surgical wound infection rate of 1.09%, not higher than tricotomy in the review of the literature. In 7 cases with infection, 3 patients were undergoing to CSF shunts, 3 patients had head injury, and one had brain tumor. The technique for preparing skin and hair for cranial procedures, its advantages and disvantages are described and discussed.

  2. A prospective controlled study: Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage

    Science.gov (United States)

    2011-01-01

    Background Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke with the high mortality twofold to sixfold higher than that for ischemic stroke. But the treatment of haematomas within the basal ganglia continues to be a matter of debate among neurologists and neurosurgeons. The purpose of this study is to judge the clinical value of minimally invasive stereotactic puncture therapy (MISPT) on acute ICH. Methods A prospective controlled study was undertaken. The clinical trial was in compliance with the WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. According to the enrollment criterion, there were 168 acute ICH cases analyzed, of which 90 cases were performed by MISPT ( MISPT group, MG) and 78 cases by Conventional craniotomy (CC group, CG), by means of compare of Glasgow Coma Scale(GCS) score, postoperative complications(PC) and rebleeding incidence(RI), moreover, long-term outcome of 1 year postoperation judged by Glasgow Outcome Scale (GOS), Barthel Index (BI), modified Rankin Scale (mRS) and case fatality(CF). Results MG patients showed obvious amelioration in GCS score compared with that of CG. The total incidence of PC in MG decreased obviously compared with that of CG. The incidences of rebleeding in MG and CG were 10.0% and 15.4% respectively. There was no obvious difference between CFs of MG and CG. For three parameters representing long-term outcome, the GOS, BI and mRS in MG were ameliorated significantly than that of CG. Conclusion These data suggested that the advantage of MISPT was displayed in minute trauma and safety, and seemed to be feasible and to had a trend towards improved long-term outcome. Trial Registration The Australian New Zealand Clinical Trials Registry (ANZCTR), the registration number:ACTRN12610000945022. PMID:21699716

  3. Long-term utility and complication profile of open craniotomy for biopsy in patients with idiopathic encephalitis.

    Science.gov (United States)

    Abdullah, Kalil G; Li, Yin; Agarwal, Prateek; Nayak, Nikhil R; Thawani, Jayesh P; Balu, Ramani; Lucas, Timothy H

    2017-03-01

    Neurosurgeons are often asked to perform open biopsy for diagnosis of encephalitis after medical investigations are non-diagnostic. These patients may be critically ill with multiple comorbidities. Patients and their families often request data regarding the success rates and complication profile of biopsy, but minimal literature exists in this area. Retrospective chart review of all patients undergoing open brain biopsy (burr hole or craniotomy) for encephalitis refractory to medical diagnosis between January 2009 and December 2013 was undertaken. Pathology records and outpatient follow-up were reviewed to determine most recent clinical status of each patient. A total of 59 patients were included with mean follow up of 20months. The average age at biopsy was 55years. The most common unconfirmed diagnoses leading to biopsy were vasculitis (44%), neoplasm (27%), infection (12%), autoimmune (12%), amyloidosis (5%). Tissue pathology was diagnostic in 42% of all cases. Overall, biopsy confirmed the preoperative diagnosis in 46% of cases and refuted the preoperative leading diagnosis in 25% of cases. At last follow-up, the tissue pathology resulted in a medical treatment change in 25% of cases. There was a 14% major neurological complication rate (postoperative stroke, hemorrhage, or neurological deficit) and 9% cardiopulmonary complication rate (delayed extubation and re-intubation) attributable to surgical intervention. In this limited series, diagnostic utility of biopsy in patients with idiopathic encephalitis is less than 50% and the major complication rate is 23%. Patients and providers must be counseled accordingly and weigh the risks and benefits of open biopsy for encephalitis cautiously. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Measuring the Gap

    Directory of Open Access Journals (Sweden)

    Xinshu She MD, MPH

    2016-02-01

    Full Text Available China is a large country where rapid development is accompanied by growing inequalities. How economic inequalities translate to health inequalities is unknown. Baseline health assessment is lacking among rural Chinese children. We aimed at assessing baseline student health of rural Chinese children and comparing them with those of urban children of similar ages. A cross-sectional study was conducted using the 2003 Global School-Based Student Health Survey among 100 students Grade 4 to 6 from rural Guizhou, China. Results were summarized and compared with public data from urban Beijing using multivariate logistic regression models. Rural children are more likely to not wash their hands before a meal (odds ratio [OR] = 5.71, P .05. Rural parents are more likely to not know their children’s whereabouts (OR = 1.81, P < .05. Rural children are more than 4 times likely to have serious injuries (OR = 4.64, P < .01 and to be bullied (OR = 4.01, P < .01. In conclusion, school-age rural Chinese children exhibit more health risk behaviors and fewer protective factors at baseline compared to their urban counterparts. Any intervention aimed at improving child health should take this distributive gap into consideration.

  5. Radiating gap filler

    International Nuclear Information System (INIS)

    2009-01-01

    Full text: In May, corrosion on the outside wall of the over 50 year old Canadian Chalk River reactor vessel caused a heavy water leak and the reactor was shut down triggering worldwide a nuclear medicine shortage. The reactor is also a major supplier of the isotope molybdenum-99 (Mo-99), a precursor of the medically widely used technetium-99 m . To fill the gap in demand, the Australian Nuclear Science and Technology Organisation has now arranged with US company Lantheus Medical Imaging, Inc., a world leader in medical imaging, to supply Mo-99. Subject to pending Australian regulatory processes, the deal is expected to assist in alleviating the world's current nuclear medicine shortage. As ANSTO is currently also the only global commercial supplier that produces Mo-99 from low enriched uranium (LEU) targets, Lantheus will be the first company bringing LEU derived Tc-99 m to the US market. To date, over 95% of Mo-99 is derived from highly enriched uranium (HEU) targets. However, there are concerns regarding proliferation risks associated with HEU targets and for commercial uses production from LEU targets would be desirable. ANSTO says that global Mo-99 supply chain is fragile and limited and it is working closely with nuclear safety and healthy regulators, both domestically and overseas, to expedite all necessary approvals to allow long-term production and export of medical isotopes.

  6. A comparison of 1 minimum alveolar concentration desflurane and 1 minimum alveolar concentration isoflurane anesthesia in patients undergoing craniotomy for supratentorial lesions.

    Science.gov (United States)

    Yildiz, Karamehmet; Bicer, Cihangir; Aksu, Recep; Dogru, Kudret; Madenoglu, Halit; Boyaci, Adem

    2011-04-01

    A critical point in craniotomy is during opening of the dura and the subsequent potential for cerebral edema. Use of desflurane in neurosurgery may be beneficial because it facilitates early postoperative neurologic evaluation; however, data on the effect of desflurane on intracranial pressure in humans are limited. Isoflurane has been used extensively in neurosurgical patients. This study compared 1 minimum alveolar concentration (MAC) desflurane with 1 MAC isoflurane in facilitating hemodynamic stability, brain relaxation, and postoperative recovery characteristics in patients who underwent craniotomy for supratentorial lesions. A total of 70 patients (aged 18-65 years), with American Society of Anesthesiologists (ASA) 1 or 2 physical status, who underwent craniotomy for supratentorial lesions, were enrolled in the study. For induction of anesthesia, fentanyl (2 μg/kg IV) and propofol (2 mg/kg IV) were administered. Endotracheal intubation was performed after administration of vecuronium (0.1 mg/kg IV) for total muscle relaxation. Before insertion of the skull pins, additional fentanyl (2 μg/kg IV) was administered. Patients were randomly allocated to 1 of 2 anesthetic regimens. For maintenance of anesthesia, 35 patients received 1 MAC of desflurane (group 1) and 35 patients received 1 MAC of isoflurane (group 2) within 50% oxygen in nitrous oxide. Intraoperatively, heart rate (HR) and mean arterial pressure (MAP) were measured and recorded before induction and 1 minute after induction, after endotracheal intubation, before skull pin insertion and 1 minute after skull pin insertion, before incision and 1 minute after incision, and before extubation and 1 minute after extubation. Also, HR and MAP were recorded at 30-minute intervals. Postoperatively, extubation time, eye opening time to verbal stimuli, orientation time, and time to reach an Aldrete postanesthetic recovery score of ≥8 were recorded. In addition, opioid consumption was calculated and recorded

  7. PhoneGap for enterprise

    CERN Document Server

    Shotts, Kerri

    2014-01-01

    This book is intended for developers who wish to use PhoneGap to develop useful, rich, secure mobile applications for their enterprise environment. The book assumes you have working knowledge of PhoneGap, HTML5, CSS3, and JavaScript, and a reasonable understanding of networking and n-tier architectures.

  8. LiGAPS-Beef 2018

    NARCIS (Netherlands)

    Linden, van der A.; Ven, van de G.W.J.; Oosting, S.J.; Ittersum, van M.K.; Boer, de I.J.M.

    2018-01-01

    LiGAPS-Beef is a mechanistic model to assess potential and feed-limited beef production in different beef production systems across the world. The model is one of the first using concepts of production ecology to simulate livestock production. LiGAPS-Beef consists of a thermoregulation sub-model, a

  9. LiGAPS-Beef 2017

    NARCIS (Netherlands)

    Linden, van der A.; Ven, van de G.W.J.; Oosting, S.J.; Ittersum, van M.K.; Boer, de I.J.M.

    2017-01-01

    LiGAPS-Beef is a mechanistic model to assess potential and feed-limited beef production in different beef production systems across the world. The model is one of the first using concepts of production ecology to simulate livestock production. LiGAPS-Beef consists of a thermoregulation sub-model, a

  10. False air-bone gap.

    Science.gov (United States)

    Rudmin, F

    1983-01-01

    A single case is reported of a severely hearing-impaired child with a finding of a large air-bone gap on pure-tone audiometry on multiple tests. Exploratory surgery found normal middle ear function. Subsequent audiometry indicated the presence of a false air-bone gap resulting from vibrotactile responses. Test procedures for identifying vibrotactile responses are discussed.

  11. Microstrip microwave band gap structures

    Indian Academy of Sciences (India)

    Microwave band gap structures exhibit certain stop band characteristics based on the periodicity, impedance contrast and effective refractive index contrast. These structures though formed in one-, two- and three-dimensional periodicity, are huge in size. In this paper, microstrip-based microwave band gap structures are ...

  12. The Emissions Gap Report 2014

    DEFF Research Database (Denmark)

    Farrell, Timothy Clifford

    This fifth Emissions Gap report has a different focus from previous years. While it updates the 2020 emissions gap analysis, it gives particular attention to the implications of the global carbon dioxide emissions budget for staying within the 2 °C limit beyond 2020. It does so because countries ...

  13. Short-term use of remifentanil during endotracheal extubation for prophylactic analgesia in neurosurgical patients after craniotomy (SURE after Craniotomy Study): a study protocol and statistical analysis plan for a randomised controlled trial

    Science.gov (United States)

    Wu, Yuan-Xing; Chen, Han; Zhou, Jian-Xin

    2014-01-01

    Introduction Acute pain is common during the endotracheal extubation period, and is related to complications and adverse outcomes. Patients with delayed extubation after craniotomy are vulnerable to pain and complications of extubation. However, pain control during extubation is still inadequate. Remifentanil, a new opioid with rapid onset and short duration of action, provides adequate analgesia during procedures with minimal effect of respiratory depression. Methods and analysis The study is a prospective, randomised, double-blinded, controlled parallel-group design. Patients with delayed extubation after intracranial surgery are screened daily. Adult patients ready for extubation are enrolled and assigned randomly to one of the two treatment study groups, labelled as the ‘Remi group’ or ‘Saline group’. Patients in the Remi group receive an intravenous bolus dose of remifentanil 0.5 μg/kg over 60 s followed by a continuous infusion 0.05 μg/kg/min for 20 min. Patients in the Saline group receive an intravenous infusion of 0.9% sodium chloride at a volume and rate equal to that of remifentanil. Pain intensity is measured by the visual analogue scale (VAS) pain score. Adverse events during drug infusion are documented and reported. Patients will be followed up until hospital discharge, death or 60 days after the trial intervention on a first come, first served basis. Details of the incidence of reintubation and reoperation within 72 h after extubation, length of stay in the intensive care unit and hospital and mortality are collected. The primary end point is the incidence of severe pain (defined as a VAS pain score more than 5 cm) during the periextubation period (defined as the period of time from immediately before extubation to 20 min after extubation). Ethics and dissemination The study was approved by the Institutional Review Board (IRB) of the Beijing Tiantan Hospital, Capital Medical University. The study findings will be

  14. Bridging the terahertz gap

    International Nuclear Information System (INIS)

    Davies, Giles; Linfield, Edmund

    2004-01-01

    Over the last century or so, physicists and engineers have progressively explored and conquered the electromagnetic spectrum. Starting with visible light, we have encroached outwards, developing techniques for generating and detecting radiation at both higher and lower frequencies. And as each successive region of the spectrum has been colonized, we have developed technology to exploit the radiation found there. X-rays, for example, are routinely used to image hidden objects. Near-infrared radiation is used in fibre-optic communications and in compact-disc players, while microwaves are used to transmit signals from your mobile phone. But there is one part of the electromagnetic spectrum that has steadfastly resisted our advances. This is the terahertz region, which ranges from frequencies of about 300 GHz to 10 THz (10 x 10 sup 1 sup 2 Hz). This corresponds to wavelengths of between about 1 and 0.03 mm, and lies between the microwave and infrared regions of the spectrum. However, the difficulties involved in making suitably compact terahertz sources and detectors has meant that this region of the spectrum has only begun to be explored thoroughly over the last decade. A particularly intriguing feature of terahertz radiation is that the semiconductor devices that generate radiation at frequencies above and below this range operate in completely different ways. At lower frequencies, microwaves and millimetre- waves can be generated by 'electronic' devices such as those found in mobile phones. At higher frequencies, near-infrared and visible light are generated by 'optical' devices such as semiconductor laser diodes, in which electrons emit light when they jump across the semiconductor band gap. Unfortunately, neither electronic nor optical devices can conveniently be made to work in the terahertz region because the terahertz frequency range sits between the electronic and optical regions of the electromagnetic spectrum. Developing a terahertz source is therefore a

  15. The fluctuating gap model

    International Nuclear Information System (INIS)

    Cao, Xiaobin

    2011-01-01

    The quasi-one-dimensional systems exhibit some unusual phenomenon, such as the Peierls instability, the pseudogap phenomena and the absence of a Fermi-Dirac distribution function line shape in the photoemission spectroscopy. Ever since the discovery of materials with highly anisotropic properties, it has been recognized that fluctuations play an important role above the three-dimensional phase transition. This regime where the precursor fluctuations are presented can be described by the so called fluctuating gap model (FGM) which was derived from the Froehlich Hamiltonian to study the low energy physics of the one-dimensional electron-phonon system. Not only is the FGM of great interest in the context of quasi-one-dimensional materials, liquid metal and spin waves above T c in ferromagnets, but also in the semiclassical approximation of superconductivity, it is possible to replace the original three-dimensional problem by a directional average over effectively one-dimensional problem which in the weak coupling limit is described by the FGM. In this work, we investigate the FGM in a wide temperature range with different statistics of the order parameter fluctuations. We derive a formally exact solution to this problem and calculate the density of states, the spectral function and the optical conductivity. In our calculation, we show that a Dyson singularity appears in the low energy density of states for Gaussian fluctuations in the commensurate case. In the incommensurate case, there is no such kind of singularity, and the zero frequency density of states varies differently as a function of the correlation lengths for different statistics of the order parameter fluctuations. Using the density of states we calculated with non-Gaussian order parameter fluctuations, we are able to calculate the static spin susceptibility which agrees with the experimental data very well. In the calculation of the spectral functions, we show that as the correlation increases, the quasi

  16. The fluctuating gap model

    Energy Technology Data Exchange (ETDEWEB)

    Cao, Xiaobin

    2011-01-15

    The quasi-one-dimensional systems exhibit some unusual phenomenon, such as the Peierls instability, the pseudogap phenomena and the absence of a Fermi-Dirac distribution function line shape in the photoemission spectroscopy. Ever since the discovery of materials with highly anisotropic properties, it has been recognized that fluctuations play an important role above the three-dimensional phase transition. This regime where the precursor fluctuations are presented can be described by the so called fluctuating gap model (FGM) which was derived from the Froehlich Hamiltonian to study the low energy physics of the one-dimensional electron-phonon system. Not only is the FGM of great interest in the context of quasi-one-dimensional materials, liquid metal and spin waves above T{sub c} in ferromagnets, but also in the semiclassical approximation of superconductivity, it is possible to replace the original three-dimensional problem by a directional average over effectively one-dimensional problem which in the weak coupling limit is described by the FGM. In this work, we investigate the FGM in a wide temperature range with different statistics of the order parameter fluctuations. We derive a formally exact solution to this problem and calculate the density of states, the spectral function and the optical conductivity. In our calculation, we show that a Dyson singularity appears in the low energy density of states for Gaussian fluctuations in the commensurate case. In the incommensurate case, there is no such kind of singularity, and the zero frequency density of states varies differently as a function of the correlation lengths for different statistics of the order parameter fluctuations. Using the density of states we calculated with non-Gaussian order parameter fluctuations, we are able to calculate the static spin susceptibility which agrees with the experimental data very well. In the calculation of the spectral functions, we show that as the correlation increases, the

  17. Assessment of the role of gabapentin in patients with supratentorial tumours undergoing craniotomy under general anaesthesia: A double-blind randomised study

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2017-01-01

    Full Text Available Background: Gabapentin attenuates the haemodynamics, decreases the catecholamine release and has a neuroprotective effect. The aim of the present study was to assess the effect of gabapentin in patients with supratentorial brain tumours undergoing craniotomy under general anaesthesia. Methods: A radial arterial line, central venous line and ventriculostomy catheters were inserted before surgery. Anaesthesia was induced with thiopental, fentanyl and atracurium and maintained with sevoflurane, fentanyl and atracurium infusion. The study included 160 patients classified randomly into two groups: Group G: The patients received gabapentin capsules 1200 mg orally 2 h before surgery. Group C: The patients received placebo capsules. Results: The heart rate, mean arterial blood pressure and intracranial pressure decreased significantly with gabapentin as compared to the control group (P < 0.05. The dose of fentanyl and end-tidal sevoflurane was lower with gabapentin than the control group (P < 0.05. The urine output was higher in the gabapentin group than the control group (P < 0.05. The Glasgow coma scale score was better in the gabapentin group as compared to the control group (P < 0.05. The incidence of nausea and vomiting was lower in the gabapentin group as compared to the control group (P < 0.05. Conclusions: Pre-operative administration of gabapentin in patients undergoing craniotomy under general anaesthesia minimised the fluctuations in haemodynamics, reduced the requirements for sevoflurane and fentanyl, decreased intracranial pressure and improved the outcomes. There were some side effects associated with gabapentin such as hypotension and bradycardia.

  18. Preservation of the olfactory tract in bifrontal craniotomy Preservação do trato olfatório em craniotomias bifrontais

    Directory of Open Access Journals (Sweden)

    Paulo H. Aguiar

    2002-03-01

    Full Text Available The bifrontal craniotomy approach used to be associated with a high percentage of olfactory tract damage. We present our experience with this technique, that was used with excellent results in a series of 11 patients that underwent the surgical approach described in this paper. We support the idea that bilateral subfrontal craniotomy allows a wide operative exposure as well as the complete anatomic and functional preservation of the olfactory tracts bilaterally.A craniotomia bifrontal costumava estar associada com alta incidência de lesão do trato olfatório. Apresentamos nossa experiência com técnica que foi usada com excelentes resultados numa série de 11 pacientes que foram submetidos à abordagem cirúrgica descrita neste estudo. Defendemos a idéia de que a craniotomia bilateral subfrontal permite uma exposição cirúrgica ampla bem como a completa preservação anatômica e funcional dos tratos olfatórios bilateralmente.

  19. Gap Surface Plasmon Waveguide Analysis

    DEFF Research Database (Denmark)

    Nielsen, Michael Grøndahl; Bozhevolnyi, Sergey I.

    2014-01-01

    Plasmonic waveguides supporting gap surface plasmons (GSPs) localized in a dielectric spacer between metal films are investigated numerically and the waveguiding properties at telecommunication wavelengths are presented. Especially, we emphasize that the mode confinement can advantageously be con...

  20. Closing the Cybersecurity Skills Gap

    Directory of Open Access Journals (Sweden)

    Rebecca Vogel

    2016-05-01

    Full Text Available The current consensus is that there is a worldwide gap in skills needed for a competent cybersecurity workforce. This skills gap has implications for the national security sector, both public and private. Although the view is that this will take a concerted effort to rectify, it presents an opportunity for IT professionals, university students, and aspirants to take-up jobs in national security national intelligence as well military and law enforcement intelligence. This paper examines context of the issue, the nature of the cybersecurity skills gap, and some key responses by governments to address the problem. The paper also examines the emerging employment trends, some of the employment challenges, and what these might mean for practice. The paper argues that the imperative is to close the cyber skills gap by taking advantage of the window of opportunity, allowing individuals interested in moving into the cybersecurity field to do so via education and training.

  1. Verb gapping: an action-gap compatibility study.

    Science.gov (United States)

    Claus, Berry

    2015-03-01

    This study addresses the processing of verb-gapping sentences, e.g., John closes a juice bottle and Jim [ ] a lemonade bottle. The goal was to explore if there would be an interaction between language comprehension and motor action not only for overt action verbs but also for gapped verbs. Participants read gapping sentences that either described clockwise or counter-clockwise manual rotations (e.g., closes vs. opens a juice bottle). Adopting a paradigm developed by Zwaan and Taylor (2006), sentence presentation was frame-by-frame. Participants proceeded from frame to frame by turning a knob either clockwise or counter clockwise. Analyses of the frame reading-times yielded a significant effect of compatibility between the linguistically conveyed action and the knob turning for the overt-verb (e.g., closes/opens a juice bottle) as well as for the gapped-verb frame (e.g., a lemonade bottle) - with longer reading times in the match condition than in the mismatch condition - but not for any of the other frames (e.g., and Jim). The results are promising in providing novel evidence for the real-time reactivation of gapped verbs and in suggesting that action simulation is not bound to the processing of overt verbs. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Is There a Gap in the Gap? Regional Differences in the Gender Pay Gap

    OpenAIRE

    Hirsch, Boris; König, Marion; Möller, Joachim

    2009-01-01

    In this paper, we investigate regional differences in the gender pay gap both theoretically and empirically. Within a spatial oligopsony model, we show that more densely populated labour markets are more competitive and constrain employers' ability to discriminate against women. Utilising a large administrative data set for western Germany and a flexible semi-parametric propensity score matching approach, we find that the unexplained gender pay gap for young workers is substantially lower in ...

  3. Decompressive craniotomy or craniectomy?

    African Journals Online (AJOL)

    Objective: Decompressive surgery is one of the available options in dealing with traumatic brain injury (TBI) when clinical and radiological evidence confirm that medical treatment may be insufficient. This can be achieved either by complete removal of the bone or by allowing it to float, but the indications and utility of these ...

  4. Craniotomy Frontal Bone Defect

    African Journals Online (AJOL)

    2018-03-01

    Mar 1, 2018 ... with cosmetic deformity of fore head (Figure 1), and he claimed that he could not get job because of ... 1: Pre-operative forontal view of patient. Figure 2: Intra operative photography of defect (A) reconstructed defect (B) ... with a cosmetic deformity of forehead on left side. (4nA and B). He was a candidate for.

  5. A Quick Reference on Anion Gap and Strong Ion Gap.

    Science.gov (United States)

    Torrente Artero, Carlos

    2017-03-01

    Metabolic acid-base disorders are common in emergency and critically ill patients. Clinicians may have difficulty recognizing their presence when multiple acid-base derangements are present in a single patient simultaneously. The anion gap and the strong ion gap concepts are useful calculations to identify the components of complex metabolic acid-base associated to the presence of unmeasured anions. This article presents their definition, normal values, indications, limitations, and guidelines for interpretation of changes in the clinical setting. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. ABORT GAP CLEANING IN RHIC

    International Nuclear Information System (INIS)

    DREES, A.; AHRENS, L.; III FLILLER, R.; GASSNER, D.; MCINTYRE, G.T.; MICHNOFF, R.; TRBOJEVIC, D.

    2002-01-01

    During the RHIC Au-run in 2001 the 200 MHz storage cavity system was used for the first time. The rebucketing procedure caused significant beam debunching in addition to amplifying debunching due to other mechanisms. At the end of a four hour store, debunched beam could account for approximately 30%-40% of the total beam intensity. Some of it will be in the abort gap. In order to minimize the risk of magnet quenching due to uncontrolled beam losses at the time of a beam dump, a combination of a fast transverse kicker and copper collimators were used to clean the abort gap. This report gives an overview of the gap cleaning procedure and the achieved performance

  7. Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation.

    Science.gov (United States)

    Brändström, Helge; Sundelin, Anna; Hoseason, Daniela; Sundström, Nina; Birgander, Richard; Johansson, Göran; Winsö, Ola; Koskinen, Lars-Owe; Haney, Michael

    2017-05-12

    Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures. A cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations. Approximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during 'flight' would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop 'inflight' related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile. DISCUSSION: These findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport. Very small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

  8. The Adaptation Gap Report - a Preliminary Assessment

    DEFF Research Database (Denmark)

    Alverson, Keith; Olhoff, Anne; Noble, Ian

    This first Adaptation Gap report provides an equally sobering assessment of the gap between adaptation needs and reality, based on preliminary thinking on how baselines, future goals or targets, and gaps between them might be defined for climate change adaptation. The report focuses on gaps in de...

  9. Gap junctions and motor behavior

    DEFF Research Database (Denmark)

    Kiehn, Ole; Tresch, Matthew C.

    2002-01-01

    The production of any motor behavior requires coordinated activity in motor neurons and premotor networks. In vertebrates, this coordination is often assumed to take place through chemical synapses. Here we review recent data suggesting that electrical gap-junction coupling plays an important role...... to the production of motor behavior in adult mammals....

  10. Globalization and the Gender Gap

    NARCIS (Netherlands)

    Oostendorp, R.H.

    2004-01-01

    There are several theoretical reasons why globalization will have a narrowing as well as a widening effect on the gender wage gap, but little is known about the actual impact, except for some country studies. This study contributes to the literature in three respects. First, it is a large

  11. Project LOCAL - Bridging The Gap

    Science.gov (United States)

    Haven, Robert N.

    1975-01-01

    Project LOCAL, a not-for-profit regional consortium, offers a broad spectrum of in-service training courses tailored to meet the needs of educators in various disciplines and levels of experience. The purpose of these offerings is to bridge the communication gap between innovative centers in computer-oriented education and staff members in Boston…

  12. The Politics of Achievement Gaps

    DEFF Research Database (Denmark)

    Valant, J.; Newark, D. A.

    2016-01-01

    For decades, researchers have documented large differences in average test scores between minority and White students and between poor and wealthy students. These gaps are a focal point of reformers’ and policymakers’ efforts to address educational inequities. However, the U.S. public’s views...

  13. Talent Management: Bridging the Gap

    Science.gov (United States)

    2015-06-12

    culling continues at each grade. By this process, the model proposes to raise the talent distribution and level. Professional sports use this method... TALENT MANAGEMENT: BRIDGING THE GAP A thesis presented to the Faculty of the U.S. Army Command and General Staff College in...

  14. Gaps in EU Foreign Policy

    DEFF Research Database (Denmark)

    Larsen, Henrik

    of Capability-Expectations Gap in the study of European foreign policy. Through examples from relevant literature, Larsen not only demonstrates how this concept sets up standards for the EU as a foreign policy actor (that are not met by most other international actors) but also shows how this curtails analysis......This book argues that theories of European foreign policy are performative: they create the objects they analyse. In this text, Larsen outlines the performativity approach to the role of theories based on the work of Derrida and goes on to examine the performative role of Christopher Hill's concept...... of EU foreign policy. The author goes on to discuss how the widespread use of the concept of ‘gap' affects the way in which EU foreign policy has been studied; and that it always produces the same result: the EU is an unfulfilled actor outside the realm of “normal” actors in IR. This volume offers new...

  15. Homolumo Gap and Matrix Model

    CERN Document Server

    Andric, I; Jurman, D; Nielsen, H B

    2007-01-01

    We discuss a dynamical matrix model by which probability distribution is associated with Gaussian ensembles from random matrix theory. We interpret the matrix M as a Hamiltonian representing interaction of a bosonic system with a single fermion. We show that a system of second-quantized fermions influences the ground state of the whole system by producing a gap between the highest occupied eigenvalue and the lowest unoccupied eigenvalue.

  16. Filling in biodiversity threat gaps

    DEFF Research Database (Denmark)

    Joppa, L. N.; O'Connor, Brian; Visconti, Piero

    2016-01-01

    increase to 10,000 times the background rate should species threatened with extinction succumb to pressures they face (4). Reversing these trends is a focus of the Convention on Biological Diversity's 2020 Strategic Plan for Biodiversity and its 20 Aichi Targets and is explicitly incorporated...... into the United Nations' 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs). We identify major gaps in data available for assessing global biodiversity threats and suggest mechanisms for closing them....

  17. Prometheus and the Keeler gap

    Science.gov (United States)

    Tajeddine, Radwan; Nicholson, Phillip D.; Hedman, Matthew M.; French, Richard G.; Tiscareno, Matthew S.; Burns, Joseph A.

    2014-11-01

    Linblad resonances with Saturn’s satellites are located at many radii in the rings. While some cause density or bending waves, others hold gap edges from spreading, like the 2:1 resonance with Mimas located at the B-ring edge, the 7:6 resonance with Janus at the A-ring edge, and the 32:31 resonance with Prometheus at the inner edge of the Keeler gap. The latter is the case of study here.Theoretically, the inner edge of the Keeler gap should have 32 regular sinusoidal lobes, where either the maximum or the minimum radius is expected to be aligned with Prometheus and rotating with its mean motion. We show that such is not the case. Fit of occultation data shows the presence of the 32:31 resonance, however, the fit residuals is as high as the amplitude of the resonance amplitude (about 2 km). Analysis of the ISS data, shows irregularities overlapping the lobes (Tiscareno et al. 2005, DPS), that follow Keplerian motion. These irregularities may be due to clumps of particles with different eccentricities than the rest of the edge particles. This phenomenon may be caused by the resonance, as it has not been observed at other circular edges were no resonance is present at their location. The ISS data also shows that the lobe’s minimum/maximum is not perfectly aligned with the longitude of Prometheus, which may be due to libration about the centre of the resonance.

  18. Gap Junctions and Chagas Disease

    Science.gov (United States)

    Adesse, Daniel; Goldenberg, Regina Coeli; Fortes, Fabio S.; Jasmin; Iacobas, Dumitru A.; Iacobas, Sanda; de Carvalho, Antonio Carlos Campos; de Narareth Meirelles, Maria; Huang, Huan; Soares, Milena B.; Tanowitz, Herbert B.; Garzoni, Luciana Ribeiro; Spray, David C.

    2013-01-01

    Gap junction channels provide intercellular communication between cells. In the heart, these channels coordinate impulse propagation along the conduction system and through the contractile musculature, thereby providing synchronous and optimal cardiac output. As in other arrhythmogenic cardiac diseases, chagasic cardiomyopathy is associated with decreased expression of the gap junction protein connexin43 (Cx43) and its gene. Our studies of cardiac myocytes infected with Trypanosoma cruzi have revealed that synchronous contraction is greatly impaired and gap junction immunoreactivity is lost in infected cells. Such changes are not seen for molecules forming tight junctions, another component of the intercalated disc in cardiac myocytes. Transcriptomic studies of hearts from mouse models of Chagas disease and from acutely infected cardiac myocytes in vitro indicate profound remodelling of gene expression patterns involving heart rhythm determinant genes, suggesting underlying mechanisms of the functional pathology. One curious feature of the altered expression of Cx43 and its gene expression is that it is limited in both extent and location, suggesting that the more global deterioration in cardiac function may result in part from spread of damage signals from more seriously compromised cells to healthier ones. PMID:21884887

  19. Hyper-active gap filling.

    Science.gov (United States)

    Omaki, Akira; Lau, Ellen F; Davidson White, Imogen; Dakan, Myles L; Apple, Aaron; Phillips, Colin

    2015-01-01

    Much work has demonstrated that speakers of verb-final languages are able to construct rich syntactic representations in advance of verb information. This may reflect general architectural properties of the language processor, or it may only reflect a language-specific adaptation to the demands of verb-finality. The present study addresses this issue by examining whether speakers of a verb-medial language (English) wait to consult verb transitivity information before constructing filler-gap dependencies, where internal arguments are fronted and hence precede the verb. This configuration makes it possible to investigate whether the parser actively makes representational commitments on the gap position before verb transitivity information becomes available. A key prediction of the view that rich pre-verbal structure building is a general architectural property is that speakers of verb-medial languages should predictively construct dependencies in advance of verb transitivity information, and therefore that disruption should be observed when the verb has intransitive subcategorization frames that are incompatible with the predicted structure. In three reading experiments (self-paced and eye-tracking) that manipulated verb transitivity, we found evidence for reading disruption when the verb was intransitive, although no such reading difficulty was observed when the critical verb was embedded inside a syntactic island structure, which blocks filler-gap dependency completion. These results are consistent with the hypothesis that in English, as in verb-final languages, information from preverbal noun phrases is sufficient to trigger active dependency completion without having access to verb transitivity information.

  20. Minipterional Craniotomy for Treatment of Unruptured Middle Cerebral Artery Aneurysms. A Single-Center Comparative Analysis with Standard Pterional Approach as Regard to Safety and Efficacy of Aneurysm Clipping and the Advantages of Reconstruction.

    Science.gov (United States)

    Sturiale, Carmelo Lucio; La Rocca, Giuseppe; Puca, Alfredo; Fernandez, Eduardo; Visocchi, Massimiliano; Marchese, Enrico; Sabatino, Giovanni; Albanese, Alessio

    2017-01-01

    Pterional craniotomy (PT) has long been the standard approach for the treatment of middle cerebral artery (MCA) aneurysms, even though it may cause temporalis muscle atrophy, facial nerve injury, and masticatory difficulties. Minipterional craniotomy (MPT) is an alternative approach that may provide the same surgical corridor, limiting the risk of postoperative esthetic and functional complications. From January 2011 to December 2014 we consecutively performed 68 craniotomies for surgical treatment of unruptured MCA aneuryms: 37 were standard PT and 31 were MPT. There were no significant differences in mean age, sex, and aneurysm topography between the two groups. The mean skin incision length was 14 cm in the PT group and 6 cm in the MPT group. According to the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS), there were no significant differences in clinical outcome at discharge or follow-up between the two groups. Also, the rates of complete aneurysm exclusion were comparable. However, the number of patients complaining of masticatory disorders was higher among those treated with PT. Finally, the number of complications observed in the PT group was higher than that in the MPT group, but only the differences in mean hospitalization length and necessity for a dural patch for reconstruction were statistically significant. In conclusion, the MPT approach is a safe and effective alternative to the standard PT for the treatment of unruptured MCA aneurysms.

  1. Innovation gaps in Scandinavian rural tourism

    DEFF Research Database (Denmark)

    Hjalager, Anne Mette; Kwiatkowski, Grzegorz; Østervig Larsen, Martin

    2018-01-01

    , the study offers a model that identifies the following five innovation gaps in Scandinavian rural tourism: (1) the portfolio gap, (2) the policy departmentalization gap, (3) the knowledge gap, (4) the change motivation gap, and (5) the resource interpretation gap. At the empirical level, the study shows...... that rural tourism has its basis in a dichotomy between authenticity and modernization. New and prospective customer groups, particularly from Germany, demand more diversified and higher quality rural tourism products than current groups, for example, in relation to outdoor opportunities, leisure festivals...

  2. Hyper-active gap filling

    Directory of Open Access Journals (Sweden)

    Akira eOmaki

    2015-04-01

    Full Text Available Much work has demonstrated that speakers of verb-final languages are able to construct rich syntactic representations in advance of verb information. This may reflect general architectural properties of the language processor, or it may only reflect a language-specific adaptation to the demands of verb-finality. The present study addresses this issue by examining whether speakers of a verb-medial language (English wait to consult verb transitivity information before constructing filler-gap dependencies, where internal arguments are fronted and hence precede the verb. This configuration makes it possible to investigate whether the parser actively makes representational commitments on the gap position before verb transitivity information becomes available. A key prediction of the view that rich pre-verbal structure-building is a general architectural property is that speakers of verb-medial languages should predictively construct dependencies in advance of verb transitivity information, and therefore that disruption should be observed when the verb has intransitive subcategorization frames that are incompatible with the predicted structure. In three reading experiments (self-paced and eye-tracking that manipulated verb transitivity, we found evidence for reading disruption when the verb was intransitive, although no such reading difficulty was observed when the critical verb was embedded inside a syntactic island structure, which blocks filler-gap dependency completion. These results are consistent with the hypothesis that in English, as in verb-final languages, information from preverbal NPs is sufficient to trigger active dependency completion without having access to verb transitivity information.

  3. Explaining the gender wage gap in Georgia

    OpenAIRE

    Khitarishvili, Tamar

    2009-01-01

    This paper evaluates gender wage differentials in Georgia between 2000 and 2004. Using ordinary least squares, we find that the gender wage gap in Georgia is substantially higher than in other transition countries. Correcting for sample selection bias using the Heckman approach further increases the gender wage gap. The Blinder Oaxaca decomposition results suggest that most of the wage gap remains unexplained. The explained portion of the gap is almost entirely attributed to industrial variab...

  4. Gap Year: Time off, with a Plan

    Science.gov (United States)

    Torpey, Elka Maria

    2009-01-01

    A gap year allows people to step off the usual educational or career path and reassess their future. According to people who have taken a gap year, the time away can be well worth it. This article can help a person decide whether to take a gap year and how to make the most of his time off. It describes what a gap year is, including its pros and…

  5. Gender Wage Gap in Urban China

    OpenAIRE

    Yuan Ni

    2005-01-01

    This paper analyses the gender wage gap and returns to education in urban China using data collected from Fangshan, Beijing. The traditional Oaxaca decomposition shows that the unexplained part seems to dominate the gender wage gap in urban China. The Appleton decomposition, which takes into account sectoral location, shows that the gender gap is mostly within sector and most of the intra-sector wage gap is unexplained. The gender pay differential due to sectoral location is small; in fact, t...

  6. A PHOTONIC BAND GAP FIBRE

    DEFF Research Database (Denmark)

    1999-01-01

    An optical fibre having a periodicidal cladding structure provididing a photonic band gap structure with superior qualities. The periodical structure being one wherein high index areas are defined and wherein these are separated using a number of methods. One such method is the introduction...... of additional low index elements, another method is providing elongated elements deformed in relation to a circular cross section. Also described is a cladding structure comprising elongated elements of a material having an index of refraction higher than that of the material adjacent thereto. Using...

  7. Superconducting gap anomaly in heavy fermion systems

    Indian Academy of Sciences (India)

    of a pseudo-gap due to superconductivity and the signature of a hybridization gap at the. Fermi level. For the choice of the model parameters, the DOS shows that the HFS is a metal and undergoes a transition to the gap-less superconducting state. Keywords. Heavy fermion superconductor; Narrow band system; Valence ...

  8. Closing the gap between research and management

    Science.gov (United States)

    Deborah M. Finch; Marcia Patton-Mallory

    1993-01-01

    In this paper, we evaluate the reasons for gaps in communication between researchers and natural resource managers and identify methods to close these gaps. Gaps originate from differing patterns of language use, disparities in organizational culture and values, generation of knowledge that is too narrowly-focused to solve complex problems, failure by managers to relay...

  9. Tunable transport gap in phosphorene.

    Science.gov (United States)

    Das, Saptarshi; Zhang, Wei; Demarteau, Marcel; Hoffmann, Axel; Dubey, Madan; Roelofs, Andreas

    2014-10-08

    In this article, we experimentally demonstrate that the transport gap of phosphorene can be tuned monotonically from ∼0.3 to ∼1.0 eV when the flake thickness is scaled down from bulk to a single layer. As a consequence, the ON current, the OFF current, and the current ON/OFF ratios of phosphorene field effect transistors (FETs) were found to be significantly impacted by the layer thickness. The transport gap was determined from the transfer characteristics of phosphorene FETs using a robust technique that has not been reported before. The detailed mathematical model is also provided. By scaling the thickness of the gate oxide, we were also able to demonstrate enhanced ambipolar conduction in monolayer and few layer phosphorene FETs. The asymmetry of the electron and the hole current was found to be dependent on the layer thickness that can be explained by dynamic changes of the metal Fermi level with the energy band of phosphorene depending on the layer number. We also extracted the Schottky barrier heights for both the electron and the hole injection as a function of the layer thickness. Finally, we discuss the dependence of field effect hole mobility of phosphorene on temperature and carrier concentration.

  10. The effect of an intraoperative, lung-protective ventilation strategy in neurosurgical patients undergoing craniotomy: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Zhang, Liyong; Xiong, Wei; Peng, Yuming; Zhang, Wei; Han, Ruquan

    2018-02-02

    Ventilator-induced lung injury is a major cause of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgery after general anesthesia. However, there is no study on the effect of a lung-protective ventilation strategy in patients undergoing neurosurgery. This is a single-center, randomized, parallel-group controlled trial which will be carried out at Beijing Tiantan Hospital, Capital Medical University. Three hundred and thirty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group and the protective-ventilation strategy group. In the control group, tidal volume (VT) will be set at 10-12 ml/kg of predicted body weight but PEEP and recruitment maneuvers will not be used. In the protective group, VT will be set at 6-8 ml/kg of predicted body weight, PEEP at 6-8 cmH 2 O, and a recruitment maneuver will be used intermittently. The primary outcome is pulmonary complications within 7 days postoperatively. Secondary outcomes include intraoperative brain relaxation, the postoperative complications within 30 days and the cost analysis. This study aims to determine if the protective, pulmonary-ventilation strategy decreases the incidence of PPCs in patients undergoing neurosurgical anesthesia. If our results are positive, the study will indicate whether the protective, pulmonary-ventilation strategy is efficiently and safely used in neurosurgical patients undergoing the craniotomy. ClinicalTrials.gov, ID: NCT02386683 . Registered on 18 October 2014.

  11. Craniotomia descompressiva para tratamento precoce da hipertensão intracraniana traumática Decompressive craniotomy for the early treatment of traumatic intracranial hypertension

    Directory of Open Access Journals (Sweden)

    Rodrigo Moreira Faleiro

    2005-06-01

    Full Text Available O papel da craniotomia descompressiva (CD no tratamento da hipertensão intracraniana (HIC refratária ainda não está estabelecido na literatura. Atualmente é recomendada como opção, pois há deficiência de trabalhos classe I ou II que suportem seu emprego. Trabalhos recentes têm avaliado a eficácia da CD quando aplicada precocemente no tratamento da HIC pós traumática. No presente trabalho analisam-se 21 pacientes nos quais a CD foi realizada precocemente. A maioria dos pacientes apresentava traumatismo cranioencefálico grave (Escala de coma glasgow There is no clear role for decompressive craniotomy (DC for the intracranial hypertension (ICH treatment in the literature. Actually, there is a lack of class I or II published data for DC, so it is recomended as a second tier option for the refractory ICH. Recent studies has analized the role of early DC for pos traumatic ICH. The present study analizes 21 patients who has received the early DC for the treatment of traumatic ICH. The majority of the patients had Glasgow Coma Scale < 9 and harboring a brain swelling or acute subdural hematoma at cranial computadorized tomography. Hydrocephalus was frequent after DC (28.5%. Good results were obtained in 11 patients (52.5%. We favour the early application of DC for pos traumatic hypertension.

  12. Predictors of Surgical Site Infection Following Craniotomy for Intracranial Neoplasms: An Analysis of Prospectively Collected Data in the American College of Surgeons National Surgical Quality Improvement Program Database.

    Science.gov (United States)

    McCutcheon, Brandon A; Ubl, Daniel S; Babu, Maya; Maloney, Patrick; Murphy, Meghan; Kerezoudis, Panagiotis; Bydon, Mohamad; Habermann, Elizabeth B; Parney, Ian

    2016-04-01

    To determine the rate of surgical site infection (SSI) after resection of an intracranial neoplasm using the American College of Surgeons National Surgical Quality Improvement Program data set and to identify potential risk factors associated with SSI. The National Surgical Quality Improvement Program Participant Use Data File was queried during the period 2006-2013 for patients who underwent a resection for an intracranial neoplasm. Multivariable logistic regression analysis was used to identify risk factors associated with SSI. Inclusion criteria were met by 12,021 patients. SSI occurred at a rate of 2.04%. SSI was significantly associated with increased rates of return to the operating room (56.1% vs. 4.0%, P 30 days (5.3% vs. 1.3%, P 4 hours (OR = 1.891, 95% CI = 1.298-2.756) were associated with an increased odds of SSI. Among cases with available chemotherapy data (n = 3504), recent chemotherapy (OR = 3.007, 95% CI = 1.460-6.196) was associated with an increased odds of SSI. This study identified patient risk factors that may assist clinical decision making regarding patient risk stratification, timing of surgery, and preoperative antibiotic prophylaxis for patients with an intracranial neoplasm undergoing craniotomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Early postoperative cognitive recovery and gas exchange patterns after balanced anesthesia with sevoflurane or desflurane in overweight and obese patients undergoing craniotomy: a prospective randomized trial.

    Science.gov (United States)

    Bilotta, Federico; Doronzio, Andrea; Cuzzone, Vincenzo; Caramia, Remo; Rosa, Giovanni

    2009-07-01

    Overweight and obese patients are at especially high risk for delayed awakening after general surgery. Whether this risk also applies to cerebral neurosurgical procedures remains unclear. This study evaluated early postoperative cognitive recovery and gas exchange patterns, after balanced anesthesia with sevoflurane or desflurane, in overweight and obese patients undergoing craniotomy for supratentorial expanding lesions. Fifty-six patients were consecutively enrolled, and randomly assigned to 1 of 2 study groups to receive balanced anesthesia with sevoflurane or desflurane. Cognitive function was evaluated with the Short Orientation Memory Concentration Test and the Rancho Los Amigos Scale and gas exchange patterns (pH, PaO2, and PaCO2) were recorded in all patients at 5 time-points: preoperatively and postoperatively, after patients reached an Aldrete score >or=9, at 15, 30, 45, and 60 minutes. Preoperative cognitive status was similar in the 2 treatment groups. Early postoperative cognitive recovery was more delayed and Short Orientation Memory Concentration Test scores at 15 and 30 minutes postanesthesia were lower in patients receiving sevoflurane-based anesthesia than in those receiving desflurane-based anesthesia (21.5+/-3.5 vs. 14.9+/-3.5) (Pcraniotomy desflurane-based anesthesia allows earlier postoperative cognitive recovery and reversal to normocapnia and normal pH.

  14. Decreased anion gap in polyclonal hypergammaglobulinemia.

    Science.gov (United States)

    Qujeq, Durdi; Mohiti, Javad

    2002-02-01

    The anion gap has proved a valuable tool in the diagnosis of various forms of acid-base disorders, although the importance of slight rises in the anion gap remains unclear. The concept of the anion gap is often misunderstood and misapplied. The relationship between gammaglobulins and the serum anion gap has not received much attention except for reports of a narrowing of the gap associated with certain monoclonal immunoglobulin G gammopathies. We present patients with polyclonal gammopathy, the magnitude of which correlated strongly and negatively with the anion gap. The anion gap can be readily calculated from routine laboratory data, and anion gap was calculated as ([Na] +[K])- ([Cl] + [HCO3]). Serum anion gaps were determined in 206 patients with polyclonal hypergammaglobulinemia and 63 healthy subjects. Serum sodium and potassium ions concentration were determined by flame photometry. Serum bicarbonate level was measured as total carbon dioxide content. Serum chloride level was determined by chlorimetric titration with silver ions. All patients with polyclonal hypergammaglobulinemia had a statistically significant reduction in their mean serum anion gaps (6.4 +/- 1.2 mmol/L) when compared with normal control volunteers (15.3 +/- 2.4 mmol/L), p anion gap and gammaglobulins concentration.

  15. Electronic properties of doped gapped graphene

    Energy Technology Data Exchange (ETDEWEB)

    Mousavi, Hamze, E-mail: hamze.mousavi@gmail.com [Department of Physics, Razi University, Kermanshah (Iran, Islamic Republic of); Nano Science and Nano Technology Research Center, Razi University, Kermanshah (Iran, Islamic Republic of)

    2013-04-01

    One of the carbon atoms in each Bravais lattice unit cell of pristine graphene plane is substituted by a foreign atom leading to a band gap in the density of states of the system. Then, the gapped graphene is randomly doped by another impurity. The density of states, electronic heat capacity and electrical conductivity of the gapped and doped gapped graphene are investigated within random tight-binding Hamiltonian model and Green's function formalism. The results show that by presence of impurities in the gapped graphene the band gap moves towards lower (higher) values of energy when dopants act as acceptors (donors). The heat capacity decreases (increases) before (after) the Schottky anomaly as well. It is also found that the electrical conductivity of the doped gapped graphene reduces on all ranges of temperature.

  16. Denmark and the gap year

    DEFF Research Database (Denmark)

    Katznelson, Noemi; Juul, Tilde Mette

    2013-01-01

    This paper describes three different educational offers to young people: “The Folk High School”, “The ‘After-school’” and 10th class. All can be considered optional Gap Years. The following diagram shows how the Danish education system is structured. The Folk High School is a training course...... of varying duration (approximately between 12 weeks and 1 year) where one lives at the school. It is primarily located after 12 school year. The ‘After-school’ is a special school structure, were the students also live at the school during their 8th, 9th, or 10th years of primary school. 10th Class...... is a voluntary school year extension of primary school. All three types of schools will be described in more detail in this paper....

  17. Spark gap produced plasma diagnostics

    International Nuclear Information System (INIS)

    Chang, H.Y.

    1990-01-01

    A Spark Gap (Applied voltage : 2-8KV, Capacitor : 4 Micro F. Dia of the tube : 1 inch, Electrode distance : .3 ∼.5 inch) was made to generate a small size dynamic plasma. To measure the plasma density and temperature as a function of time and position, we installed and have been installing four detection systems - Mach-Zehnder type Interferometer for the plasma refractivity, Expansion speed detector using two He-Ne laser beams, Image Processing using Lens and A Optical-Fiber Array for Pointwise Radiation Sensing, Faraday Rotation of a Optical Fiber to measure the azimuthal component of B-field generated by the plasma drift. These systems was used for the wire explosion diagnostics, and can be used for the Laser driven plasma also

  18. Photonic band gap structure simulator

    Science.gov (United States)

    Chen, Chiping; Shapiro, Michael A.; Smirnova, Evgenya I.; Temkin, Richard J.; Sirigiri, Jagadishwar R.

    2006-10-03

    A system and method for designing photonic band gap structures. The system and method provide a user with the capability to produce a model of a two-dimensional array of conductors corresponding to a unit cell. The model involves a linear equation. Boundary conditions representative of conditions at the boundary of the unit cell are applied to a solution of the Helmholtz equation defined for the unit cell. The linear equation can be approximated by a Hermitian matrix. An eigenvalue of the Helmholtz equation is calculated. One computation approach involves calculating finite differences. The model can include a symmetry element, such as a center of inversion, a rotation axis, and a mirror plane. A graphical user interface is provided for the user's convenience. A display is provided to display to a user the calculated eigenvalue, corresponding to a photonic energy level in the Brilloin zone of the unit cell.

  19. Narrow gap electronegative capacitive discharges

    Energy Technology Data Exchange (ETDEWEB)

    Kawamura, E.; Lieberman, M. A.; Lichtenberg, A. J. [Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California 94720 (United States)

    2013-10-15

    Narrow gap electronegative (EN) capacitive discharges are widely used in industry and have unique features not found in conventional discharges. In this paper, plasma parameters are determined over a range of decreasing gap length L from values for which an electropositive (EP) edge exists (2-region case) to smaller L-values for which the EN region connects directly to the sheath (1-region case). Parametric studies are performed at applied voltage V{sub rf}=500 V for pressures of 10, 25, 50, and 100 mTorr, and additionally at 50 mTorr for 1000 and 2000 V. Numerical results are given for a parallel plate oxygen discharge using a planar 1D3v (1 spatial dimension, 3 velocity components) particle-in-cell (PIC) code. New interesting phenomena are found for the case in which an EP edge does not exist. This 1-region case has not previously been investigated in detail, either numerically or analytically. In particular, attachment in the sheaths is important, and the central electron density n{sub e0} is depressed below the density n{sub esh} at the sheath edge. The sheath oscillations also extend into the EN core, creating an edge region lying within the sheath and not characterized by the standard diffusion in an EN plasma. An analytical model is developed using minimal inputs from the PIC results, and compared to the PIC results for a base case at V{sub rf}=500 V and 50 mTorr, showing good agreement. Selected comparisons are made at the other voltages and pressures. A self-consistent model is also developed and compared to the PIC results, giving reasonable agreement.

  20. [Comparison of extent of postoperative hydrocephalus in patients between intervertional therapy with embolism and craniotomy occlusion in Hunt-Hess III-IV level aneurysm induced subarachnoid hemorrhage and their prognosis].

    Science.gov (United States)

    Liu, Yang; Sun, Shengkai; Chen, Xuyi; Cheng, Shixiang; Qin, Zhizhen; Liu, Xiu; Chen, Xiaochu; Ning, Lili; Wang, Zhihong

    2015-02-01

    To analyze and compare the difference and prognosis between vascular embolization and craniotomy occlusion in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) with Hunt-Hess level III-IV, and acute postoperative hydrocephalus. A retrospective study was conducted on 767 patients who had undergone vascular embolization (vascular embolization group, n = 403) or craniotomy occlusion operation (craniotomy occlusion operation group, n = 364), and the patients with postoperative acute hydrocephalus were screened. The clinical data of patients of both groups was analyzed. By judging short-term prognosis in patients with hydrocephalus with Glasgow outcome scale (GOS) score estimated at discharge, the advantages and disadvantages of two surgical procedures were compared. The number of cases with postoperative hydrocephalus in vascular embolization group was 56 (13.90%), while that in craniotomy occlusion group was 33 (9.07%). The difference between the two groups of incidence of hydrocephalus was statistically significant (χ (2) = 4.350, P = 0.037). In 767 patients with aSAH, the incidence of hydrocephalus among the patients after the hematoma removal operation was significantly lower than that of patients without hematoma removal [3.07% (11/358) vs. 19.07% (78/409), χ (2) = 47.635, P = 0.000]. The incidence of hydrocephalus among the patients after ventricular drainage was significantly lower than that of patients without the drainage [2.77% (19/685) vs. 85.37% (70/82), χ (2) = 487.032, P = 0.000]. In 403 cases of vascular embolization group, the incidence of hydrocephalus in the patients after the hematoma removal operation was lower than that of patients without it [8.06% (5/62) vs. 14.96% (51/341), χ (2) = 2.082, P = 0.168]. The incidence of hydrocephalus in the patients after the ventricular drainage was lower than that of patients without drainage [2.59% (9/347) vs. 83.93% (47/56), χ (2) = 266.599, P = 0.000]. In 364 cases of craniotomy occlusion

  1. The Adaptation Gap Report. Towards Global Assessment

    DEFF Research Database (Denmark)

    2017-01-01

    of the temperature goal. The 2017 Adaptation Gap Report, which is the third global Adaptation Gap Report by UN Environment – prepared in collaboration with the Global Centre of Excellence on Climate Adaptation – focuses on one of the key questions arising in the wake of the global goal: What are the ways forward...... Change (UNFCCC) to prepare for the implementation of the Paris Agreement. In contrast to previous Adaptation Gap Reports, the 2017 report focuses on issues relating to frameworks, comprising concepts, methodologies and data, rather than on assessing a particular dimension of the adaptation gap. Future...... Adaptation Gap Reports will return to assessments of specific adaptation gaps. An international team of experts, assessing the latest literature and practical experience within the topic area, has prepared the report. The process has been overseen by a steering committee, and all chapters have undergone...

  2. The early career gender wage gap

    OpenAIRE

    Sami Napari

    2006-01-01

    In Finland the gender wage gap increases significantly during the first 10 years after labor market entry accounting most of the life-time increase in the gender wage gap. This paper focuses on the early career gender wage differences among university graduates and considers several explanations for the gender wage gap based on the human capital theory, job mobility and labor market segregation. Gender differences in the accumulation of experience and in the type of education explain about 16...

  3. 30 CFR 56.6603 - Air gap.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Air gap. 56.6603 Section 56.6603 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Explosives Extraneous Electricity § 56.6603 Air gap. At least a 15-foot air gap...

  4. PBX 9502 air-gap tests

    Energy Technology Data Exchange (ETDEWEB)

    Dickson, Peter [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Novak, Alan M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Foley, Timothy J. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Campbell, Christopher Charles [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-06-29

    A small number of simple air-gap tests were performed on 1-inch diameter PBX 9502 cylinders to determine an approximate threshold for detonation failure. The primary diagnostics were streak imaging and dent measurements in a steel witness plate. Relight was found to occur, with negligible excess transit time, for air gaps up to 1 mm. Relight did not occur with a 3-mm air gap.

  5. The gender wage gap in four countries

    OpenAIRE

    Daly, Anne; Kawaguchi, Akira; Meng, Xin; Mumford, Karen

    2006-01-01

    In a series of studies written during the 1980s Bob Gregory and his co-authors compared the gender wage gap in Australia with that found in other countries. They found it was not the difference in human capital endowments that explained different gender wage gaps but rather the rewards for these endowments. They concluded that country-specific factors, especially the institutional environment, were important in explaining the gender wage gap. This study updates Gregory's work by comparing the...

  6. CBF and CMRo/sub 2/ during craniotomy for small supratentorial cerebral tumours in enflurane anaesthesia. A dose-response study

    Energy Technology Data Exchange (ETDEWEB)

    Madsen, J.B.; Cold, G.E.; Eriksen, H.O.; Eskesen, V.; Blatt-Lyon, B.

    1986-01-01

    In 14 patients with supratentorial cerebral tumors with midline shift less than or equal to 10 mm, cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRo/sub 2/) were measured twice on the contralateral side of the craniotomy, using a modification of the Kety and Schmidt method. For induction of anaesthesia, thiopental, fentanyl and pancuronium were used. The anaesthesia was maintained with enflurane 1% in nitrous oxide 67%. Moderate hypocapnia to a level averaging 4.3 kPa was achieved. The patients were divided into two groups. In group 1 (n=7), 1% enflurane was used throughout the anaesthesia, and CBF and CMRo/sub 2/ measured about 70 min after induction averaged 30.1 ml 100 g/sup -1/ min/sub -1/ and 1.98 ml O/sub 2/ 100 g/sup -1/ min/sup -1/, respectively. During the second CBF study 1 h later, CBF and CMRo/sub 2/ were unchanged (P>0.05). In group 2 (n=7), the inspiratory enflurane concentration was increased from 1 to 2% after the first CBF measurement. In this group a significant decrease in CMRo/sub 2/ was observed, while CBF was unchanged. In six patients EEG was recorded simultaneously with the CBF measurements. In patients subjected to increasing enflurane concentration (Group 2), a suppression in the EEG activity was observed without spike waves. It is concluded that enflurane induces a dose-related decrease in CMRo/sub 2/ and suppression in the EEG activity, whereas CBF was unchanged.

  7. Comparison of endoscopic endonasal and bifrontal craniotomy approaches for olfactory groove meningiomas: A matched pair analysis of outcomes and frontal lobe changes on MRI.

    Science.gov (United States)

    de Almeida, John R; Carvalho, Felipe; Vaz Guimaraes Filho, Francisco; Kiehl, Tim-Rasmus; Koutourousiou, Maria; Su, Shirley; Vescan, Allan D; Witterick, Ian J; Zadeh, Gelareh; Wang, Eric W; Fernandez-Miranda, Juan C; Gardner, Paul A; Gentili, Fred; Snyderman, Carl H

    2015-11-01

    We compare the outcomes and postoperative MRI changes of endoscopic endonasal (EEA) and bifrontal craniotomy (BFC) approaches for olfactory groove meningiomas (OGM). All patients who underwent either BFC or EEA for OGM were eligible. Matched pairs were created by matching tumor volumes of an EEA patient with a BFC patient, and matching the timing of the postoperative scans. The tumor dimensions, peritumoral edema, resectability issues, and frontal lobe changes were recorded based on preoperative and postoperative MRI. Postoperative fluid-attenuated inversion recovery (FLAIR) hyperintensity and residual cystic cavity (porencephalic cave) volume were compared using univariable and multivariable analyses. From a total of 70 patients (46 EEA, 24 BFC), 10 matched pairs (20 patients) were created. Three patients (30%) in the EEA group and two (20%) in the BFC had postoperative cerebrospinal fluid leaks (p=0.61). Gross total resections were achieved in seven (70%) of the EEA group and nine (90%) of the BFC group (p=0.26), and one patient from each group developed a recurrence. On postoperative MRI, there was no significant difference in FLAIR signal volumes between EEA and BFC approaches (6.9 versus 13.3 cm(3); p=0.17) or in porencephalic cave volumes (1.7 versus 5.0 cm(3); p=0.11) in univariable analysis. However, in a multivariable analysis, EEA was associated with less postoperative FLAIR change (p=0.02) after adjusting for the volume of preoperative edema. This study provides preliminary evidence that EEA is associated with quantifiable improvements in postoperative frontal lobe imaging. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Gap solitons in Rabi lattices.

    Science.gov (United States)

    Chen, Zhaopin; Malomed, Boris A

    2017-03-01

    We introduce a two-component one-dimensional system, which is based on two nonlinear Schrödinger or Gross-Pitaevskii equations (GPEs) with spatially periodic modulation of linear coupling ("Rabi lattice") and self-repulsive nonlinearity. The system may be realized in a binary Bose-Einstein condensate, whose components are resonantly coupled by a standing optical wave, as well as in terms of the bimodal light propagation in periodically twisted waveguides. The system supports various types of gap solitons (GSs), which are constructed, and their stability is investigated, in the first two finite bandgaps of the underlying spectrum. These include on- and off-site-centered solitons (the GSs of the off-site type are additionally categorized as spatially even and odd ones), which may be symmetric or antisymmetric, with respect to the coupled components. The GSs are chiefly stable in the first finite bandgap and unstable in the second one. In addition to that, there are narrow regions near the right edge of the first bandgap, and in the second one, which feature intricate alternation of stability and instability. Unstable solitons evolve into robust breathers or spatially confined turbulent modes. On-site-centered GSs are also considered in a version of the system that is made asymmetric by the Zeeman effect, or by birefringence of the optical waveguide. A region of alternate stability is found in the latter case too. In the limit of strong asymmetry, GSs are obtained in a semianalytical approximation, which reduces two coupled GPEs to a single one with an effective lattice potential.

  9. Gap solitons in Rabi lattices

    Science.gov (United States)

    Chen, Zhaopin; Malomed, Boris A.

    2017-03-01

    We introduce a two-component one-dimensional system, which is based on two nonlinear Schrödinger or Gross-Pitaevskii equations (GPEs) with spatially periodic modulation of linear coupling ("Rabi lattice") and self-repulsive nonlinearity. The system may be realized in a binary Bose-Einstein condensate, whose components are resonantly coupled by a standing optical wave, as well as in terms of the bimodal light propagation in periodically twisted waveguides. The system supports various types of gap solitons (GSs), which are constructed, and their stability is investigated, in the first two finite bandgaps of the underlying spectrum. These include on- and off-site-centered solitons (the GSs of the off-site type are additionally categorized as spatially even and odd ones), which may be symmetric or antisymmetric, with respect to the coupled components. The GSs are chiefly stable in the first finite bandgap and unstable in the second one. In addition to that, there are narrow regions near the right edge of the first bandgap, and in the second one, which feature intricate alternation of stability and instability. Unstable solitons evolve into robust breathers or spatially confined turbulent modes. On-site-centered GSs are also considered in a version of the system that is made asymmetric by the Zeeman effect, or by birefringence of the optical waveguide. A region of alternate stability is found in the latter case too. In the limit of strong asymmetry, GSs are obtained in a semianalytical approximation, which reduces two coupled GPEs to a single one with an effective lattice potential.

  10. Addressing the vaccine confidence gap.

    Science.gov (United States)

    Larson, Heidi J; Cooper, Louis Z; Eskola, Juhani; Katz, Samuel L; Ratzan, Scott

    2011-08-06

    Vaccines--often lauded as one of the greatest public health interventions--are losing public confidence. Some vaccine experts have referred to this decline in confidence as a crisis. We discuss some of the characteristics of the changing global environment that are contributing to increased public questioning of vaccines, and outline some of the specific determinants of public trust. Public decision making related to vaccine acceptance is neither driven by scientific nor economic evidence alone, but is also driven by a mix of psychological, sociocultural, and political factors, all of which need to be understood and taken into account by policy and other decision makers. Public trust in vaccines is highly variable and building trust depends on understanding perceptions of vaccines and vaccine risks, historical experiences, religious or political affiliations, and socioeconomic status. Although provision of accurate, scientifically based evidence on the risk-benefit ratios of vaccines is crucial, it is not enough to redress the gap between current levels of public confidence in vaccines and levels of trust needed to ensure adequate and sustained vaccine coverage. We call for more research not just on individual determinants of public trust, but on what mix of factors are most likely to sustain public trust. The vaccine community demands rigorous evidence on vaccine efficacy and safety and technical and operational feasibility when introducing a new vaccine, but has been negligent in demanding equally rigorous research to understand the psychological, social, and political factors that affect public trust in vaccines. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Maximizing band gaps in plate structures

    DEFF Research Database (Denmark)

    Halkjær, Søren; Sigmund, Ole; Jensen, Jakob Søndergaard

    2006-01-01

    Band gaps, i.e., frequency ranges in which waves cannot propagate, can be found in elastic structures for which there is a certain periodic modulation of the material properties or structure. In this paper, we maximize the band gap size for bending waves in a Mindlin plate. We analyze an infinite...

  12. Superconducting gap anomaly in heavy fermion systems

    Indian Academy of Sciences (India)

    Within this approximation the equation for the superconducting gap is derived, which depends on the effective position of the energy level of the -electrons relative to the Fermi level. The latter in turn depends on the occupation probability f of the -electrons. The gap equation is solved self-consistently with the equation ...

  13. The Wage Gap and Administrative Salaries Today.

    Science.gov (United States)

    Beyer, Kirk D.

    1992-01-01

    Analysis of national data on college administrator salaries by gender, minority/nonminority status, years of service, and institution type found that wage gaps related to gender and minority status persisted in 1991-92 but that interaction of length of service with other study variables explained a significant amount of this gap. (MSE)

  14. Public Perceptions of the Pay Gap

    Science.gov (United States)

    Hill, Catherine; Silva, Elena

    2005-01-01

    Women have made gains toward closing the gender pay gap during the past two decades. Much of the progress occurred during the 1980s, with smaller gains in the 1990s (Institute for Women's Policy Research 2004). Women's achievements in higher education are partly responsible for narrowing the pay gap in the 1980s and 1990s. As more women earned…

  15. Closing the Gender Gap: Act Now

    Science.gov (United States)

    OECD Publishing (NJ3), 2012

    2012-01-01

    Gender gaps are pervasive in all walks of economic life and imply large losses in terms of foregone productivity and living standards to the individuals concerned and the economy. This new OECD report focuses on how best to close these gender gaps under four broad headings: (1) Gender equality, social norms and public policies; and gender equality…

  16. Estimating Gender Wage Gaps: A Data Update

    Science.gov (United States)

    McDonald, Judith A.; Thornton, Robert J.

    2016-01-01

    In the authors' 2011 "JEE" article, "Estimating Gender Wage Gaps," they described an interesting class project that allowed students to estimate the current gender earnings gap for recent college graduates using data from the National Association of Colleges and Employers (NACE). Unfortunately, since 2012, NACE no longer…

  17. Delaying the Academy: A Gap Year Education

    Science.gov (United States)

    O'Shea, Joseph

    2011-01-01

    This investigation serves as one of the first empirical analyses to examine the international volunteering gap year from an educational perspective, concluding an in-depth case study of a prominent gap year organisation in the UK. Contrary to widespread industry promotion of international development, the findings suggest that the experience can…

  18. 30 CFR 57.6603 - Air gap.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Air gap. 57.6603 Section 57.6603 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Explosives Extraneous Electricity-Surface and Underground § 57.6603 Air gap. At...

  19. Optical response and excitons in gapped graphene

    DEFF Research Database (Denmark)

    Pedersen, Thomas Garm; Jauho, Antti-Pekka; Pedersen, K.

    2009-01-01

    Graphene can be rendered semiconducting via energy gaps introduced in a variety of ways, e.g., coupling to substrates, electrical biasing, or nanostructuring. To describe and compare different realizations of gapped graphene we propose a simple two-band model in which a "mass" term is responsible...

  20. Spectral Gaps in Graphene Antidot Lattices

    DEFF Research Database (Denmark)

    Barbaroux, Jean-Marie; Cornean, Decebal Horia; Stockmeyer, Edgardo

    2017-01-01

    We consider the gap creation problem in an antidot graphene lattice, i.e. a sheet of graphene with periodically distributed obstacles. We prove several spectral results concerning the size of the gap and its dependence on different natural parameters related to the antidot lattice....

  1. Low band gap polymers for organic photovoltaics

    DEFF Research Database (Denmark)

    Bundgaard, Eva; Krebs, Frederik C

    2007-01-01

    Low band gap polymer materials and their application in organic photovoltaics (OPV) are reviewed. We detail the synthetic approaches to low band gap polymer materials starting from the early methodologies employing quinoid homopolymer structures to the current state of the art that relies...... in photovoltaic applications and give a tabular overview of rarely applied materials....

  2. Addressing the market research skills gap

    OpenAIRE

    Nunan, Daniel

    2015-01-01

    This Viewpoint focuses on the debate in market research around the gap between academia and practitioners. It argues that the debate misses the key role that universities play in the provision of market research skills and that it is this skills gap that needs to be addressed in order to ensure the future of research as a profession.

  3. String matching with variable length gaps

    DEFF Research Database (Denmark)

    Bille, Philip; Gørtz, Inge Li; Vildhøj, Hjalte Wedel

    2012-01-01

    We consider string matching with variable length gaps. Given a string T and a pattern P consisting of strings separated by variable length gaps (arbitrary strings of length in a specified range), the problem is to find all ending positions of substrings in T that match P. This problem is a basic...

  4. PhoneGap 3 beginner's guide

    CERN Document Server

    Natili, Giorgio

    2013-01-01

    Written in a friendly, example-driven Beginner's Guide format, there are plenty of step-by-step instructions to help you get started with PhoneGap.If you are a web developer or mobile application developer interested in an examples-based approach to learning mobile application development basics with PhoneGap, then this book is for you.

  5. Gap junctions and connexin-interacting proteins

    NARCIS (Netherlands)

    Giepmans, Ben N G

    2004-01-01

    Gap junctions form channels between adjacent cells. The core proteins of these channels are the connexins. Regulation of gap junction communication (GJC) can be modulated by connexin-associating proteins, such as regulatory protein phosphatases and protein kinases, of which c-Src is the

  6. Clinical usefulness of the serum anion gap.

    Science.gov (United States)

    Lee, Sik; Kang, Kyung Pyo; Kang, Sung Kyew

    2006-03-01

    The anion gap in the serum is useful in the interpretation of acid-base disorders and in the diagnosis of other conditions. In the early 1980s, ion-selective electrodes for specific ionic species were introduced for the measurement of serum electrolytes. This new method has caused a shift of the anion gap from 12±4 mEq/L down 6±3 mEq/L. It is worthy for clinicians to understand the range of normal anion gap and the measuring methods for serum sodium and chloride in the laboratories that support their practice. While an increase in the anion gap is almost always caused by retained unmeasured anions, a decrease in the anion gap can be generated by multiple mechanisms.

  7. Double-Gap Soft Diffraction Results from CDF

    International Nuclear Information System (INIS)

    Goulianos, K.

    2002-01-01

    We present a study of (anti)pp collisions with a leading antiproton and a rapidity gap in addition to that associated with the antiproton. The second gap is either within the region available to the proton dissociation products, (anti)p + p → ((anti)p + gap) + X + gap + Y, or adjacent to the outgoing proton (anti)p + p → ((anti)p + gap) + X + (gap + p ). Results are reported for two-gap to one-gap event ratios and compared with one-gap to no-gap ratios and with theoretical expectations. (author)

  8. A comparison of the wide gap and narrow gap resistive plate chamber

    International Nuclear Information System (INIS)

    Cerron Zeballos, E.; Crotty, I.; Hatzifotiadou, D.; Valverde, J.L.; Neupane, S.; Peskov, V.; Singh, S.; Williams, M.C.S.; Zichichi, A.

    1996-01-01

    In this paper we study the performance of a wide gap RPC and compare it with that of a narrow gap RPC, both operated in avalanche mode. We have studied the total charge produced in the avalanche. We have measured the dependence of the performance with rate. In addition we have considered the effect of the tolerance of gas gap and calculated the power dissipated in these two types of RPC. We find that the narrow gap RPC has better timing ability; however the wide gap has superior rate capability, lower power dissipation in the gas volume and can be constructed with less stringent mechanical tolerances. (orig.)

  9. The Knowledge Gap Versus the Belief Gap and Abstinence-Only Sex Education.

    Science.gov (United States)

    Hindman, Douglas Blanks; Yan, Changmin

    2015-08-01

    The knowledge gap hypothesis predicts widening disparities in knowledge of heavily publicized public affairs issues among socioeconomic status groups. The belief gap hypothesis extends the knowledge gap hypothesis to account for knowledge and beliefs about politically contested issues based on empirically verifiable information. This analysis of 3 national surveys shows belief gaps developed between liberals and conservatives regarding abstinence-only sex education; socioeconomic status-based knowledge gaps did not widen. The findings partially support both belief gap and knowledge gap hypotheses. In addition, the unique contributions of exposure to Fox News, CNN, and MSNBC in this process were investigated. Only exposure to Fox News was linked to beliefs about abstinence-only sex education directly and indirectly through the cultivation of conservative ideology.

  10. Clinical Usefulness of the Serum Anion Gap

    OpenAIRE

    Lee, Sik; Kang, Kyung Pyo; Kang, Sung Kyew

    2006-01-01

    The anion gap in the serum is useful in the interpretation of acid-base disorders and in the diagnosis of other conditions. In the early 1980s, ion-selective electrodes for specific ionic species were introduced for the measurement of serum electrolytes. This new method has caused a shift of the anion gap from 12±4 mEq/L down 6±3 mEq/L. It is worthy for clinicians to understand the range of normal anion gap and the measuring methods for serum sodium and chloride in the laboratories that suppo...

  11. Method for Bubbledeck Concrete Slab with Gaps

    Directory of Open Access Journals (Sweden)

    Sergiu Călin

    2009-01-01

    Full Text Available The composite slabs are made of BubbleDeck type slab elements with spherical gaps, poured in place on transversal and longitudinal directions. By introducing the gaps leads to a 30...50\\% lighter slab which reduces the loads on the columns, walls and foundations, and of course of the entire building. BubbleDeck slab elements are plates with ribs on two directions made of reinforced concrete or precast concrete with spherical shaped bubbles. These slab elements have a bottom and an upper concrete part connected with vertical ribs that go around the gaps.

  12. Abort Gap Cleaning for LHC Run 2

    CERN Document Server

    Uythoven, J; Bravin, E; Goddard, B; Hemelsoet, GH; Höfle, W; Jacquet, D; Kain, V; Mazzoni, S; Meddahi, M; Valuch, D

    2015-01-01

    To minimise the beam losses at the moment of an LHC beam dump the 3 μs long abort gap should contain as few particles as possible. Its population can be minimised by abort gap cleaning using the LHC transverse damper system. The LHC Run 1 experience is briefly recalled; changes foreseen for the LHC Run 2 are presented. They include improvements in the observation of the abort gap population and the mechanism to decide if cleaning is required, changes to the hardware of the transverse dampers to reduce the detrimental effect on the luminosity lifetime and proposed changes to the applied cleaning algorithms.

  13. Infectious Disease Practice Gaps in Dermatology.

    Science.gov (United States)

    Hopp, Shelby; Quest, Tyler L; Wanat, Karolyn A

    2016-07-01

    The article highlights different educational and practice gaps in infectious diseases as they pertain to dermatology. These gaps include the use of antibiotics in relation to atopic dermatitis and acne vulgaris, treatment of skin and soft tissue infection, and diagnosis and treatment of onychomycosis. In addition, practice gaps related to use of imiquimod for molluscum contagiosum, risk of infections related to immunosuppressive medications and rates of vaccination, and the use of bedside diagnostics for diagnosing common infections were discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Finding Maximal Pairs with Bounded Gap

    DEFF Research Database (Denmark)

    Brodal, Gerth Stølting; Lyngsø, Rune B.; Pedersen, Christian N. S.

    1999-01-01

    . In this paper we present methods for finding all maximal pairs under various constraints on the gap. In a string of length n we can find all maximal pairs with gap in an upper and lower bounded interval in time O(n log n+z) where z is the number of reported pairs. If the upper bound is removed the time reduces...... to O(n+z). Since a tandem repeat is a pair where the gap is zero, our methods can be seen as a generalization of finding tandem repeats. The running time of our methods equals the running time of well known methods for finding tandem repeats....

  15. LHC Abort Gap Monitoring and Cleaning

    CERN Document Server

    Meddahi, M; Boccardi, A; Butterworth, A; Fisher, A S; Gianfelice-Wendt, E; Goddard, B; Hemelsoet, G H; Höfle, W; Jacquet, D; Jaussi, M; Kain, V; Lefevre, T; Shaposhnikova, E; Uythoven, J; Valuch, D

    2010-01-01

    Unbunched beam is a potentially serious issue in the LHC as it may quench the superconducting magnets during a beam abort. Unbunched particles, either not captured by the RF system at injection or leaking out of the RF bucket, will be removed by using the existing damper kickers to excite resonantly the particles in the abort gap. Following beam simulations, a strategy for cleaning the abort gap at different energies was proposed. The plans for the commissioning of the beam abort gap cleaning are described and first results from the beam commissioning are presented.

  16. No difference in emergence time and early cognitive function between sevoflurane-fentanyl and propofol-remifentanil in patients undergoing craniotomy for supratentorial intracranial surgery.

    Science.gov (United States)

    Magni, G; Baisi, F; La Rosa, I; Imperiale, C; Fabbrini, V; Pennacchiotti, M L; Rosa, G

    2005-07-01

    Balanced anesthesia with sevoflurane-fentanyl has been widely accepted as anesthetic management for neurosurgery. Propofol-remifentanil regimen has been successfully used in various surgical settings, but a comprehensive comparison of sevoflurane-fentanyl and propofol-remifentanil anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery has not yet been done. The aim of this prospective, randomized, open-label clinical trial was to compare clinical properties of sevoflurane-fentanyl with propofol-remifentanil anesthesia in patients undergoing supratentorial intracranial surgery. The primary endpoint was to compare early postoperative recovery and cognitive functions within the two groups; we also evaluated hemodynamic events, vomiting, shivering, and pain. One hundred twenty patients (64 males; age 15-75 years) were randomized to either total intravenous anesthesia (group T) or sevoflurane anesthesia (group S). Emergence and extubation times and cognitive function (Short Orientation Memory Concentration Test [SOMCT]) were compared in the two groups. Brain swelling, incidence of hypotensive and hypertensive episodes, postoperative vomiting, shivering, and pain were also analyzed. The mean emergence time (12.2 +/- 4.9 minutes for group S versus 12.3 +/- 6.1 minutes for group T; P = 0.92) and extubation time (18.2 +/- 2.3 minutes for group S versus 18.3 +/- 2.1 minutes for group T; P = 0.80) were similar in the two groups. Average SOMCT scores, both 15 minutes after extubation (25.6 +/- 4.9 in group S versus 23.9 +/- 7.5 in group T; P = 0.14) and 45 minutes after extubation (27.3 +/- 2.2 in group S versus 26.0 +/- 5.1 in group T; P = 0.07) were also comparable. Brain swelling was present in seven and five patients in groups S and T, respectively (P = 0.76). Hypotension was present in 12% (group S) and 28% (group T) of patients (P = 0.02). Hypertension was present in 17% of patients in group S and 40% of patients in group T (P = 0

  17. School Segregation and Racial Academic Achievement Gaps

    Directory of Open Access Journals (Sweden)

    Sean F. Reardon

    2016-09-01

    Full Text Available Although it is clear that racial segregation is linked to academic achievement gaps, the mechanisms underlying this link have been debated since James Coleman published his eponymous 1966 report. In this paper, I examine sixteen distinct measures of segregation to determine which is most strongly associated with academic achievement gaps. I find clear evidence that one aspect of segregation in particular—the disparity in average school poverty rates between white and black students’ schools—is consistently the single most powerful correlate of achievement gaps, a pattern that holds in both bivariate and multivariate analyses. This implies that high-poverty schools are, on average, much less effective than lower-poverty schools and suggests that strategies that reduce the differential exposure of black, Hispanic, and white students to poor schoolmates may lead to meaningful reductions in academic achievement gaps.

  18. Region 9 Tribal Environmental GAP Funding

    Science.gov (United States)

    EPA Region 9 invites Indian Environmental General Assistance Program (GAP) grant proposals from federally recognized tribal governments and eligible intertribal consortia for FY2019 work plan program development activities.

  19. Rapidity gaps in jet events at DΦ

    International Nuclear Information System (INIS)

    Zylberstejn, A.

    1996-01-01

    Preliminary results from the Dφ experiment on jet production with rapidity gaps in pp-bar collisions are presented. A class of di-jet events with a forward rapidity gap is observed at center-of-mass energies √s = 1800 GeV and 630 GeV. The number of events with rapidity gaps at both centre-of-mass energies is significantly greater than the expectation from multiplicity fluctuations and is consistent with a hard single diffractive process. A class of events with two forward gaps and central di-jets is also observed at 1800 GeV. This topology is consistent with hard double pomeron exchange. We also present results on the observation of a class of events with low particle multiplicity between jets, attributable to the exchange of a strongly-interacting color-singlet. (author)

  20. Spinal Gap Junction Channels in Neuropathic Pain

    OpenAIRE

    Jeon, Young Hoon; Youn, Dong Ho

    2015-01-01

    Damage to peripheral nerves or the spinal cord is often accompanied by neuropathic pain, which is a complex, chronic pain state. Increasing evidence indicates that alterations in the expression and activity of gap junction channels in the spinal cord are involved in the development of neuropathic pain. Thus, this review briefly summarizes evidence that regulation of the expression, coupling, and activity of spinal gap junction channels modulates pain signals in neuropathic pain states induced...

  1. Gap between jets at the LHC

    Energy Technology Data Exchange (ETDEWEB)

    Royon, Christophe [CEA/IRFU/Service de physique des particules, CEA/Saclay, 91191 Gif-sur-Yvette cedex (France)

    2013-04-15

    We describe a NLL BFKL calculation implemented in the HERWIG MC of the gap between jets cross section, that represent a test of BFKL dynamics. We compare the predictions with recent measurements at the Tevatron and present predictions for the LHC. We also discuss the interesting process of looking for gap between jets in diffractive events when protons are detected in the ATLAS Forward Physics (AFP) detectors.

  2. Columbia River Component Data Gap Analysis

    Energy Technology Data Exchange (ETDEWEB)

    L. C. Hulstrom

    2007-10-23

    This Data Gap Analysis report documents the results of a study conducted by Washington Closure Hanford (WCH) to compile and reivew the currently available surface water and sediment data for the Columbia River near and downstream of the Hanford Site. This Data Gap Analysis study was conducted to review the adequacy of the existing surface water and sediment data set from the Columbia River, with specific reference to the use of the data in future site characterization and screening level risk assessments.

  3. Vortex induced vibrations in gapped restrainted pipes

    International Nuclear Information System (INIS)

    Veloso, P. de A.A.; Loula, A.F.D.

    1984-01-01

    The vortex induced vibration problem of gapped restrained piping is solved numerically. The model proposed by Skop-Griffin is used to describe the pipe-fluid interaction. The variational formulation is obtained modeling the gapped restraints as non-linear elastic springs. The regularized problem is solved using a finite element discretization for the spatial domain. In the time domain a finite difference discretization is used for the lift coefficient equatin and a Newmark discretization for the equation of motion. (Author) [pt

  4. The Gender Earnings Gap: Some International Evidence

    OpenAIRE

    Francine D. Blau; Lawrence M. Kahn

    1992-01-01

    This paper uses micro-data to analyze international differences in the gender pay gap among a sample of ten industrialized nations. We particularly focus on explaining the surprisingly low ranking of the U.S. in comparison to other industrialized countries. Empirical research on gender pay gaps has traditionally focused on the role of gender-specific factors, particularly gender differences in qualifications and differences in the treatment of otherwise equally qualified male and female worke...

  5. Theory of hard diffraction and rapidity gaps

    International Nuclear Information System (INIS)

    Del Duca, V.

    1995-06-01

    In this talk we review the models describing the hard diffractive production of jets or more generally high-mass states in presence of rapidity gaps in hadron-hadron and lepton-hadron collisions. By rapidity gaps we mean regions on the lego plot in (pseudo)-rapidity and azimuthal angle where no hadrons are produced, between the jet(s) and an elastically scattered hadron (single hard diffraction) or between two jets (double hard diffraction). (orig.)

  6. Numerical simulation of supersonic gap flow.

    Directory of Open Access Journals (Sweden)

    Xu Jing

    Full Text Available Various gaps in the surface of the supersonic aircraft have a significant effect on airflows. In order to predict the effects of attack angle, Mach number and width-to-depth ratio of gap on the local aerodynamic heating environment of supersonic flow, two-dimensional compressible Navier-Stokes equations are solved by the finite volume method, where convective flux of space term adopts the Roe format, and discretization of time term is achieved by 5-step Runge-Kutta algorithm. The numerical results reveal that the heat flux ratio is U-shaped distribution on the gap wall and maximum at the windward corner of the gap. The heat flux ratio decreases as the gap depth and Mach number increase, however, it increases as the attack angle increases. In addition, it is important to find that chamfer in the windward corner can effectively reduce gap effect coefficient. The study will be helpful for the design of the thermal protection system in reentry vehicles.

  7. THE PAL 5 STAR STREAM GAPS

    International Nuclear Information System (INIS)

    Carlberg, R. G.; Hetherington, Nathan; Grillmair, C. J.

    2012-01-01

    Pal 5 is a low-mass, low-velocity-dispersion, globular cluster with spectacular tidal tails. We use the Sloan Digital Sky Survey Data Release 8 data to extend the density measurements of the trailing star stream to 23 deg distance from the cluster, at which point the stream runs off the edge of the available sky coverage. The size and the number of gaps in the stream are measured using a filter which approximates the structure of the gaps found in stream simulations. We find 5 gaps that are at least 99% confidence detections with about a dozen gaps at 90% confidence. The statistical significance of a gap is estimated using bootstrap resampling of the control regions on either side of the stream. The density minimum closest to the cluster is likely the result of the epicyclic orbits of the tidal outflow and has been discounted. To create the number of 99% confidence gaps per unit length at the mean age of the stream requires a halo population of nearly a thousand dark matter sub-halos with peak circular velocities above 1 km s –1 within 30 kpc of the galactic center. These numbers are a factor of about three below cold stream simulation at this sub-halo mass or velocity but, given the uncertainties in both measurement and more realistic warm stream modeling, are in substantial agreement with the LCDM prediction.

  8. Experience with small-gap undulators

    International Nuclear Information System (INIS)

    Stefan, P.; Krinsky, S.

    1996-01-01

    Small-gap undulators offer enhanced performance as synchrotron radiation sources, by providing extended tuning range and the possibility of higher photon energies via short-period, small-gap devices. Challenges associated with the operation of small-gap undulators arise from their requirement for small beam apertures and the resulting possibility of lifetime degradation, beam instabilities, and radiation hazards. To investigate these fundamental limitations, we have constructed an R ampersand D small-gap undulator for the X13 straight section of the NSLS 2.584 GeV X-ray Ring and have tested it during studies shifts and normal user shifts during the last year. This device, the NSLS prototype small-gap undulator (PSGU), consists of a variable-aperture vacuum chamber and a 16-mm-period pure-permanent-magnet undulator, both mounted to a common elevator base stage. The design output spectrum of 2.5 keV in the fundamental (and 7.5 keV in the third harmonic) was obtained with a magnet gap of 5.6 mm and an electron beam aperture of 2.5 mm. The partial lifetime contribution for these parameters was observed to be about 40 hr. Details of the synchrotron radiation output spectrum, lifetime dependence on aperture, and bremsstrahlung radiation production will be presented. copyright 1996 American Institute of Physics

  9. Water limits to closing yield gaps

    Science.gov (United States)

    Davis, Kyle Frankel; Rulli, Maria Cristina; Garrassino, Francesco; Chiarelli, Davide; Seveso, Antonio; D'Odorico, Paolo

    2017-01-01

    Agricultural intensification is often seen as a suitable approach to meet the growing demand for agricultural products and improve food security. It typically entails the use of fertilizers, new cultivars, irrigation, and other modern technology. In regions of the world affected by seasonal or chronic water scarcity, yield gap closure is strongly dependent on irrigation (blue water). Global yield gap assessments have often ignored whether the water required to close the yield gap is locally available. Here we perform a gridded global analysis (10 km resolution) of the blue water consumption that is needed annually to close the yield gap worldwide and evaluate the associated pressure on renewable freshwater resources. We find that, to close the yield gap, human appropriation of freshwater resources for irrigation would have to increase at least by 146%. Most study countries would experience at least a doubling in blue water requirement, with 71% of the additional blue water being required by only four crops - maize, rice, soybeans, and wheat. Further, in some countries (e.g., Algeria, Morocco, Syria, Tunisia, and Yemen) the total volume of blue water required for yield gap closure would exceed sustainable levels of freshwater consumption (i.e., 40% of total renewable surface and groundwater resources).

  10. Anion Gap Blood Test: MedlinePlus Lab Test Information

    Science.gov (United States)

    ... https://medlineplus.gov/labtests/aniongapbloodtest.html Anion Gap Blood Test To use the sharing features on this page, please enable JavaScript. What is an Anion Gap Blood Test? An anion gap blood test is a way ...

  11. Development of Multidimensional Gap Conductance model using Virtual Link Gap Element

    International Nuclear Information System (INIS)

    Kim, Hyo Chan; Yang, Yong Sik; Kim, Dae Ho; Bang, Je Geon; Kim, Sun Ki; Koo, Yang Hyun

    2013-01-01

    The gap conductance that determines temperature gradient between pellet and cladding can be quite sensitive to gap thickness. For instance, once the gap size increases up to several micrometers in certain region, difference of pellet surface temperatures increases up to 100 Kelvin. Therefore, iterative thermo-mechanical coupled analysis is required to solve temperature distribution throughout pellet and cladding. Recently, multidimensional fuel performance codes have been being developed in the advanced countries to evaluate thermal behavior of fuel for off normal conditions and DBA(design based accident) conditions using the Finite Element Method (FEM). FRAPCON-FRAPTRAN code system, which is well known as the verified and reliable code, incorporates 1D thermal module and multidimensional mechanical module. In this code, multidimensional gap conductance model is not applied. ALCYONE developed by CEA introduces equivalent heat convection coefficient that represents multidimensional gap conductance as a function of gap thickness. BISON, which is multidimensional fuel performance code developed by INL, owns multidimensional gap conductance model using projected thermal contact. In general, thermal contact algorithm is nonlinear calculation which is expensive approach numerically. The gap conductance model for multi-dimension is difficult issue in terms of convergence and nonlinearity because gap conductance is function of gap thickness which depends on mechanical analysis at each iteration step. In this paper, virtual link gap (VLG) element has been proposed to resolve convergence issue and nonlinear characteristic of multidimensional gap conductance. In terms of calculation accuracy and convergence efficiency, the proposed VLG model was evaluated. LWR fuel performance codes should incorporate thermo-mechanical loop to solve gap conductance problem, iteratively. However, gap conductance in multidimensional model is difficult issue owing to its nonlinearity and

  12. Miliariapustulosa in post craniotomy patient

    Science.gov (United States)

    Dalimunthe, D. A.; Putra, I. B.; Jusuf, N. K.

    2018-03-01

    Miliaria is a skin disorder due to blockage/interruption of the eccrine sweat glands that often caused by increased heat, humidity, and resident skin organism. Types of miliaria are miliariacrystalline, miliariarubra, and miliariaprofunda. Miliariapustulosa isarare variant of miliariarubra in which vesicles develop into pustules. Miliariapustulosa is often misdiagnosed because it has a similar appearance like other skin disorder with pustules as their main lesion. A 16-year-old female was consulted from Neurosurgeon Department H. Adam Malik General Hospital with reddish papules and pustules accompanied with pain and itchy at the back and chest since 12 days of hospitalization. They firstly rose in the back region then spread to chest, neck and became pustules. Dermatology status showed in interscapular, thoracic and collie region, miliary pustules and erythematous papules were found. Differential diagnoses were miliariapustulosa, steroid acne and drug allergic eruption with miliariapustulosa as working diagnosis. Lotiofaberi combined with gentamycin sulfate cream 0.1%, and cetirizine 10 mg tablet once daily were given as treatments. The patientwas advised to wear lightweight clothing and avoid exposure to conditions of high heat and humidity. After seven days of treatment, the patient showed good clinical improvement.

  13. Tire Crumb Research Study Literature Review / Gap ...

    Science.gov (United States)

    In order to more fully understand data gaps in human exposure and toxicity to tire crumb materials, ATSDR, CPSC and EPA undertook a collaborative effort in the form of a scientific literature review and subsequent gaps analysis. The first objective of the Literature Review and Gap Analysis (LRGA) collaboration was to identify the existing body of literature related specifically to human exposure to tire crumb materials through the use of synthetic turf athletic fields and playgrounds. The second objective was to characterize and summarize the relevant data from the scientific literature. The final objective was to review the summary information and identify data gaps to build on the current understanding of the state-of-the-science and inform the development of specific research efforts that would be most impactful in the near-term. Because of the need for additional information, the U.S. Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (ATSDR), and the U.S. Consumer Product Safety Commission (CPSC) launched a multi-agency action plan to study key environmental human health questions. The Federal Research Action Plan includes numerous activities, including research studies (U.S. EPA, 2016). A key objective of the Action Plan is to identify key knowledge gaps.

  14. Regulation of gap junctions by protein phosphorylation

    Directory of Open Access Journals (Sweden)

    J.C. Sáez

    1998-05-01

    Full Text Available Gap junctions are constituted by intercellular channels and provide a pathway for transfer of ions and small molecules between adjacent cells of most tissues. The degree of intercellular coupling mediated by gap junctions depends on the number of gap junction channels and their activity may be a function of the state of phosphorylation of connexins, the structural subunit of gap junction channels. Protein phosphorylation has been proposed to control intercellular gap junctional communication at several steps from gene expression to protein degradation, including translational and post-translational modification of connexins (i.e., phosphorylation of the assembled channel acting as a gating mechanism and assembly into and removal from the plasma membrane. Several connexins contain sites for phosphorylation for more than one protein kinase. These consensus sites vary between connexins and have been preferentially identified in the C-terminus. Changes in intercellular communication mediated by protein phosphorylation are believed to control various physiological tissue and cell functions as well as to be altered under pathological conditions.

  15. Trunnion Collar Removal Machine - Gap Analysis Table

    International Nuclear Information System (INIS)

    Johnson, M.

    2005-01-01

    The purpose of this document is to review the existing the trunnion collar removal machine against the ''Nuclear Safety Design Bases for License Application'' (NSDB) [Ref. 10] requirements and to identify codes and standards and supplemental requirements to meet these requirements. If these codes and standards can not fully meet these requirements then a ''gap'' is identified. These gaps will be identified here and addressed using the ''Trunnion Collar Removal Machine Design Development Plan'' [Ref. 15]. The codes and standards, supplemental requirements, and design development requirements for the trunnion collar removal machine are provided in the gap analysis table (Appendix A, Table 1). Because the trunnion collar removal machine is credited with performing functions important to safety (ITS) in the NSDB [Ref. 10], design basis requirements are applicable to ensure equipment is available and performs required safety functions when needed. The gap analysis table is used to identify design objectives and provide a means to satisfy safety requirements. To ensure that the trunnion collar removal machine performs required safety functions and meets performance criteria, this portion of the gap analysis tables supplies codes and standards sections and the supplemental requirements and identifies design development requirements, if needed

  16. Treefall Gap Mapping Using Sentinel-2 Images

    Directory of Open Access Journals (Sweden)

    Iván Barton

    2017-11-01

    Full Text Available Proper knowledge about resources in forest management is fundamental. One of the most important parameters of forests is their size or spatial extension. By determining the area of treefall gaps inside the compartments, a more accurate yield can be calculated and the scheduling of forestry operations could be planned better. Several field- and remote sensing-based approaches are in use for mapping but they provide only static measurements at high cost. The Earth Observation satellite mission Sentinel-2 was put in orbit as part of the Copernicus programme. With the 10-m resolution bands, it is possible to observe small-scale forestry operations like treefall gaps. The spatial extension of these gaps is often less than 200 m2, thus their detection can only be done on sub-pixel level. Due to the higher temporal resolution of Sentinel-2, multiple observations are available in a year; therefore, a time series evaluation is possible. The modelling of illumination can increase the accuracy of classification in mountainous areas. The method was tested on three deciduous forest sites in the Börzsöny Mountains in Hungary. The area evaluation produced less than 10% overestimation with the best possible solutions on the sites. The presented work shows a low-cost method for mapping treefall gaps which delivers annual information about the gap area in a deciduous forest.

  17. Gendered Justice Gaps in Bosnia-Herzegovina

    DEFF Research Database (Denmark)

    Björkdahl, Annika; Mannergren Selimovic, Johanna

    2014-01-01

    A gendered reading of the liberal peacebuilding and transitional justice project in Bosnia-Herzegovina raises critical questions concerning the quality of the peace one hopes to achieve in transitional societies. By focusing on three-gendered justice gaps-the accountability, acknowledgement......, and reparations gaps-this article examines structural constraints for women to engage in shaping and implementing transitional justice, and unmasks transitional justice as a site for the long-term construction of the gendered post-conflict order. Thus, the gendered dynamics of peacebuilding and transitional...... justice have produced a post-conflict order characterized by gendered peace and justice gaps. Yet, we conclude that women are doing justice within the Bosnian-Herzegovina transitional justice project, and that their presence and participation is complex, multilayered, and constrained yet critical....

  18. Non-metallic gage for gap

    International Nuclear Information System (INIS)

    Hiroki, Hideo.

    1996-01-01

    The present invention concerns a non-metallic gage for detecting a gap which can not be seen from the out side such as a gap between a water pipe and fuel rods without damaging an objective material as to whether the gap is formed within a standard value or not. The gage is made of a synthetic resin, for example, polyacetal having such a hardness as not damaging the objective material and endurable to repeating flexure upon use. The gage comprises a short gage portion having a predetermined standard thickness and an flexible extended connection portion reduced in the thickness. Provision of the extended connection portion enables wide range flexure thereof such as ±60deg relative to insertion direction during insertion operation upon testing to solve a drawback in the prior art such as worry of breakage of the gage, thereby enabling to conduct inspection rapidly at high reliability. (N.H.)

  19. LHC Abort Gap Filling by Proton Beam

    CERN Document Server

    Fartoukh, Stéphane David; Shaposhnikova, Elena

    2004-01-01

    Safe operation of the LHC beam dump relies on the possibility of firing the abort kicker at any moment during beam operation. One of the necessary conditions for this is that the number of particles in the abort gap should be below some critical level defined by quench limits. Various scenarios can lead to particles filling the abort gap. Time scales associated with these scenarios are estimated for injection energy and also coast where synchrotron radiation losses are not negligible for uncaptured particle motion. Two cases are considered, with RF on and RF off. The equilibrium distribution of lost particles in the abort gap defines the requirements for maximum tolerable relative loss rate and as a consequence the minimum acceptable longitudinal lifetime of the proton beam in collision.

  20. Sustainability Tools Inventory - Initial Gaps Analysis | Science ...

    Science.gov (United States)

    This report identifies a suite of tools that address a comprehensive set of community sustainability concerns. The objective is to discover whether "gaps" exist in the tool suite’s analytic capabilities. These tools address activities that significantly influence resource consumption, waste generation, and hazard generation including air pollution and greenhouse gases. In addition, the tools have been evaluated using four screening criteria: relevance to community decision making, tools in an appropriate developmental stage, tools that may be transferrable to situations useful for communities, and tools with requiring skill levels appropriate to communities. This document provides an initial gap analysis in the area of community sustainability decision support tools. It provides a reference to communities for existing decision support tools, and a set of gaps for those wishing to develop additional needed tools to help communities to achieve sustainability. It contributes to SHC 1.61.4

  1. Closing the gap on unmeasured anions

    Science.gov (United States)

    Kellum, John A

    2003-01-01

    Many critically ill and injured patients, especially those with metabolic acidosis, have abnormally high levels of unmeasured anions in their blood. At the same time, such patients are prone to hypoalbuminemia, which makes the traditional anion gap calculation inaccurate. Thus, little is known about the epidemiology and clinical consequences of an excess in unmeasured anions in the blood. Indeed, even the etiology of these "missing ions" is often unclear. Unfortunately, more precise means of quantifying unmeasured anions, such as the strong ion gap (SIG), are cumbersome to use clinically. However, a simple means of correcting the anion gap can be used to estimate SIG and may provide additional insight into this common clinical problem. PMID:12793870

  2. Long-Term Survival of a Patient with Brainstem and Recurrent Brain Metastasis from Stage IV Nonsmall Cell Lung Cancer Treated with Multiple Gamma Knife Radiosurgeries and Craniotomies: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Andrew F. Lamm

    2012-01-01

    Full Text Available The prognosis of patients diagnosed with stage IV nonsmall cell lung cancer that have brain and brainstem metastasis is very poor, with less than a third surviving a year past their initial date of diagnosis. We present the rare case of a 57-year-old man who is a long-term survivor of brainstem and recurrent brain metastasis, after aggressive treatment. He is now five and a half years out from diagnosis and continues to live a highly functional life without evidence of disease. Four separate Gamma Knife stereotactic radiosurgeries in conjunction with two craniotomies were utilized since his initial diagnosis to treat recurrent brain metastasis while chemoradiation therapy and thoracic surgery were used to treat his primary disease in the right upper lung. In his situation, Gamma Knife radiosurgery proved to be a valuable, safe, and effective tool for the treatment of multiply recurrent brain metastases within critical normal structures.

  3. Widening the Gap: Pre-University Gap Years and the "Economy of Experience"

    Science.gov (United States)

    Heath, Sue

    2007-01-01

    Embarking upon a pre-university gap year is an increasingly popular option among British students. Drawing on Brown et al.'s work on positional conflict theory and the increased importance of the "economy of experience", this paper seeks to explore this growing popularity and argues that the gap year's enhanced profile raises important…

  4. The Civic Engagement Gap(s): Youth Participation and Inequality from 1976 to 2009

    Science.gov (United States)

    Gaby, Sarah

    2017-01-01

    Civic participation in the United States is highly unequal, resulting in a "civic engagement gap" between socioeconomic, racial, and gender groups. Variation in civic participation and the civic engagement gap remain contested, primarily as a result of inconsistent definitions and measurement issues in previous work. Using consistent…

  5. Minding the Gap: Utility of the Anion Gap in the Differential Diagnosis of Metabolic Acidosis.

    Science.gov (United States)

    Bell, Susan Givens

    2017-07-01

    The anion gap, in conjunction with other laboratory results, can be a useful clue in the differential diagnosis of metabolic acidosis. There are three primary causes of metabolic acidosis: loss of base, decreased renal excretion of acid, and increased acid production. Depending on the cause of metabolic acidosis, the anion gap may be elevated or normal.

  6. EVA Systems Technology Gaps and Priorities 2017

    Science.gov (United States)

    Johnson, Brian J.; Buffington, Jesse A.

    2017-01-01

    Performance of Extra-Vehicular Activities (EVA) has been and will continue to be a critical capability for human space flight. Human exploration missions beyond LEO will require EVA capability for either contingency or nominal activities to support mission objectives and reduce mission risk. EVA systems encompass a wide array of products across pressure suits, life support systems, EVA tools and unique spacecraft interface hardware (i.e. EVA Translation Paths and EVA Worksites). In a fiscally limited environment with evolving transportation and habitation options, it is paramount that the EVA community's strategic planning and architecture integration products be reviewed and vetted for traceability between the mission needs far into the future to the known technology and knowledge gaps to the current investments across EVA systems. To ascertain EVA technology and knowledge gaps many things need to be brought together, assessed and analyzed. This includes an understanding of the destination environments, various mission concept of operations, current state of the art of EVA systems, EVA operational lessons learned, and reference advanced capabilities. A combined assessment of these inputs should result in well-defined list of gaps. This list can then be prioritized depending on the mission need dates and time scale of the technology or knowledge gap closure plan. This paper will summarize the current state of EVA related technology and knowledge gaps derived from NASA's Exploration EVA Reference Architecture and Operations Concept products. By linking these products and articulating NASA's approach to strategic development for EVA across all credible destinations an EVA could be done in, the identification of these gaps is then used to illustrate the tactical and strategic planning for the EVA technology development portfolio. Finally, this paper illustrates the various "touch points" with other human exploration risk identification areas including human health and

  7. Gribov gap equation at finite temperature

    Energy Technology Data Exchange (ETDEWEB)

    Canfora, Fabrizio; Pais, Pablo [Centro de Estudios Cientificos (CECS), Valdivia (Chile); Universidad Andres Bello, Santiago (Chile); Salgado-Rebolledo, Patricio [Centro de Estudios Cientificos (CECS), Valdivia (Chile); Universidad de Concepcion, Departamento de Fisica, Concepcion (Chile); Universite Libre de Bruxelles and International Solvay Insitutes, Physique Theorique et Mathematique, Bruxelles (Belgium)

    2014-05-15

    In this paper the Gribov gap equation at finite temperature is analyzed. The solutions of the gap equation (which depend explicitly on the temperature) determine the structure of the gluon propagator within the semi-classical Gribov approach. The present analysis is consistent with the standard confinement scenario for low temperatures, while for high enough temperatures, deconfinement takes place and a free gluon propagator is obtained. An intermediate regime in between the confined and free phases can be read off from the resulting gluon propagator, which appears to be closely related to partial deconfinement. (orig.)

  8. The Gender Wage Gap and Domestic Violence.

    Science.gov (United States)

    Aizer, Anna

    2010-09-01

    Three quarters of all violence against women is perpetrated by domestic partners. This study exploits exogenous changes in the demand for labor in female-dominated industries to estimate the impact of the male-female wage gap on domestic violence. Decreases in the wage gap reduce violence against women, consistent with a household bargaining model. These findings shed new light on the health production process as well as observed income gradients in health and suggest that in addition to addressing concerns of equity and efficiency, pay parity can also improve the health of American women via reductions in violence.

  9. Closing the gap between formalism and application

    DEFF Research Database (Denmark)

    Christensen, Ole Ravn

    2008-01-01

    A common problem in learning mathematics concerns the gap between, on the one hand, doing the formalisms and calculations of abstract mathematics and, on the other hand, applying these in a specific contextualized setting for example the engineering world. The skills acquired through problem......-based learning (PBL), in the special model used at Aalborg University, Denmark, may give us some idea of how to bridge this gap. Through an investigation of a series of examples of student projects concerning the application of mathematical subjects-such as matrices, differential equations, cluster analysis...

  10. Astroglial gap junctions shape neuronal network activity.

    Science.gov (United States)

    Pannasch, Ulrike; Derangeon, Mickael; Chever, Oana; Rouach, Nathalie

    2012-05-01

    Astrocytes, the third element of the tripartite synapse, are active players in neurotransmission. Up to now, their involvement in neuronal functions has primarily been investigated at the single cell level. However, a key property of astrocytes is that they communicate via extensive networks formed by gap junction channels. Recently, we have shown that this networking modulates the moment to moment basal synaptic transmission and plasticity via the regulation of extracellular potassium and glutamate levels. Here we show that astroglial gap junctional communication also regulates neuronal network activity. We discuss these findings and their implications for brain information processing.

  11. Soil moisture in sessile oak forest gaps

    Science.gov (United States)

    Zagyvainé Kiss, Katalin Anita; Vastag, Viktor; Gribovszki, Zoltán; Kalicz, Péter

    2015-04-01

    By social demands are being promoted the aspects of the natural forest management. In forestry the concept of continuous forest has been an accepted principle also in Hungary since the last decades. The first step from even-aged stand to continuous forest can be the forest regeneration based on gap cutting, so small openings are formed in a forest due to forestry interventions. This new stand structure modifies the hydrological conditions for the regrowth. Without canopy and due to the decreasing amounts of forest litter the interception is less significant so higher amount of precipitation reaching the soil. This research focuses on soil moisture patterns caused by gaps. The spatio-temporal variability of soil water content is measured in gaps and in surrounding sessile oak (Quercus petraea) forest stand. Soil moisture was determined with manual soil moisture meter which use Time-Domain Reflectometry (TDR) technology. The three different sizes gaps (G1: 10m, G2: 20m, G3: 30m) was opened next to Sopron on the Dalos Hill in Hungary. First, it was determined that there is difference in soil moisture between forest stand and gaps. Second, it was defined that how the gap size influences the soil moisture content. To explore the short term variability of soil moisture, two 24-hour (in growing season) and a 48-hour (in dormant season) field campaign were also performed in case of the medium-sized G2 gap along two/four transects. Subdaily changes of soil moisture were performed. The measured soil moisture pattern was compared with the radiation pattern. It was found that the non-illuminated areas were wetter and in the dormant season the subdaily changes cease. According to our measurements, in the gap there is more available water than under the forest stand due to the less evaporation and interception loss. Acknowledgements: The research was supported by TÁMOP-4.2.2.A-11/1/KONV-2012-0004 and AGRARKLIMA.2 VKSZ_12-1-2013-0034.

  12. ANION GAP NO SANGUE VENOSO EM EQUINOS

    Directory of Open Access Journals (Sweden)

    Luís Carlos Ribeiro Fan

    1994-01-01

    Full Text Available RESUMO A influência do sangue venoso na determinação do anion gap foi estudada em 50 equinos adultos clinicamente sadios no município de Santa Maria, RS. Os resultados obtidos em mEq/1 foram: sódio 140 ± 2,0; potássio 4,2 ± 0,5; cloreto 102 ± 12 e bicarbonato 26,9 ± 2,0. Conclui-se que o sangue venoso pode substituir o arterial na determinação do anion gap em equinos.

  13. Modified skin incision for avoiding the lesser occipital nerve and occipital artery during retrosigmoid craniotomy: potential applications for enhancing operative working distance and angles while minimizing the risk of postoperative neuralgias and intraoperative hemorrhage.

    Science.gov (United States)

    Tubbs, R Shane; Fries, Fabian N; Kulwin, Charles; Mortazavi, Martin M; Loukas, Marios; Cohen-Gadol, Aaron A

    2016-10-01

    Chronic postoperative neuralgias and headache following retrosigmoid craniotomy can be uncomfortable for the patient. We aimed to better elucidate the regional nerve anatomy in an effort to minimize this postoperative complication. Ten adult cadaveric heads (20 sides) were dissected to observe the relationship between the lesser occipital nerve and a traditional linear versus modified U incision during retrosigmoid craniotomy. Additionally, the relationship between these incisions and the occipital artery were observed. The lesser occipital nerve was found to have two types of course. Type I nerves (60%) remained close to the posterior border of the sternocleidomastoid muscle and some crossed anteriorly over the sternocleidomastoid muscle near the mastoid process. Type II nerves (40%) left the posterior border of the sternocleidomastoid muscle and swung medially (up to 4.5cm posterior to the posterior border of the sternocleidomastoid muscle) as they ascended over the occiput. The lesser occipital nerve was near a midpoint of a line between the external occipital protuberance and mastoid process in all specimens with the type II nerve configuration. Based on our findings, the inverted U incision would be less likely to injure the type II nerves but would necessarily cross over type I nerves, especially more cranially on the nerve at the apex of the incision. As the more traditional linear incision would most likely transect the type I nerves and more so near their trunk, the U incision may be the overall better choice in avoiding neural and occipital artery injury during retrosigmoid approaches. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Increasing gap junctional coupling: a tool for dissecting the role of gap junctions

    DEFF Research Database (Denmark)

    Axelsen, Lene Nygaard; Haugan, Ketil; Stahlhut, Martin

    2007-01-01

    . In a number of cases, gap junctions have been implicated in the initiation and progress of disease, and experimental uncoupling has been used to investigate the exact role of coupling. The inverse approach, i.e., to increase coupling, has become possible in recent years and represents a new way of testing......Much of our current knowledge about the physiological and pathophysiological role of gap junctions is based on experiments where coupling has been reduced by either chemical agents or genetic modification. This has brought evidence that gap junctions are important in many physiological processes...... the role of gap junctions. The aim of this review is to summarize the current knowledge obtained with agents that selectively increase gap junctional intercellular coupling. Two approaches will be reviewed: increasing coupling by the use of antiarrhythmic peptide and its synthetic analogs...

  15. Subgroup Achievement and Gap Trends: Delaware

    Science.gov (United States)

    Center on Education Policy, 2010

    2010-01-01

    In grade 8 (the only grade in which subgroup trends were analyzed by achievement level), Delaware students showed consistent gains in math at the basic, proficient, and advanced levels for racial/ethnic subgroups, low income students, and boys and girls. There were mixed results in reading. Achievement gaps narrowed in both reading and math in…

  16. Subgroup Achievement and Gap Trends: Massachusetts, 2010

    Science.gov (United States)

    Center on Education Policy, 2010

    2010-01-01

    This paper profiles the student subgroup achievement and gap trends in Massachusetts for 2010. In grade 8 (the only grade in which subgroup trends were analyzed by achievement level), Massachusetts showed across-the-board gains--improvements in both reading and math at the basic, proficient and advanced levels for all racial/ethnic subgroups, low…

  17. Subgroup Achievement and Gap Trends: Illinois

    Science.gov (United States)

    Center on Education Policy, 2010

    2010-01-01

    In grade 8 (the only grade in which subgroup trends were analyzed by achievement level), Illinois students showed mostly gains in both reading and math at the basic, proficient, and advanced levels for racial/ethnic subgroups, low income students, and boys and girls. There was mixed progress made in narrowing achievement gaps in reading and math…

  18. Subgroup Achievement and Gap Trends: Kentucky, 2010

    Science.gov (United States)

    Center on Education Policy, 2010

    2010-01-01

    This paper profiles the student subgroup achievement and gap trends in Kentucky for 2010. In grade 8 (the only grade in which subgroup trends were analyzed by achievement level), Kentucky showed mostly gains in both reading and math at the basic, proficient, and advanced levels for racial/ethnic subgroups, low income students, and boys and girls.…

  19. Subgroup Achievement and Gap Trends: Florida

    Science.gov (United States)

    Center on Education Policy, 2010

    2010-01-01

    In grade 8 (the only grade in which subgroup trends were analyzed by achievement level), Florida students showed gains almost across the board in both reading and math at the basic, proficient, and advanced levels for racial/ethnic subgroups, low income students, and boys and girls. Progress has been made in narrowing achievement gaps in both…

  20. The Gender Gap in Top Corporate Jobs.

    Science.gov (United States)

    Bertrand, Marianne; Hallock, Kevin F.

    2001-01-01

    Women, about 2% of a sample of top executives, earned about 45% less than men. Three-fourths of the gap may be explained by women managing smaller companies and being less likely to be chair/president. Gender segregation or unequal promotion may play a role. Between 1992-1997, women nearly tripled their representation among top executives, mostly…

  1. The Racial School-Climate Gap

    Science.gov (United States)

    Voight, Adam

    2013-01-01

    Education inequity is a persistent reality of American culture. As early as kindergarten, there are marked differences in academic performance between racial minority students and their peers. These differences are sustained as students progress through school. One aspect of students' social experience that may help to explain the gap is school…

  2. Subgroup Achievement and Gap Trends: Hawaii

    Science.gov (United States)

    Center on Education Policy, 2010

    2010-01-01

    Hawaii showed improvement in reading and math in grade 8 at the basic, proficient, and advanced levels for Asian and white students, low income students, and boys and girls. Gains in math tended to be larger than in reading. Trends in closing achievement gaps were mixed. Comparable data were available from 2007 through 2009. (Contains 9 tables.)…

  3. AIR GAP CONTROL SYSTEM FOR HYDROGENERATORS

    Directory of Open Access Journals (Sweden)

    I. O. Zaitsev

    2017-01-01

    Full Text Available In this paper, we report of the solving the actual problem of control the air gap in the hydrogenerators. The aim of the study was development of a computerized information-measuring system for measuring the air gap in the hydrogenator, which used two capacitive sensors with parallel coplanar electrodes, and the method of determining the shape of the envelope parameters hydrogenerator rotor poles relative to the center axis of rotation, using the measurement results of the air gap.In practical studies of the sensor circuit it has been shown that its use allows for the informative value of the sensor capacitance conversion function to obtain a high accuracy and resolution measurement with digital linearization of converting function of the sensor with use program utility. To determine the form deviations of the envelope line of the rotor pole from the ideal cylinder, which is one of the main structural defects of the technological errors as results the distortion of the shape of the air gap in the hydrogenator, when the machine was manufacture and assembly. It is proposed to describe the shape of the envelope to use a Fourier transform. Calculation of the coefficients of the Fourier series is performed using the method of least squares as the regression coefficients.Application of this method in processing the measuring data in a computerized information-measuring system the developed with the primary converter with coplanar parallel electrodes allowed attaining the high measurement accuracy and resolution informative in magnitude of the capacity.

  4. The Dual Gap Function for Variational Inequalities

    International Nuclear Information System (INIS)

    Zhang Jianzhong; Wan Changyu; Xiu Naihua

    2003-01-01

    In this paper we further study the dual gap function G, which was introduced by Marcotte and Zhu, for the variational inequality problem (VIP). We characterize the directional derivative and subdifferential of G. Based on these, we get a better understanding of the concepts of a global error bound, weak sharpness, and minimum principle sufficiency property for the pseudo-monotone

  5. Globalization and the gender wage gap

    NARCIS (Netherlands)

    Oostendorp, R.H.

    2009-01-01

    There are several theoretical reasons why globalization will have a narrowing as well as a widening effect on the gender wage gap, but little is known about the actual impact, except for some country studies. This study contributes to the literature in three respects. First, it is a large

  6. Quantifying the Gender Gap in Science Interests

    Science.gov (United States)

    Baram-Tsabari, Ayelet; Yarden, Anat

    2011-01-01

    Nearly 5,000 self-generated science-related K-12 students' questions, classified into seven science subjects, were used to quantitatively measure the gender gap in science interests and its change with age. In this data set, a difference between boys' and girls' science interests did not exist during early childhood, but increased over 20-fold by…

  7. Ethnicity and Gender Gaps in Early Childhood

    Science.gov (United States)

    Hansen, Kirstine; Jones, Elizabeth M.

    2011-01-01

    Gender differences in academic performance and achievement have been of policy concern for decades--both interest in lower performance by girls in the areas of mathematics and science and, more recently, in boys' underperformance in most other academic areas. Much previous research has focused on gender gaps, while overlooking other factors that…

  8. Nurse leaders and the innovation competence gap.

    Science.gov (United States)

    White, Kenneth R; Pillay, Rubin; Huang, Xuan

    2016-01-01

    Nurses are well-positioned for innovation in health care delivery, although innovation is not generally learned in formal educational programs. The purpose of this study was to assess critical competencies for innovation success among nurse leaders in academia and practice, the perceived gaps on those competencies, and teaching methods that would be helpful in developing competencies related to innovation. A Web-enabled descriptive survey design was used to capture nurse leaders' perceptions of important innovation competencies and how they assess their level of competence in the particular innovation domain. Preferred approaches for innovation pedagogy were also queried. Respondents indicated significant gaps in 18 of 19 innovation competencies. Implications are for inclusion of innovation competencies in formal and continuing nursing education. The most preferred innovation pedagogical approaches are case studies of failures and successes and project- and field-based approaches. Traditional lectures are the least preferred way to address innovation competency gaps. There is a significant gap in innovation competencies among nurse leaders in practice and academia. The way we teach innovation needs to involve closer collaboration between academia and practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. The Sources of the Communication Gap

    NARCIS (Netherlands)

    He, S.; Offerman, T.; van de Ven, J.

    Face-to-face communication drastically increases cooperation rates in social dilemmas. We test which factors are the most important drivers of this communication gap. We distinguish three main categories. First, communication may decrease social distance. Second, communication may enable subjects to

  10. Fabrication of gap-optimized CMUT.

    Science.gov (United States)

    Ahrens, Oliver; Buhrdorf, Andreas; Hohlfeld, Dennis; Tebje, Lars; Binder, Josef

    2002-09-01

    A recently introduced set up of capacitive micromachined ultrasonic transducers (cMUT) combines a conductive membrane above a structured sacrificial layer. All previous approaches either require an additional metallic electrode or do not possess a structured sacrificial layer and, consequently, may make exact adjustment of the membrane dimensions difficult. The present set ups are especially suited for the fabrication of cMUT with gap heights ranging between 50 nm and 2 microm between the electrodes. Large gaps are a prerequisite to enabling sufficient deflections of the membrane and, therewith, to generating high pressure gradients. On the other hand, small gap sizes are desirable for detecting weak ultrasonic sources. This paper focuses on the fabrication process of cMUT to realize electrode separation above 500 nm and, in addition, on the manufacturing of cMUT with gaps below 500 nm. The successful realization has been proven by some basic experimental investigations. Finally, the fundamental equations of a frequently chosen simulation model are documented, as a number of ambiguities exist in the common literature.

  11. AUDIT EXPECTATION GAP: AUDITORS IN UNENDING ROLE ...

    African Journals Online (AJOL)

    GRACE

    Key Words: Expectation gap, Auditors, Shareholders, Self-regulation, Audit expectation. Introduction. The primary objective of ... dissatisfaction of companies' stakeholders, including shareholders, current and potential investors, creditors etc. ..... agreement with what the questionnaire seeks. In order to ensure reliability of ...

  12. Subgroup Achievement and Gap Trends: Nevada, 2010

    Science.gov (United States)

    Center on Education Policy, 2010

    2010-01-01

    This paper profiles the student subgroup achievement and gap trends in Nevada for 2010. In grade 8 (the only grade in which subgroup trends were analyzed by achievement level), Nevada showed across-the-board gains--improvements in both reading and math at the basic, proficient and advanced levels for all racial/ethnic subgroups, low income…

  13. Measurement of plasma flows into tile gaps

    Czech Academy of Sciences Publication Activity Database

    Dejarnac, Renaud; Komm, Michael; Stöckel, Jan; Pánek, Radomír

    2008-01-01

    Roč. 382, č. 1 (2008), s. 31-34 ISSN 0022-3115 R&D Projects: GA AV ČR KJB100430602 Institutional research plan: CEZ:AV0Z20430508 Keywords : Tokamak diagnostic * Gaps * Ion saturation current * Edge modeling * Sheaths Subject RIV: BL - Plasma and Gas Discharge Physics Impact factor: 1.501, year: 2008

  14. Decomposing Achievement Gaps among OECD Countries

    Science.gov (United States)

    Zhang, Liang; Lee, Kristen A.

    2011-01-01

    In this study, we use decomposition methods on PISA 2006 data to compare student academic performance across OECD countries. We first establish an empirical model to explain the variation in academic performance across individuals, and then use the Oaxaca-Blinder decomposition method to decompose the achievement gap between each of the OECD…

  15. Bridging the Gap: Pracademics in Foreign Policy

    Science.gov (United States)

    Murphy, Ann Marie; Fulda, Andreas

    2011-01-01

    In his seminal work "Bridging the Gap: Theory and Practice in Foreign Policy", Alexander George (1993) lamented the great divide between academia and the foreign policymaking community, arguing that greater interaction between scholars and policymakers would produce better policy. We share George's belief that scholars and practitioners each have…

  16. Enterprise Bargaining and the Gender Earnings Gap.

    Science.gov (United States)

    Wooden, Mark

    1997-01-01

    Examination of the widening gender earnings gap in Australia indicates that women's wages continue to lag behind those of men. The main factor appears to be women's concentration in part-time work in enterprises where bargaining is less likely to occur. (JOW)

  17. Anaesthetic hazards of the 'passion gap'

    African Journals Online (AJOL)

    slaves imported by the Dutch East India Company from the. East, the early white settJers and, later, blacks. Within this population there are two small distinctive communities: the. Griquas and the Cape Malays.3,4. Why does the 'passion gap' exist among the Cape Coloureds? The popular belief is that the teeth are removed ...

  18. EurepGAP certification for small producers

    NARCIS (Netherlands)

    Valk, van der O.M.C.

    2006-01-01

    The majority of agriculture practitioners worldwide are smallholders. Compliance with market related standards, such as set by EurepGAP, is crucial for obtaining and maintaining international market access, particularly to the European Union. Private standards must allow for innovative and cost

  19. Infrastructural gap: Commons, state and anthropology

    NARCIS (Netherlands)

    Dalakoglou, Dimitris

    2016-01-01

    An infrastructural gap (IG) emerged after the outbreak of the crisis in 2008 and it refers to the difficulty of the state and the private sector in sustaining the level of infrastructural networks in the Western world. Yet, infrastructures comprise the realm where the state or the market materialize

  20. Sustainability Tools Inventory Initial Gap Analysis

    Science.gov (United States)

    This report identifies a suite of tools that address a comprehensive set of community sustainability concerns. The objective is to discover whether "gaps" exist in the tool suite’s analytic capabilities. These tools address activities that significantly influence resource consu...

  1. AUDIT EXPECTATION GAP: PERSPECTIVES OF AUDITORS AND ...

    African Journals Online (AJOL)

    assurance of audit report (v) independence of auditors in performance of their duties. The study concluded that ... There is now a considerable evidence of a gap when external auditor's understanding of their roles ... To examine the expectation of the various audited account users of the external auditor. 3. To examine the ...

  2. Phononic band gap structures as optimal designs

    DEFF Research Database (Denmark)

    Jensen, Jakob Søndergaard; Sigmund, Ole

    2003-01-01

    In this paper we use topology optimization to design phononic band gap structures. We consider 2D structures subjected to periodic loading and obtain the distribution of two materials with high contrast in material properties that gives the minimal vibrational response of the structure. Both in...

  3. Disentangling agronomic and economic yield gaps

    NARCIS (Netherlands)

    Dijk, van Michiel; Morley, Tomas; Jongeneel, Roel; Ittersum, van Martin; Reidsma, Pytrik; Ruben, Ruerd

    2017-01-01

    Despite its frequent use in policy discussions on future agricultural production, both the concept of the yield gap and its determinants are understood differently by economists and agronomists. This study provides a micro-level framework that disentangles and integrates agronomic and economic

  4. impairs gap junction function causing congenital cataract

    Indian Academy of Sciences (India)

    Navya

    2017-03-24

    Mar 24, 2017 ... Connexin 46 (Cx46) is important for gap junction channels formation which plays crucial role in the preservation of lens homeostasis and transparency. Previously, we have identified a missense mutation. (p.V44M) of Cx46 in a congenital cataract family. This study aims at dissecting the potential.

  5. A simple proof of Debreu's Gap Lemma

    African Journals Online (AJOL)

    Abstract. Debreu's Gap Lemma is central to the proof of his fundamental result on the existence of continuous utility functions. A short proof based on a standard textbook construction of utility functions on countable linearly ordered sets is presented here. The proof is accessible to students with limited mathematical ...

  6. The Reed Elsevier stock price gap

    NARCIS (Netherlands)

    Kamp, B.

    1995-01-01

    This is the report of a limited study on the structural stock price differences between Reed and Elsevier. The purpose of this study is to provide an overview of the problem area and to formulate and discuss several hypotheses regarding the causes of this gap. The research was performed by

  7. Artificial Oxide Heterostructures with Tunable Band Gap

    Science.gov (United States)

    2016-12-20

    tunable band gap and band structures in epitaxial grown CaMnO3. The efforts have been devoted to (1) the thin film growth; (2) the tunable optical...plan to pursue a claim for personal or organizational intellectual property? Changes in research objectives (if any): Change in AFOSR Program Officer

  8. Understanding the Gender Gap in Introductory Physics

    Science.gov (United States)

    Finkelstein, Noah; Kost, Lauren; Pollock, Steven

    2008-04-01

    While it has been suggested interactive engagement (IE) techniques can eliminate the gender gap (the difference in performance between men and women on measures of conceptual learning), we find that, at our institution, the gender gap persisted from pre to posttest in IE classes (Pollock, Physical Review: ST PER. 3, 010107, 2007). This talk reports on a three-part follow-up study that investigates what factors contribute to the gender gap. First, we analyze student grades in different components of the course and find that men and women's course grades are not significantly different (p>0.1), but men outscore women on exams and women outscore men on homework and participation. Second, we compare average posttest scores of men and women who score similarly on the pretest and find that there are no significant differences between men and women's average posttest scores. Finally, we analyze other factors in addition to the pretest score that could influence the posttest score and find that gender does not account for a majorportion of the variation in posttest scores when a measure of mathematics performance is included. These findings indicate that the gender gap exists in interactive physics classes, but may be due in large part to differences in preparation, background, and math skills as assessed by traditional survey instruments.

  9. Structure and function of gap junction proteins: role of gap junction proteins in embryonic heart development.

    Science.gov (United States)

    Ahir, Bhavesh K; Pratten, Margaret K

    2014-01-01

    Intercellular (cell-to-cell) communication is a crucial and complex mechanism during embryonic heart development. In the cardiovascular system, the beating of the heart is a dynamic and key regulatory process, which is functionally regulated by the coordinated spread of electrical activity through heart muscle cells. Heart tissues are composed of individual cells, each bearing specialized cell surface membrane structures called gap junctions that permit the intercellular exchange of ions and low molecular weight molecules. Gap junction channels are essential in normal heart function and they assist in the mediated spread of electrical impulses that stimulate synchronized contraction (via an electrical syncytium) of cardiac tissues. This present review describes the current knowledge of gap junction biology. In the first part, we summarise some relevant biochemical and physiological properties of gap junction proteins, including their structure and function. In the second part, we review the current evidence demonstrating the role of gap junction proteins in embryonic development with particular reference to those involved in embryonic heart development. Genetics and transgenic animal studies of gap junction protein function in embryonic heart development are considered and the alteration/disruption of gap junction intercellular communication which may lead to abnormal heart development is also discussed.

  10. Complete surface plasmon-polariton band gap and gap-governed waveguiding, bending and splitting

    Science.gov (United States)

    Wu, Fengqin; Han, Dezhuan; Hu, Xinhua; Liu, Xiaohan; Zi, Jian

    2009-05-01

    We show theoretically that a complete band gap for surface plasmon-polaritons (SPPs) can exist in a flat metal surface coated with a two-dimensional periodic array of dielectric cylinders. Based on the SPP band gap, gap-governed SPP waveguides, bends and splitters at telecom wavelengths can be achieved by introducing line defects. Numerical simulations show that the proposed SPP waveguides have a very low loss, while SPP bends and splitters can bend and split guided SPPs efficiently. The proposed SPP waveguides, bends and splitters could thus be exploited to construct compact integrated optical circuits in the emerging field of plasmonics.

  11. Results of the GAP-4 experiment on molten-fuel drainage through intersubassembly gap geometry

    International Nuclear Information System (INIS)

    Spencer, B.W.; Vetter, D.; Wesel, R.; Sienicki, J.J.

    1983-01-01

    One of the key issues in assessment of the meltout phase of a hypothetical core disruptive accident in the LMFBR system involves the timing and paths for dispersal of molten fuel from the disrupted core. A program of experiments is underway at Argonne National Laboratory to investigate molten fuel penetration through these postulated escape paths. The purpose of the GAP-4 test was to examine the penetration distances of molten fuel flowing through the flat, narrow channels representing the intersubassembly gap geometry. In the experiment design, the gap geometry was selected to be two-dimensional on the basis that the gap volume in a reactor design would be interconnected and continuous. The molten fuel used in these tests was a mixture of UO 2 (81%) and molybdenum (19%) which was generated by an exothermic thermite reaction at a temperature of approx. 3470 K

  12. Electronic band transformation from indirect gap to direct gap in Si–H compound

    International Nuclear Information System (INIS)

    Jian-Ning, Ding; Ning-Yi, Yuan; Jun-Xiong, Wang; Biao, Kan; Xiao-Shuang, Chen

    2010-01-01

    The electronic band structures of periodic models for Si–H compounds are investigated by the density functional theory. Our results show that the Si–H compound changes from indirect-gap semiconductor to direct-gap semiconductor with the increase of H content. The density of states, the partial density of states and the atomic charge population are examined in detail to explore the origin of this phenomenon. It is found that the Si–Si bonds are affected by H atoms, which results in the electronic band transformation from indirect gap to direct gap. This is confirmed by the nearest neighbour semi-empirical tight-binding (TB) theory. (condensed matter: electronic structure, electrical, magnetic, and optical properties)

  13. Bridging the gap between production and consumption

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    Until the dramatic events of 1991, the Western World uranium market was virtually isolated from its Eastern Bloc counterpart. The subsequent breakdown of the barriers between the two markets has had profound consequences. In fact, it is forcing the industry to discard its earlier market projections and to develop a new understanding of changing market dynamics. One of these changes can be witnessed in the world's uranium production and consumption equation. A gap both wide and growing exists between uranium production and consumption in the Western World with annual production falling below consumption since 1983. The gap has increased from about 14 million lbs U3O8 equivalent in 1987 to over 58 million lbs in 1991. The consumption line represents annual uranium requirements of all nuclear reactors in the Western World. The number of reactors has increased from 303 reactors in 1987 to 351 in 1991

  14. Inception report and gap analysis. Boiler inspection

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-06-01

    This inception and gap analysis report on boilers in Latvia, has been prepared in the framework of the 'Implementation of the EU directive on energy performance of buildings: development of the Latvian Scheme for energy auditing of building and inspection of boilers'. The report is the basis for the establishment of training of boiler inspectors; it develops a gap analysis for better understanding and estimating the number of installations in Latvia and develops suggestions for the institutional set up. In particular includes information on existing standard and regulation on boiler, suggestion for the content of the training material of experts for boiler inspections and a syllabus of the training course. A specific section is dedicated to the suggestion for certification system of trained boiler inspectors. (au)

  15. Gap Assessment in the Emergency Response Community

    Energy Technology Data Exchange (ETDEWEB)

    Barr, Jonathan L.; Burtner, Edwin R.; Pike, William A.; Peddicord, Annie M Boe; Minsk, Brian S.

    2010-09-27

    This report describes a gap analysis of the emergency response and management (EM) community, performed during the fall of 2009. Pacific Northwest National Laboratory (PNNL) undertook this effort to identify potential improvements to the functional domains in EM that could be provided by the application of current or future technology. To perform this domain-based gap analysis, PNNL personnel interviewed subject matter experts (SMEs) across the EM domain; to make certain that the analyses reflected a representative view of the community, the SMEs were from a variety of geographic areas and from various sized communities (urban, suburban, and rural). PNNL personnel also examined recent and relevant after-action reports and U.S. Government Accountability Office reports.

  16. Closing the Knowledge Gap in Foreign Markets

    DEFF Research Database (Denmark)

    Lyles, Marjorie A.; Pedersen, Torben; Petersen, Bent

    The study explores how firms close their knowledge gaps in relation to business environments of foreign markets. Potential determinants are derived from traditional internationalization process theory as well as more recent literature on organizational learning processes, including the concept...... of absorptive capacity. Building on these two literature streams a conceptual model is developed and tested on a set of primary data of Danish firms and their foreign market operations. The empirical study suggests that factors considered essential in traditional internationalization process theory......, such as experiential learning, explains only a very limited part of perceived knowledge gaps. When factors pertaining to the concepts of absorptive capacity and superstitious learning are added, the explanatory power improves significantly. Apparently, our understanding of firms' internationalization processes can...

  17. Flexowriters, Punch Paper Poetry and Ontological Gaps

    DEFF Research Database (Denmark)

    Søndergaard, Morten

    2013-01-01

    . As it has been pointed out in resent research, the archive has become a buzzword in recent years (Elliasson, 2009). The archive, in this view, is the stage for new combinations of art, life and politics. Thus a conceptual reworking is taking place – most recently explained theoretically as the interference...... able to close the gap between the different paradigmatic ‘regimes’ defining the archival practice in the process of transformation. The ‘unheard’ not only witnesses this on an empirical level; it points, I would claim, towards an ontological gap between archival practices and the theoretical scope...... of the humanities within the last 30 years. And it points towards a transdisciplinary ‘solution’ of the problem....

  18. Bounded Gaps between Products of Special Primes

    Directory of Open Access Journals (Sweden)

    Ping Ngai Chung

    2014-03-01

    Full Text Available In their breakthrough paper in 2006, Goldston, Graham, Pintz and Yıldırım proved several results about bounded gaps between products of two distinct primes. Frank Thorne expanded on this result, proving bounded gaps in the set of square-free numbers with r prime factors for any r ≥ 2, all of which are in a given set of primes. His results yield applications to the divisibility of class numbers and the triviality of ranks of elliptic curves. In this paper, we relax the condition on the number of prime factors and prove an analogous result using a modified approach. We then revisit Thorne’s applications and give a better bound in each case.

  19. Boundary Hamiltonian Theory for Gapped Topological Orders

    Science.gov (United States)

    Hu, Yuting; Wan, Yidun; Wu, Yong-Shi

    2017-06-01

    We report our systematic construction of the lattice Hamiltonian model of topological orders on open surfaces, with explicit boundary terms. We do this mainly for the Levin-Wen string-net model. The full Hamiltonian in our approach yields a topologically protected, gapped energy spectrum, with the corresponding wave functions robust under topology-preserving transformations of the lattice of the system. We explicitly present the wavefunctions of the ground states and boundary elementary excitations. The creation and hopping operators of boundary quasi-particles are constructed. It is found that given a bulk topological order, the gapped boundary conditions are classified by Frobenius algebras in its input data. Emergent topological properties of the ground states and boundary excitations are characterized by (bi-) modules over Frobenius algebras.

  20. Bands and gaps in Nekrasov partition function

    Science.gov (United States)

    Gorsky, A.; Milekhin, A.; Sopenko, N.

    2018-01-01

    We discuss the effective twisted superpotentials of 2d N = (2, 2) theories arising upon the reduction of 4d N = 2 gauge theories on the Ω-deformed cigar-like geometry. We explain field-theoretic origins of the gaps in the spectrum in the corresponding quantum mechanical (QM) systems. We find local 2d descriptions of the physics near these gaps by resumming the non-perturbative part of the twisted superpotential and discuss arising wall-crossing phenomena. The interpretation of the associated phenomena in the classical Liouville theory and in the scattering of two heavy states in AdS3 gravity is suggested. Some comments concerning a possible interpretation of the band structure in QM in terms of the Schwinger monopole-pair production in 4d are presented.