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Markus Klimek - One of the best experts on this subject based on the ideXlab platform.

  • Awake Craniotomy versus Craniotomy under general anesthesia for the surgical treatment of insular glioma: choices and outcomes
    Neurological research, 2017
    Co-Authors: Benjamin Yaël Gravesteijn, M. E. Keizer, Audrey Vincent, Joost W. Schouten, Robert Jan Stolker, Markus Klimek
    Abstract:

    Objective: 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 fr...

  • Awake Craniotomy: improving the patient's experience.
    Current opinion in anaesthesiology, 2015
    Co-Authors: Jan-willem Potters, Markus Klimek
    Abstract:

    PURPOSE OF REVIEW 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. RECENT FINDINGS 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. SUMMARY 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.

  • Inflammatory profile of awake function-controlled Craniotomy and Craniotomy under general anesthesia.
    Mediators of inflammation, 2009
    Co-Authors: Markus Klimek, Jaap Willem Hol, Jan Klein, Stephan C.a. Wens, Claudia Heijmans-antonissen, Sjoerd P. Niehof, Arnaud J. P. E. Vincent, Freek J. Zijlstra
    Abstract:

    Background. 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 those procedures cause different inflammatory responses. Methods. Twenty patients undergoing Craniotomy under general anesthesia and 20 patients undergoing awake function-controlled Craniotomy were included in this prospective, observational, two-armed study. Circulating levels of IL-6, IL-8, and IL-10 were determined pre-, peri-, and postoperatively in both patient groups. VAS scores for pain, anxiety, and stress were taken at four moments pre- and postoperatively to evaluate physical pain and mental duress. 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.

  • Awake Craniotomy induces fewer changes in the plasma amino acid profile than Craniotomy under general anesthesia.
    Journal of neurosurgical anesthesiology, 2009
    Co-Authors: Jaap Willem Hol, Markus Klimek, Marieke Van Der Heide-mulder, Dirk L. Stronks, Arnoud Vincent, Jan Klein, Freek J. Zijlstra, Durk Fekkes
    Abstract:

    In this prospective, observational, 2-armed study, we compared the plasma amino acid profiles of patients undergoing awake Craniotomy to those undergoing Craniotomy under general anesthesia. Both experimental groups were also compared with a healthy, age-matched and sex-matched reference group not undergoing surgery. It is our intention to investigate whether plasma amino acid levels provide information about physical and emotional stress, as well as pain during awake Craniotomy versus Craniotomy under general anesthesia. Both experimental groups received preoperative, perioperative, and postoperative dexamethasone. The plasma levels of 20 amino acids were determined preoperative, perioperative, and postoperatively in all groups and were correlated with subjective markers for pain, stress, and anxiety. In both Craniotomy groups, preoperative levels of tryptophan and valine were significantly decreased whereas glutamate, alanine, and arginine were significantly increased relative to the reference group. Throughout time, tryptophan levels were significantly lower in the general anesthesia group versus the awake Craniotomy group. The general anesthesia group had a significantly higher phenylalanine/tyrosine ratio, which may suggest higher oxidative stress, than the awake group throughout time. Between experimental groups, a significant increase in large neutral amino acids was found postoperatively in awake Craniotomy patients, pain was also less and recovery was faster. A significant difference in mean hospitalization time was also found, with awake Craniotomy patients leaving after 4.53+/-2.12 days and general anesthesia patients after 6.17+/-1.62 days; P=0.012. This study demonstrates that awake Craniotomy is likely to be physically and emotionally less stressful than general anesthesia and that amino acid profiling holds promise for monitoring postoperative pain and recovery.

Claudia Unterhofer - One of the best experts on this subject based on the ideXlab platform.

Donald E G Griesdale - One of the best experts on this subject based on the ideXlab platform.

  • Craniotomy versus craniectomy for acute traumatic subdural hematoma in the united states a national retrospective cohort analysis
    World Neurosurgery, 2016
    Co-Authors: Barret Rush, Justin F Rousseau, Mypinder S Sekhon, Donald E G Griesdale
    Abstract:

    Objective 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. Methods 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. Results 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 Conclusions 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.

Alfredo Quiñones-hinojosa - One of the best experts on this subject based on the ideXlab platform.

  • The extended retrosigmoid approach for neoplastic lesions in the posterior fossa: technique modification
    Neurosurgical Review, 2011
    Co-Authors: Shaan M. Raza, Alfredo Quiñones-hinojosa
    Abstract:

    Approaches to the cerebellar-pontine angle and petroclival region can be challenging due to intervening eloquent neurovascular structures and cerebellar retraction required to view this anatomic compartment with the standard retrosigmoid technique. As previously described [ 11 ], the extended retrosigmoid provides additional access to space ventral to the brainstem through mobilization of the sigmoid sinus. We report our further experience and modifications of this approach for neoplastic pathology. The standard Craniotomy is utilized, and the burr holes are placed slightly beyond the transverse sinus as well as the transverse–sigmoid junction and down towards the foramen magnum, as low as possible. Another burr hole is placed over the cerebral hemisphere to facilitate the dural dissection below the bone flap and over the transverse and sigmoid sinuses. We then perform a standard retrosigmoid Craniotomy with a craniotome and the transverse and sigmoid sinuses are skeletonized. Consequently, the sigmoid sinus can then mobilized anteriorly to provide an unobstructed view in line with the petrous bone, while exposure of the transverse sinus provides access to the tentorium. Fifteen patients (March 2006–July 2008) underwent this approach to manage neoplastic lesions, including five meningiomas, three schwannomas, one epidermoid, and four intra-axial metastatic lesions. The nine extra-axial lesions were predominantly in the cerebellar-pontine angle with extension medial to the seventh/eighth nerve complex to the petroclival region. Gross total resection was obtained in all patients. The primary complication due to the exposure was a clinically asymptomatic sigmoid sinus thrombosis in one patient. Requiring a fundamental change in the management of the venous sinuses, the extended retrosigmoid Craniotomy permits mobilization of the sigmoid and transverse sinuses. In this process, the entire cerebellar-pontine angle extending from the tentorium to the foramen magnum can be visualized with minimal cerebellar retraction. This technical modification over the standard retrosigmoid approach may provide a useful advantage to neurosurgeons dealing with these complex lesions.

  • A surgical modification for performing orbitozygomatic osteotomies: technical note
    Neurosurgical Review, 2010
    Co-Authors: James E. Conway, Shaan M. Raza, Khan Li, Michael W. Mcdermott, Alfredo Quiñones-hinojosa
    Abstract:

    The addition of orbitozygomatic osteotomies to the fronto-temporo-sphenoidal Craniotomy minimizes brain retraction required to reach deep seated pathology by allowing additional soft tissue dissection and strategic cranial bone removal. We report a modification of this technique in order to reduce soft tissue and cosmetic morbidity while increasing the efficiency with which this technique is performed. A two piece fronto-temporo-sphenoidal Craniotomy combined with orbitozygomatic osteotomies was analyzed via cadaver dissection. The Craniotomy and orbitozygomatic osteotomies were performed using the foot plate of the craniotome to facilitate the orbitozygomatic osteotomies. A similar technique was utilized in the operating room to safely create the two piece fronto-temporo-sphenoidal Craniotomy and orbitozygomatic osteotomies in a series of patients. The illustrated technique was performed in cadavers and the results were analyzed in a series of 18 consecutive patients with minimum 3-month follow-up. Increased efficiency, good tissue preservation, and minimal soft tissue damage with no orbital injury were noted with a high rate of gross total lesional resection. With the added safety of a cutting instrument separated from the orbital soft tissues by a footplate, tissue trauma was minimized. Orbitozygomatic osteotomies are frequently added to the fronto-temporo-sphenoidal Craniotomy in order to reach intracranial pathology that would previously have required excessive brain retraction to address. This manuscript details the use of a single drill system that can be used for both the Craniotomy and the safe and efficient generation of orbitozygomatic osteotomies.

Dingqiang Han - One of the best experts on this subject based on the ideXlab platform.

  • Space Registration and Experiment of Craniotomy Robot
    2018 IEEE 8th Annual International Conference on CYBER Technology in Automation Control and Intelligent Systems (CYBER), 2018
    Co-Authors: Tengfei Cui, Xingguang Duan, Dingqiang Han, Huanyu Tian
    Abstract:

    In view of the characteristics of high complexity and high risk of Craniotomy, a robotic system of intelligent human Craniotomy was developed. This paper mainly expounds the registration scheme of robot, operating tool and skull coordinate system in the Craniotomy robot system, and carries out the cranial model test. Experimental results show that the registration accuracy of the spatial registration scheme is high, and it is feasible to meet the needs of the Craniotomy system.

  • Craniotomy robot system based on human-machine parallel collaboration
    2016 IEEE International Conference on Mechatronics and Automation, 2016
    Co-Authors: Yue Zhan, Xingguang Duan, Tengfei Cui, Dingqiang Han
    Abstract:

    Craniotomy is the first choice of treatment of brain tumors, cerebrovascular disease, brain injury and cerebral hemorrhage disease, but the Craniotomy method is time-consuming and laborious, the structure of skull is complex and important nerve and blood vessels distribute. As a result, the risk of Craniotomy is high, and the operation is highly dependent on surgeons' experience, which leads to high pressure and fatigue of the surgeon, reducing the effectiveness of subsequent surgery. According to the characteristics of high complexity and high risk of Craniotomy, this paper puts forward a Craniotomy robot system based on human-machine parallel collaboration, by combining human-machine collaborative parallel control, active constraint and force feedback technology, combined the high precision of robot system with surgeon's operating experience, to guarantee comfort, safety and precision of Craniotomy.