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Shih-Tseng Lee, Tai-Ngar Lui, Chen-Nen Chang and Wen-Chun Cheng

✓ A review is reported of the seizure incidence in 726 patients who underwent 740 posterior fossa operations via a suboccipital craniectomy without prophylactic anticonvulsant agents. Thirteen patients (1.8%) experienced seizures within 2 weeks postoperatively. Five of these patients (0.7% of the series) had seizures within 24 hours after operation. The incidence was highest for patients with medulloblastoma (7.2%) followed by those with astrocytoma (2.3%). Also, a higher percentage was found in patients with preoperative ventriculoperitoneal shunt or intraoperative ventriculostomy (2.7%) than in those without (1%), but the difference was not statistically significant. Metabolic acidosis (80%) and hyponatremia (20%) were the major causes of the seizures that developed within 24 hours after operation. Follow-up computerized tomography showed no definite lesion in these patients. Hydrocephalus (75%) and supratentorial hemorrhage remote from the operative site (25%) were detected in the patients who developed seizures between the 2nd and 14th postoperative day. Two of these patients also had postoperative bacterial meningitis. This review suggests that seizures are a possible complication in the early postoperative period after suboccipital craniectomy for posterior fossa lesions.

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Tzu-Kang Lin, Chen-Nen Chang and Yau-Yau Wai

✓ In most cases, intracerebral hemorrhage during pregnancy or puerperium results from cerebral aneurysms or arteriovenous malformations. The authors present a case of a 30-year-old woman whose symptoms from a traumatic carotid-cavernous fistula had completely resolved 1½ years after the event, but recurred 4 years later, causing two hemorrhages during pregnancy (33rd and 35th week of gestation) and one during the postpartum period (10 days after Caesarean section). Partial thrombosis of the cavernous sinus with obliteration of most of the drainage from the fistula accounted for the resolution of clinical symptoms, but also promoted back-flow to the preserved drainage of superficial cortical veins. The hemodynamic changes and the hormonal effects due to the patient's subsequent pregnancy further aggravated the venous engorgement and finally caused rupture. All three hematomas occurred in the vicinity of the extremely dilated veins, suggesting that back-flow with venous hypertension was the probable cause for the intracerebral hematomas. Spontaneous healing of the carotid-cavernous fistula should be confirmed with cerebral angiography.

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Ming-Dar Tsai, Chen-Nen Chang, Yat-Sen Ho and Alexander Dah-Jium Wang

✓ Infestation of the central nervous system with sparganum, the larva of Spirometra mansoni, is rare. Only 27 cases have been reported in the literature; however, the true incidence might be underestimated. Two cases are reported that were definitively diagnosed by stereotactic biopsy techniques. Without a positive histological diagnosis, the first case would have been diagnosed as having a metastatic brain tumor and a course of radiotherapy would probably have been initiated. Differentiation between granuloma of cerebral sparganosis and brain tumors such as meningiomas, gliomas, and metastatic tumors is often difficult before operation. Detailed magnetic resonance imaging might offer some help in such cases. Emphasis is placed on the increasing importance of stereotactic surgery in the diagnosis and treatment of an intracerebral mass lesion, including cerebral sparganosis.

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Ching-Chang Chen, Peng-Wei Hsu, Shih-Tseng Lee, Chen-Nen Chang, Kuo-Chen Wei, Chieh-Tsai Wu, Yung-Hsin Hsu, Tzu-Kang Lin, Sai-Cheung Lee and Yin-Cheng Huang

Object

Liver cirrhosis was identified as an independent predictor of poor outcomes in patients suffering trauma and in those undergoing major surgeries. The aim of this study was to report the authors' experiences treating patients with cirrhosis who undergo brain surgeries.

Methods

Between 2004 and 2009, 121 consecutive patients with cirrhosis underwent 144 brain procedures. Patients were categorized as Child-Turcotte-Pugh (referred to as “Child”) Class A, B, or C. The patient profiles, including the severity of cirrhosis, reason for surgery, complications, and prognosis factors, were analyzed.

Results

In this retrospective study, the overall surgical complication rate for patients with cirrhosis was 52.1% and the mortality rate was 24.3%. For patients with acute traumatic brain injury (TBI), the complication, rebleeding, and mortality rates reached 84.4%, 68.8%, and 37.5%, respectively. Surgery for TBI was a significant risk factor for postoperative complications (p = 0.0002) and postoperative hemorrhage (p < 0.0001). Otherwise, according to the Child classification, the complication rate increased in a stepwise fashion from 38.7% to 60% to 84.2%, the rebleeding rate from 29.3% to 48.0% to 63.2%, and the mortality rate from 5.3% to 38% to 63.2% for Child A, B, and C, respectively. The Child classification was associated with higher risk of complications—Child B vs A OR 2.84 (95% CI 1.28–6.29), Child C vs A OR 5.39 (95% CI 1.32–22.02). It was also associated with risk of death—Child C vs A OR 30.43 (95% CI 7.71–120.02), Child B vs A OR 10.88 (95% CI 3.42–34.63).

Conclusions

Liver cirrhosis is a poor comorbidity factor for brain surgery. The authors' results suggest that the Child classification used independently is a poor prognostic factor; in addition, grave outcomes were observed in patients with TBI.