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Hiroki Ushirozako, Tomohiko Hasegawa, Yu Yamato, Go Yoshida, Tatsuya Yasuda, Tomohiro Banno, Hideyuki Arima, Shin Oe, Yuki Mihara, Tomohiro Yamada, Koichiro Ide, Yuh Watanabe, Keichi Nakai, Takaaki Imada, and Yukihiro Matsuyama

.2%) 0.265  Hypoglycemic 88 (14.1%) 73 (11.4%) 0.153  Anticoagulation 98 (15.7%) 74 (11.6%) 0.033 * Laboratory data  Serum albumin, g/dl 4.2 ± 0.5 4.3 ± 0.4 0.002 *  Lymphocyte count, /μl 1622 ± 665 1698 ± 663 0.043 * PNI 50.1 ± 6.5 51.3 ± 6.2 0.001 * Surgical factor  Length of surgery, mins 242 ± 113 262 ± 122 0.003 *  Estimated blood loss, ml 556 ± 656 736 ± 984 <0.001 *  Instrumentation use 508 (81.5%) 448 (70.2%) <0.001 * SSI occurrence 21 (3.4%) 33 (5.2%) 0.114  Superficial 9 (1.4%) 15 (2.4%) 0.239  Deep 12 (1.9%) 18 (2.8%) 0.297 Values are expressed as number

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Carolina Gesteira Benjamin, Rajeev D. Sen, John G. Golfinos, Chandra Sen, J. Thomas Roland Jr., Sean McMenomey, and Donato Pacione

approach 26 (35.1) Translabyrinthine approach 22 (29.7) Supratentorial craniotomy 24 (32.4) Middle fossa approach 2 (2.7) Risk Factors for Postoperative Sinus Thrombosis Twenty-four (32.4%) of the 74 patients had postoperative MRV studies confirming a sinus thrombosis. Of these 24 patients, 16 were male and 8 were female. The mean age and BMI in the thrombosis group were 49.4 ± 12 years and 26.2 ± 6.8, respectively. The mean length of surgery was 284.79 ± 109 minutes, and the mean intraoperative fluid balance was 854.17 ± 750 cm 3 , with mannitol being used in 9 of the

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Douglas A. Hardesty, Matthew R. Sanborn, Whitney E. Parker, and Phillip B. Storm

had perioperative seizures. There was no difference in seizure incidence between the 2 conditions when a distinction was made. There was no association between cortical tumor location (frontal, parietal, temporal, or occipital, either combined or independently), tumor pathology, tumor size, gross-total resection, EBL, EBL/kg, or length of surgery, and perioperative seizure risk (all p > 0.05). Multifactorial Analysis Logistic regression was performed to delineate the relative contributions of the identified statistically significant unifactorial risk factors

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Rafael A. Vega, Camila Lyon, Jeannette F. Kierce, Gary W. Tye, Ann M. Ritter, and Jennifer L. Rhodes

patients unless otherwise indicated. Means are presented with SDs. As expected after EPO/iron therapy, the P group had a higher mean preoperative hemoglobin level (12.0 ± 1.4 g/dl vs 9.7 ± 1.2 g/dl for the C group, p < 0.001). Reflecting the more aggressive surgical technique, the mean operative blood loss in the P group was 212.0 ± 168.2 ml versus 114.5 ± 60.8 ml for the C group (p = 0.004). The mean length of surgery was longer for the P group ( Table 2 ), 4.0 hours compared with 2.8 hours for the C group (p < 0.001). In the P group the type of craniosynostosis was

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Alessandro Siccoli, Marlies P. de Wispelaere, Marc L. Schröder, and Victor E. Staartjes

by Ostelo et al. at the 6-week or 12-month postoperative follow-up. 26 Thus, an improvement from baseline of ≥ 30% represented clinical success in functional disability (ODI) or pain severity scores (NRS). Reoperation Any reoperations were tracked. The analysis of reoperations was stratified into reoperations at the index level and overall reoperations. Perioperative Parameters Length of hospital stay in hours and length of surgery in minutes were obtained. We identified patients with an extended length of stay, defined as greater than 28 hours. This cutoff was

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Stephen Hentschel, Paul Steinbok, D. Douglas Cochrane, and John Kestle

procedure after the vertex and parietal craniectomies, if proceeding with a planned occipital or frontal remodeling would necessitate a blood transfusion. This occurred in only one patient. Other surgical techniques, which could not be examined in this study, may have played a role in limiting blood loss. These included the use of the Colorado needle for the skin incision, application of microfibrillar collagen to the subgaleal flaps, and, perhaps, a more meticulous approach to obtaining rapid hemostasis. It is noteworthy, in this regard, that the length of surgery

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Frank J. Yuk, Jonathan J. Rasouli, Marc S. Arginteanu, Alfred A. Steinberger, Frank M. Moore, Kevin C. Yao, John M. Caridi, and Yakov Gologorsky

2–5 C3–T1 13 3 55, M 38 C4 corpectomy, C3–7 C2–L1 DISH 11 4 72, M 30 None C2–S1 AS 3 Mean 64.5 31.8 DISH = diffuse idiopathic skeletal hyperostosis. All patients underwent PSO at T2. The caudal level of instrumentation was to T4 in 2 patients and T5 in the others. The median estimated blood loss was 1.25 L, length of surgery was nearly 5 hours, and hospital stay was 4 days. There were no neurological complications. There were no notable other complications, such as infection, bleeding, and prolonged stay. No patients have required revision surgery. Discharge was

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Brian P. Walcott, Navid Redjal, and Jean-Valery C. E. Coumans

Neurosurgical patients are at a high risk for infectious sequelae following operations. For neurosurgery in particular, the risk of surgical site infection has a unique implication given the proximity of the CSF and the CNS. Patient factors contribute to some degree; for example, cancer and trauma are often associated with impaired nutritional status, known risk factors for infection. Additionally, care-based factors for infection must also be considered, such as the length of surgery, the administration of steroids, and tissue devascularization (such as a craniotomy bone flap). When postoperative infection does occur, attention is commonly focused on potential lapses in surgical “sterility.” Evidence suggests that the surgical field is not free of microorganisms. The authors propose a paradigm shift in the nomenclature of the surgical field from “sterile” to “clean.” Continued efforts aimed at optimizing immune capacity and host defenses to combat potential infection are warranted.

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Matthew F. Sacino, Cheng-Ying Ho, Jonathan Murnick, Tammy Tsuchida, Suresh N. Magge, Robert F. Keating, William D. Gaillard, and Chima O. Oluigbo

OBJECTIVE

Previous meta-analysis has demonstrated that the most important factor in seizure freedom following surgery for focal cortical dysplasia (FCD) is completeness of resection. However, intraoperative detection of epileptogenic dysplastic cortical tissue remains a challenge, potentially leading to a partial resection and the need for reoperation. The objective of this study was to determine the role of intraoperative MRI (iMRI) in the intraoperative detection and localization of FCD as well as its impact on surgical decision making, completeness of resection, and seizure control outcomes.

METHODS

The authors retrospectively reviewed the medical records of pediatric patients who underwent iMRI-assisted resection of FCD at the Children's National Health System between January 2014 and April 2015. Data reviewed included demographics, length of surgery, details of iMRI acquisition, postoperative seizure freedom, and complications. Postsurgical seizure outcome was assessed utilizing the Engel Epilepsy Surgery Outcome Scale.

RESULTS

Twelve consecutive pediatric patients (8 females and 4 males) underwent iMRI-guided resection of FCD lesions. The mean age at the time of surgery was 8.8 years ± 1.6 years (range 0.7 to 18.8 years), and the mean duration of follow up was 3.5 months ± 1.0 month. The mean age at seizure onset was 2.8 years ± 1.0 year (range birth to 9.0 years). Two patients had Type 1 FCD, 5 patients had Type 2A FCD, 2 patients had Type 2B FCD, and 3 patients had FCD of undetermined classification. iMRI findings impacted intraoperative surgical decision making in 5 (42%) of the 12 patients, who then underwent further exploration of the resection cavity. At the time of the last postoperative follow-up, 11 (92%) of the 12 patients were seizure free (Engel Class I). No patients underwent reoperation following iMRI-guided surgery.

CONCLUSIONS

iMRI-guided resection of FCD in pediatric patients precluded the need for repeat surgery. Furthermore, it resulted in the achievement of complete resection in all the patients, leading to a high rate of postoperative seizure freedom.

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Sandro M. Krieg, Lukas Bobinski, Lucia Albers, and Bernhard Meyer

OBJECTIVE

Lateral lumbar interbody fusion (LLIF) is frequently used for anterior column stabilization. Many authors have reported that intraoperative neuromonitoring (IONM) of the lumbar plexus nerves is mandatory for this approach. However, even with IONM, the reported motor and sensory deficits are still considerably high. Thus, the authors’ approach was to focus on the indication, trajectory, and technique instead of relying on IONM findings per se. The objective of this study therefore was to analyze the outcome of our large cohort of patients who underwent LLIF without IONM.

METHODS

The authors report on 157 patients included from 2010 to 2016 who underwent LLIF as an additional stabilizing procedure following dorsal instrumentation. LLIF-related complications as well as clinical outcomes were evaluated.

RESULTS

The mean follow-up was 15.9 ± 12.0 months. For 90.0% of patients, cage implantation by LLIF was the first retroperitoneal surgery. There were no cases of surgery-related hematoma, vascular injury, CSF leak, or any other visceral injury. Between 1 and 4 cages were implanted per surgery, most commonly at L2–3 and L3–4. The mean length of surgery was 92.7 ± 35 minutes, and blood loss was 63.8 ± 57 ml. At discharge, 3.8% of patients presented with a new onset of motor weakness, a new sensory deficit, or the deterioration of leg pain due to LLIF surgery. Three months after surgery, 3.5% of the followed patients still reported surgery-related motor weakness, 3.6% leg pain, and 9.6% a persistent sensory deficit due to LLIF surgery.

CONCLUSIONS

The results of this series demonstrate that the complication rates for LLIF without IONM are comparable, if not superior, to those in previously reported series using IONM. Hence, the authors conclude that IONM is not mandatory for LLIF procedures if the surgical approach is tailored to the respective level and if the visualization of nerves is performed.