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Pawel G. Ochalski, David O. Okonkwo, Michael J. Bell and P. David Adelson

. Four hours after arrival, a follow-up head CT scan showed the epidural hematoma to be stable in size ( Fig. 1D ) and her score improved to a 9T, with eyes opening to stimulation and the ability to follow simple commands. At 6.5 hours after admission, she required sedation for closed reduction of her right femur fracture and suturing of her facial lacerations. She received 75 μg of fentanyl (~ 3 μg/kg) and 2 mg of midazolam intravenously. On reexamination 2.5 hours later after bedside surgical procedures had been performed, her GCS score had worsened to 7T. She was

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Eric Suero Molina, Stephanie Schipmann, Isabelle Mueller, Johannes Wölfer, Christian Ewelt, Matthias Maas, Benjamin Brokinkel and Walter Stummer

B rain tumors located near eloquent regions represent a surgical challenge when pursuing a good functional outcome after resection. For more than a century, awake craniotomies have been part of the treatment of tumors and other pathologies located in eloquent regions. Victor Horsley was one of the first surgeons to stimulate the brain cortex during epilepsy surgery under local anesthesia in 1887. 17 Conscious sedation has helped surgeons assess important neurological functions while preserving functional integrity when performing resection of tumor tissue in

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M. Asif Taqi, Sajid S. Suriya, Ajeet Sodhi, Syed A. Quadri, Mudassir Farooqui, Atif Zafar and Martin M. Mortazavi

, 7 , 9 , 14 , 21 The clinical outcome after mechanical thrombectomy is contingent on timely recanalization of the intracranial blood vessel. 20 , 24 , 25 The choice of sedation method in IAT has significant consequences on the timing of reperfusion and clinical outcome of thrombectomy. The options for sedation include general anesthesia (GA) with intubation, conscious sedation (CS) without intubation, and monitored anesthesia care (MAC) without intubation. There is a paucity of evidence in the literature regarding the impact of choice of sedation on neurological

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Pierpaolo Peruzzi, Sergio D. Bergese, Adolfo Viloria, Erika G. Puente, Mahmoud Abdel-Rasoul and E. Antonio Chiocca

) tumor vol in cm 3 1.00  average 16.3 16.6  range 1–49 0.5–56.8  <10 11 (50) 11 (50)  10–25 7 (32) 6 (28)  >25 4 (18) 5 (22) OR time in minutes 0.261  average 283 312  range 154–432 155–513 image-guided navigation 22 (100) 22 (100) 1.00 intraop MRI 2 (8) 8 (32) 0.069 * Tumor was asymptomatic and detected on follow-up MR imaging. Anesthesia and Surgical Technique Conscious-Sedation Craniotomy The patients were brought to the preoperative holding area for anesthesia

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Weier Li, Scott D. Wait, Robert J. Ogg, Matt A. Scoggins, Ping Zou, James Wheless and Frederick A. Boop

uncooperative children with lesions requiring resection. In combination with other imaging techniques, such as DTI and tractography, the neurosurgeon has an increasing arsenal of imaging techniques that can help localize primary visual cortex or pathways adjacent to surgical lesions. 5 , 10 These tools should prove valuable in improving the totality of resection while preserving visual functions. The ability to study children under sedation with these techniques makes this technology, and its potential benefits, available to younger patients. Methods Patient

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Christopher S. Ogilvy, Xinyu Yang, Osama A. Jamil, Erik F. Hauck, L. Nelson Hopkins, Adnan H. Siddiqui and Elad I. Levy

, endovascular treatment was associated with fewer adverse outcomes, decreased mortality, and shorter lengths of stay than microsurgical treatment. In the majority of studies reported to date, endovascular treatment of unruptured aneurysms is performed in patients after the induction of general anesthesia. At Millard Fillmore Gates Hospital (Buffalo, New York), however, most patients undergoing endovascular treatment for intracranial unruptured aneurysms are treated under conscious sedation with local anesthesia. The purpose of the present study is to analyze the

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Gad Bar-Joseph, Yoav Guilburd, Ada Tamir and Joseph N. Guilburd

A dequate sedation and analgesia is a basic, important measure in controlling ICP in both adult and pediatric patients with various intracranial pathological entities and reduced intracranial compliance. 1 , 9 Deepening sedation is one of the routine first steps when ICP rises. The available sedative and hypnotic agents—opioids, benzodiazepines, propofol, or barbiturates—decrease blood pressure and may potentially decrease CPP. Ketamine is unique among the anesthetic agents in that it maintains protective airway reflexes and spontaneous respiration

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Shunsuke Tachibana

TO THE EDITOR: I read with great interest the article by Suero Molina and colleagues 3 regarding their study on the use of dexmedetomidine in awake craniotomy for glioma ( Suero Molina E, Schipmann S, Mueller I, et al: Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies in glioma surgery: an analysis of 180 patients. J Neurosurg 129 :1223–1230, November 2018 ). The authors showed that the use of dexmedetomidine creates excellent conditions for awake craniotomy, and I think that the evidence from 180 cases will affect the

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Jørgen Gabrielsen, Asger Bendtsen, Henrik Eriksen and Steen Andersen

pressure (ICP) due to head injury and one (Case 3) had a brain tumor. None of the patients suffered from concurrent liver, kidney, or endocrine disease, and none had taken barbiturates previously. Therapy Protocol The patients with increased ICP were intubated with a nasoendotracheal tube connected to a respirator and then hyperventilated to a PaCO 2 of 25 to 28 mm Hg, with PaO 2 greater than 90 mm Hg. Pentobarbital (Mebumal) was given as a sedative in an initial dose of approximately 4 mg/kg body weight and a maintenance dose of 2 mg/kg/hr. Sedation continued

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Jed A. Hartings, Laura B. Ngwenya, Christopher P. Carroll and Brandon Foreman

TO THE EDITOR: We wish to congratulate Carlson et al. 1 on their important study demonstrating the effect of ketamine sedation to suppress injurious spreading depolarizations (SDs) during intensive care after severe brain injury ( Carlson AP, Abbas M, Alunday RL, et al: Spreading depolarization in acute brain injury inhibited by ketamine: a prospective, randomized, multiple crossover trial. J Neurosurg [epub ahead of print May 25, 2018; DOI: 10.3171/2017.12.JNS171665] ). SDs have been intensively studied as a causative mechanism of lesion development and