Cerebral Vasospasm as a “Hidden Danger” after Craniotomy: A Systematic Review of Case Reports and Case Series | Chapter 3 | Medical Science: Updates and Prospects Vol. 5

 

Background: Cerebral vasospasm following tumour craniotomy (CVACT) is a rarely reported yet potentially devastating postoperative complication with significant neurological consequences. Unlike cerebral vasospasm associated with aneurysmal subarachnoid haemorrhage, which has been extensively studied, CVACT remains poorly understood with respect to its pathophysiology, early detection, and management. This lack of clarity often leads to delayed diagnosis and suboptimal therapeutic strategies. In this chapter, we present a comprehensive synthesis of the current literature, drawing upon published case reports and case series to identify emerging clinical patterns, key risk factors, available diagnostic approaches, and therapeutic responses associated with CVACT. The objective is to consolidate and interpret existing evidence regarding predisposing factors, potential underlying mechanisms, clinical presentation, diagnostic modalities, treatment strategies, and patient outcomes, thereby improving clinical awareness and informing future research directions.

 

Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines, utilising the PubMed and ScienceDirect databases. This review employed a Boolean combination of the MeSH terms and keywords "cerebral vasospasm," "craniotomy," and "brain tumour" to identify instances of cerebral vasospasm following tumour craniotomy (CVACT). The study protocol, which outlines the methodologies used in the systematic review, has been registered with the PROSPERO database. The inclusion criteria for this review consisted of case reports and case series published in English and available in full text, with no restrictions on publication year. Furthermore, gray literature was not excluded from the review. The final search was completed in May 2024.

 

Results: We included 60 inclusion patients from 14 case reports and 13 case series, with 33 (55%) females and 27 (45%) males, with a mean age of 44.05 ± 16.8 years. The most common tumours were pituitary adenomas, which were found in 22 (36.66%). The most common tumour location was the middle cranial fossa (75%), and the most common surgery technique used was transsphenoidal surgery (50%). Most of those who experience vasospasm have a craniotomy with the TSS technique (50%), with complications of intraoperative bleeding. The range of onset of VS symptoms postoperatively was 0–30 days (mean 6.59d). The symptoms included asymptomatic, headache, loss of vision, hemiparesis, diplopia, etc. The vascular involvement was mainly anterior circulation (78.33%). The diagnostic tools most commonly used were angiography and transcranial doppler (TCD). The most common management of VS from the included studies was pharmacology. The survival rate was 61.66%. We found that the tumour location and vascular-affected vasospasm were significantly correlated with mortality rates: p = 0.015 and p = 0.02.

 

Conclusions: Cerebral vasospasm after craniotomy tumour removal (CVACT) frequently arises in tumours situated in the medial cranial fossa, predominantly pituitary adenomas and meningiomas. The minimally invasive surgical approach of TSS may contribute to the mechanism of CVACT incidence. The existence of preoperative vascular pathology, such as encasement or narrowing, appears to be a predictor alongside the incidence of intra- or postoperative haemorrhage. The vascular structures most susceptible to vasospasm are located in the anterior circulation of the Willis circle, which appears to correlate with the vascular problems that typically undergo preoperative encasement of the internal carotid artery (ICA). The most reliable and real-time diagnostic instrument employed is TCD, while imaging continues to be the gold standard. Nimodipine treatment continues to be a viable therapeutic option that can enhance patient outcomes.

 

 

Author(s) Details

Khairunnisai Tarimah
Department of Anesthesiology and Intensive Therapy Subdivision Neuroanesthesia and Critical Care,  Dr Hasan Sadikin Hospital, Padjadjaran University, Bandung 40161, West Java, Indonesia and Department of Anesthesiology and Intensive Therapy, RSUD Kota Mataram, Al-Azhar Islamic University Mataram, Mataram 83127, West Nusa Tenggara, Indonesia.

 

Dewi Yulianti Bisri
Department of Anesthesiology and Intensive Therapy Subdivision Neuroanesthesia and Critical Care, Dr Hasan Sadikin Hospital, Padjadjaran University, Bandung 40161, West Java, Indonesia.

 

Radian Ahmad Halimi
Department of Anesthesiology and Intensive Therapy Subdivision Neuroanesthesia and Critical Care, Dr Hasan Sadikin Hospital, Padjadjaran University, Bandung 40161, West Java, Indonesia.

 

Elvan Wiyarta
Intensive Care Department, University of Indonesia Hospital, Depok 16424, West Jawa, Indonesia and Service Department, Risetku, South Jakarta 12820, Jakarta, Indonesia.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v5/6893

Study about Control of Hemorrhage in Liver Trauma | Chapter 11 | Issues and Developments in Medicine and Medical Research Vol. 1

 Background: Controlling haemorrhage after significant liver trauma is still a surgical challenge, since surgeons are regularly confronted with difficult scenarios. Hemorrhage management is first achieved in small liver injuries by packing the bleeding location.

The goal of this study was to examine our experience with bleeding control in significant liver damage.

Materials and Procedures: Our investigation lasted from January 2009 to December 2012 and was conducted prospectively.

There were 173 patients with liver trauma in our study.

Bimanual compression was utilised in 13 patients (15.3%), Pringle procedure in 23 patients (27%), perihepatic packing in 10 patients (11.8%), Foley catheter balloon tamponade in 2 patients (2.4%), and intrahepatic tamponade in 4 patients in the case of an emergent laparotomy (4.7 percent ). Electrocoagulation of the liver injury was used in 12 patients (14.1%), haemostasis and biliostasis followed by hepatic closure 41 patients (48.2%), haemostasis and biliostasis without hepatic closure 6 patients (7.1%), tamponade with a pedicled vascularized omental flap (pedicled omentum hepatorrhaphy) 7 patients (8.2%), anatomic (1.2 percent ).

The surgical procedures used in preplanned laparotomies included left hepatectomy in one patient (16.6%), right hepatectomy in one patient (16.6%), and nonanatomic/atypical liver resections in four patients (66.7 percent ). The severity of the liver injury (z= 5.2912, p=0.00001), other concomitant abdominal organ injuries (z=4.0743, p=0.00005), the volume of blood transfusion received (p=0.03207), and age (p=0.04944) all had a significant impact on treatment success.

The overall mortality rate was 13%.

Conclusion: Perihepatic packing and surgical intervention in two sessions have dramatically increased survival rates in serious liver trauma in our experience.

Author(S) Details

Skënder Buci
Department of Surgery, University Hospital of Trauma, Tirana, Albania.

Dorina Shtjefni
Department of Surgery, University Hospital of Trauma, Tirana, Albania.

Arben Gjata
Department of General Surgery, UHC “Mother Teresa”, Tirana, Albania.

Gjovalin Bushi
Department of Surgery, University Hospital of Trauma, Tirana, Albania.

Sonja (Saraçi) Butorac
Department of Radiology, University Hospital of Trauma, Tirana, Albania.

View Book:- https://stm.bookpi.org/IDMMR-V1/article/view/5049

Study about Control of Hemorrhage in Liver Trauma | Chapter 11 | Recent Developments in Medicine and Medical Research Vol. 13

 Background: Controlling haemorrhage after significant liver trauma is still a surgical challenge, since surgeons are regularly confronted with difficult scenarios. Hemorrhage management is first achieved in small liver injuries by packing the bleeding location.

The goal of this study was to examine our experience with bleeding control in significant liver damage.

Materials and Procedures: Our investigation lasted from January 2009 to December 2012 and was conducted prospectively.

There were 173 patients with liver trauma in our study.

Bimanual compression was utilised in 13 patients (15.3%), Pringle procedure in 23 patients (27%), perihepatic packing in 10 patients (11.8%), Foley catheter balloon tamponade in 2 patients (2.4%), and intrahepatic tamponade in 4 patients in the case of an emergent laparotomy (4.7 percent ). Electrocoagulation of the liver injury was used in 12 patients (14.1%), haemostasis and biliostasis followed by hepatic closure 41 patients (48.2%), haemostasis and biliostasis without hepatic closure 6 patients (7.1%), tamponade with a pedicled vascularized omental flap (pedicled omentum hepatorrhaphy) 7 patients (8.2%), anatomic (1.2 percent ).

The surgical procedures used in preplanned laparotomies included left hepatectomy in one patient (16.6%), right hepatectomy in one patient (16.6%), and nonanatomic/atypical liver resections in four patients (66.7 percent ). The severity of the liver injury (z= 5.2912, p=0.00001), other concomitant abdominal organ injuries (z=4.0743, p=0.00005), the volume of blood transfusion received (p=0.03207), and age (p=0.04944) all had a significant impact on treatment success.

The overall mortality rate was 13%.

Conclusion: Perihepatic packing and surgical intervention in two sessions have dramatically increased survival rates in serious liver trauma in our experience.

Author(S) Details

Skënder Buci
Department of Surgery, University Hospital of Trauma, Tirana, Albania.

Dorina Shtjefni
Department of Surgery, University Hospital of Trauma, Tirana, Albania.

Arben Gjata
Department of General Surgery, UHC “Mother Teresa”, Tirana, Albania.

Gjovalin Bushi
Department of Surgery, University Hospital of Trauma, Tirana, Albania.

Sonja (Saraçi) Butorac
Department of Radiology, University Hospital of Trauma, Tirana, Albania.

View Book:- https://stm.bookpi.org/IDMMR-V1/article/view/5049

Incidence and Factors Influencing the Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study | Chapter 2 | Highlights on Medicine and Medical Science Vol. 5

 Introduction: Sigmoid volvulus (SV) is one of the commonest causes of intestinal obstruction in Uganda. The purpose of this study was to determine the incidence and the factors influencing the outcome of management of SV in Northern Uganda Methodology: This study was divided into two parts. The purpose of the retrospective study was to determine the incidence over a two-year period. Patients 13 years and older with SV were included in the one-year prospective study to determine the factors influencing outcome and were followed up to the 30th postoperative day. The Gulu University IRB provided ethical approval. STATA/IC version 12.1 was used for data analysis. The end result was an uneventful recovery, morbidity, and mortality. In Northern Uganda, the incidence of SV was 251.8 per 100,000 surgical population in two years. Data from 103 patients were analyzed; 18 (17.48 percent) of them developed complications such as wound sepsis (10.7%), wound dehiscence (8.7%), and anastomotic leak (8.7%). (7.7 percent ). There were 8 deaths, for a 7.7 percent mortality rate. Hypernatraemia (RR=14.9; 95 percent CI: 1.46-152.9) and ileo-sigmoid knotting (RR = 4.94; 95 percent CI: 1.3018.78) were factors associated with a high risk of adverse outcome. When compared to Hartmann's procedure, resection and primary anastomosis had a better outcome (RR=0.15; 95 percent CI: 0.02- 0.099). In Northern Uganda, the incidence of SV was 251.8 per 100,000 surgical population in two years. Preoperative hypernatraemia and ileo-sigmoid knotting were risk factors for morbidity and mortality. Colostomy had a higher risk of morbidity and mortality than resection and primary anastomosis.

Author (s) Details

Richard Wismayer
Department of Surgery, Faculty of Medicine, University of Edinburgh, United Kingdom and Department of Surgery, Faculty of Medicine, Gulu University, Gulu, Uganda.

View Book :- https://stm.bookpi.org/HMMS-V5/article/view/1727