Article
Elective craniotomy for intraventricular tumors: postoperative challenges
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Published: | June 9, 2017 |
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Objective: Following craniotomy for intraventricular tumors patients often show a tendency for delayed postoperative awakening. Consequently early postoperative neurological monitoring is challenging and a head CT is frequently ordered to rule out postoperative complications. Our goal was to quantify time to extubation and critical postoperative events after elective craniotomies for intraventricular tumors as compared to craniotomies for extraventricular lesions.
Methods: We prospectively enrolled all electively performed craniotomies on patients older than 18 years from November 2011 until August 2016. Extubation was aimed for postoperatively in the OR for all cases. CT scanning within 48 hours after surgery was performed only in cases of unexpected neurological findings or prolonged somnolence after cessation of sedation. The two patient groups (intraventricular tumors vs. extraventricular lesions) were compared in terms of time to extubation, need for emergency head CT and urgent operative revision within 48 hours. The prospective study on elective craniotomies was registered at ClinicalTrials.gov (NCT01987648).
Results: Of 977 elective craniotomies 26 (2.7%) were performed for intraventricular tumors. Mean time to extubation after skin closure in the group with extraventricular lesions (group 1) was 25.5 minutes (± standard deviation 26.2) and 34.0 minutes (±27.3) in the group with craniotomy for intraventricular tumors (group 2) (p = 0.104). In group 2 urgent head CTs were statistically significantly more often ordered than in group 1 (rate 34.6% and 11.5%, respectively, odds ratio 4.09 (95% confidence interval 1.78-9.40), p = 0.002). The rate for urgent operative intervention within 48 hours in group 2 was 3.8% (1 case, external ventricular drain) compared to 1.9% in group 1 (18 cases, OR 2.07, 95% CI 0.27-16.15, p = 0.404).
Conclusion: Craniotomy for intraventricular tumors is associated with a higher rate of critical events postoperatively such as a higher rate of CTs, and a tendency for delayed emergence from anesthesia. This cohort requires especially close and diligent postoperative monitoring.