gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Elective craniotomy for intraventricular tumors: postoperative challenges

Meeting Abstract

  • Ralph T. Schär - Bern, Switzerland
  • Christa Schwarz - Bern, Switzerland
  • Werner Z'graggen - Inselspital Bern, Neurologie, Bern, Switzerland
  • Andreas Raabe - Inselspital, Bern University Hospital, Department of Neurosurgery, Bern, Switzerland
  • Jürgen Beck - Inselspital Universität Bern, Klinik für Neurochirurgie, Bern, Switzerland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.28.07

doi: 10.3205/17dgnc351, urn:nbn:de:0183-17dgnc3518

Published: June 9, 2017

© 2017 Schär et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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.