Awake Craniotomy for Tumour Excision

Background

Craniotomy and excision of tumours can produce neurological deficits if the tumour is located close to eloquent areas of the brain. One technique of overcoming this problem is to keep the patient ‘awake’ during surgery.

Methods

Eight patients with intra cranial space occupying lesions (ICSOL) were operated ‘awake’, using a combination of skull block with sedation and analgesia. A mixture of 0.125% bupivacaine and 0.5% lignocaine was used for various nerve and field blocks. Midazolam, fentanyl and propofol in titrated doses were used to achieve conscious sedation.

Result

The procedure was successful in all the patients. They tolerated the procedure well and were able to follow the commands intraoperatively as desired. There were no significant complications.

Conclusion

Awake craniotomy with skull blocks with sedation and analgesia is a well established procedure. It requires a good rapport between surgeon, anaesthesiologist and the patient.Key Words: Awake craniotomy, Skull block, Sedation, Analgesia     

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胆道系统恶性肿瘤包括胆管癌和胆囊癌 ,前者主要指原发于肝内、肝门部和远端肝外胆管的恶性肿瘤。至今胆系肿瘤仍依ＴＮＭ分类法分为 0～Ⅳ期。 0期 :为原位癌 ;Ⅰ期 :肿瘤局限于粘膜层、肌层 ;Ⅱ期 :出现局部浸润 ;Ⅲ期 :在Ⅰ或Ⅱ期基础上肿瘤累及邻近组织或肝十二指肠韧带上淋巴结 ;Ⅳ期 :出现肝脏等器官受累或远处转移或出现以下之一区域的淋巴结转移 ,如胰周、十二指肠周、肝门周、腹腔及肠系膜。1　诊断胆系恶性肿瘤的诊断 ,主要依靠临床表现、实验室检查以及影象学检查。临床表现特异性不强 ,其中最基本的表现为胆道梗阻症状 ,同时可…     

Reduction of sound levels with antinoise in MR imaging

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Atrial myxoma: National incidence,diagnosis and surgical management

Despite being the most common benign intracardiac tumour with an excellent prognosis after surgical excision the incidence of atrial myxoma (except at autopsy) is unknown. We reviewed all patients admitted to the National Cardiac Surgery Unit (n=26) with an atrial myxoma over a fifteen year period (1977–1991) to compile national incidence data and assess pre-operative diagnosis, management, surgical technique, and outcome. Preoperative symptoms were: congestive cardiac failure (12 patients), embolism (8 patients), constitutional (3 patients), asymptomatic (2 patients) and tachyarrhythmia (1 patient). The diagnosis was confirmed by 2D echocardiography alone in thirteen patients and by a combination of echocardiography and angiography in thirteen patients. At operation the site of the tumour was left atrial in 24 patients and bi-atrial in two patients. All cases were confirmed by histology. All patients made a good post-operative recovery, although one patient survived a pulmonary embolus and one patient developed a deep venous thrombosis. There has been one late death (five months after surgery) from a cerebrovascular accident. Serial echocardiography has revealed one recurrence to date (8 years after surgery). The surgical incidence of these tumours in the Republic of Ireland over the study period was 0.5 atrial myxomas/million population/year. Although rare atrial myxomas are the most important cardiac tumours to diagnose as the results from surgery are excellent.     

High mobility group proteins 1 and 2 recognize chromium-damaged DNA

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Treatment of localized prostate cancer using a combination of high dose rate Iridium‐192 brachytherapy and external beam irradiation: Initial Australian experience

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Endogenous protein phosphorylation by resting and activated human neutrophils

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