Outpatient brain tumor surgery: innovation in surgical neurooncology

Abstract

Object Recent studies of conventional craniotomies and image-guided biopsies have afforded a solid characterization of surgical morbidity and the timing of its occurrence. This report outlines a novel 11-year experience with outpatient image-guided biopsy and outpatient craniotomy for supratentorial intraaxial brain tumors. Methods During the period between August 1996 and May 2007, 117 awake image-guided biopsies and 145 elective craniotomies for tumor resection were prospectively selected to be performed as outpatient procedures. Data were recorded for each patient regarding tumor histological type, reasons for admission if planned early discharge failed, and surgical complications. Results Successful discharge from the Day Surgery Unit was possible in 109 (93%) of 117 biopsy cases and 136 (94%) of 145 craniotomy cases (only 2 of which [1.5%] required unplanned readmission after discharge). Neurological worsening occurred in 5.1% of the patients who underwent image-guided biopsies, and in 5.5% of those who underwent outpatient craniotomies (based on intent-to-treat group analysis). No patient suffered an adverse event with alteration in outcome because of planned outpatient discharge. Conclusions Outpatient image-guided brain biopsy and outpatient craniotomy for tumor resection are safe and effective procedures in selected patients.

Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study

“…8 As well, an awake craniotomy (AC) can be safely used for many supratentorial tumours, allowing for a potentially faster recovery and discharge from the hospital, as short stay or even as day surgery. [9][10][11][12] The purpose of this retrospective observational study was to assess the incidence of same-day discharge from hospital in patients undergoing craniotomy for supratentorial brain tumours as well as to explore the associated perioperative factors, anesthesia techniques, and complications.…”

Value-based neurosurgery: the example of microvascular decompression surgery

“…12 Although numerous surgical specialties have adopted ERAS and Fast-track protocols for various ambulatory and inpatient surgeries, the literature attesting to their current use in an adapted form to neurosurgical cases is scarce. 3,4,6,10,33 A few studies have reported that outpatient brain tumor surgery, spinal decompression, and carotid endarterectomy are safe and feasible in selected patients. 3,4,6,10,33 A comprehensive assessment of the applicability of an ERAS-like perioperative protocol for neurosurgical procedures is lacking.…”

Intraoperational Thermal Control of Perifocal Edema in Photodynamic Therapy of Malignant Brain Tumors

“…Operative intervention does not provide ablasticity, therefore, the development and application of techniques with a selective effect on tumor cells including photodynamic therapy (PDT) is of current interest now. PDT increases a radicality degree in glioma removal due to the fact that tumor cells are destroyed by the mechanisms, which differ from the effect of chemotherapy or radiotherapy [4], improves long-term results increasing patients' survival [5]. PDT is considered [5][6][7] to be based on three main mechanisms of action.…”

“…PDT increases a radicality degree in glioma removal due to the fact that tumor cells are destroyed by the mechanisms, which differ from the effect of chemotherapy or radiotherapy [4], improves long-term results increasing patients' survival [5]. PDT is considered [5][6][7] to be based on three main mechanisms of action. Firstly, the interaction between light energy (photons) and a photosensitizer selectively accumulated in tumor cells results in the occurrence of free radical compounds, which damage mitochondria, DNA and membranes of tumor cells causing their apoptosis and lysis.…”