Postoperative circuits in patients undergoing elective craniotomy. A narrative review

Reoperation-requiring postoperative intracranial haemorrhage after posterior fossa craniotomy: Retrospective case-series

“…Taylor and co-workers found that 44/50 (88%) of the haemorrhages occurred within 6 h, none between six and 24 h and 6/50 (12%) after more than 24 h. They did not specify the location of the craniotomies, but nevertheless recommended prolonged monitoring (beyond 6 h) of cases operated in the posterior fossa, assuming a risk of hydrocephalus and lower cranial nerve palsies with an associated threat to airway and respiratory response ( Taylor et al, 1995 ). This assumption has been frequently cited and seems to be the main source for recommendations that patients operated in the posterior fossa should be monitored for 24 h. Hurtado and co-workers recently reviewed the literature on postoperative circuits in patients undergoing elective craniotomy and suggested a decision algorithm ( Hurtado et al, 2020 ). This algorithm recommends 24 h monitoring of cases operated in the posterior fossa, based on the same reasoning.…”

“…Emergency operation and a large tissue surface after tumour or infarct resection could be risk-factors, but the small sample size in this study precludes us from drawing conclusions. The decision algorithm suggested by Hurtado and co-workers recommend customized duration of the postoperative monitoring, based on an assessment of individual patients’ risk profile ( Hurtado et al, 2020 ). However, from the literature, the evidence for inclusion of posterior fossa operation as a risk factor in such assessments is weak.…”

“…Seifman and co-workers reviewed the literature in 2011, and recommended close clinical monitoring for 6 h after all craniotomies ( Seifman et al, 2011 ). In a more recent review, Hurtado and co-workers concluded that there is no need to systematically admit all craniotomy cases to a postoperative critical care unit ( Hurtado et al, 2020 ). Still, they recommended that patients operated in the posterior fossa should be monitored for 24 h, due to the risk of compromising the lower cranial nerves and the increased risk of complications.…”

Complications of a posterior fossa post-surgical patient, review of a case

“…Patients who failed extubation were compared with those who were successfully extubated for length of ICU stay, length of hospital stay, tracheotomy, ICU mortality, hospital mortality, pulmonary complications and functional outcome, in this study we talk about 43 patients, re-intubation was respiratory failure in 41.6%, they had extubation failure within 24-35 h after extubation; and 8 (18.6%) had failed extubation within 36-48 h after extubation, as in the case described above, which cannot be extubated due to damage or injury to cranial nerves V, IX and XII. 4 Another study reveals that neurosurgical patients are at risk of neurological complications, mainly in the immediate postoperative period. The presence in the postoperative period of new neurological deficits may be indicative of cerebral edema or hemorrhage.…”

Significant perioperative parameters affecting postoperative complications within 30 days following craniotomy for primary malignant brain tumors

“…Numerous factors may predict the development of PC1M following a craniotomy for primary malignant brain tumors (PMBT). These factors can be grouped into patient-related, surgery-related, and anesthesia-related categories (Harland et al 2020 ; Hurtado et al, 2020 ; Lonjaret et al 2017 ; Missios et al 2015 ). However, to the best of our knowledge, the perioperative changes of serum laboratory parameters and renal clearance have not been considered potential predictors of PC1M development.…”