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Outpatient Craniotomy for Brain Tumor: A Pilot Feasibility Study in 46 Patients

  • Mark Bernstein (a1)

Abstract:

Background:

Since 1991 the author has routinely performed awake craniotomy for intra-axial brain tumors with low complication rate and low resource utilization. In late 1996 a pilot study was initiated to assess the feasibility of performing craniotomy for tumor resection as an outpatient procedure.

Methods:

A rigorous protocol was developed and adhered to, based around the patient's arrival at hospital at 6:00 a.m, undergoing image-guided awake craniotomy with cortical mapping, and being discharged by 6:00 p.m.

Results:

During the 48 month period from December 1996 to December 2000, 245 awake craniotomies were performed and of those, 46 patients were entered into the outpatient craniotomy protocol. Pathology in the 46 intent-to-treat group was: 21 metastasis, 19 glioma, and six miscellaneous. Four patients required conversion to inpatients and one patient was readmitted later the same evening due to headache. Thus 41/46 patients successfully completed the protocol (89%). There were five complications in the 46 intent-to-treat group (10.9%).

Conclusions:

Outpatient craniotomy for brain tumor is a feasible option which appears safe and effective for selected patients. Besides being resource-friendly, the procedure may be psychologically less traumatic to patients than standard craniotomy for brain tumor. Proper prospective studies including satisfaction surveys would help resolve these issues and will be the next step.

RÉSUMÉ: Introduction:

Depuis 1991, l'auteur a effectué de routine l'exérèse de tumeurs cérébrales intra-axiales par crâniotomie sans anesthésie générale, en chirurgie ambulatoire. Le taux de complications est bas et l'utilisation des ressources est minime. En 1996, une étude pilote a été mise sur pied pour évaluer la faisabilité de la crâniotomie pour l'exérèse de tumeurs en chirurgie ambulatoire.

Méthodes:

Un protocole rigoureux a été développé et réalisé, à partir du moment où le patient arrive à l'hôpital à 6:00, subit une crâniotomie sans anesthésie générale guidée par imagerie avec cartographie corticale jusqu'au moment où il quitte l'hôpital à 18:00.

Résultats:

Pendant une période de 48 mois entre Décembre 1996 et décembre 2000, 245 crâniotomies sans anesthésie générale ont été effectuées dont 46 selon le protocole de chirurgie d'un jour. Les diagnostics suivants ont été posés à l'examen anatomopathologique chez les 46 patients inclus dans l'étude: 21 métastases, 19 gliomes et six tumeurs variées. Chez quatre patients on a dû recourir à l'hospitalisation et un patient a été réadmis le soir même pour céphalée. Donc 41 des 46 patients ont complété le protocole avec succès (89%). Cinq complications sont survenues dans le groupe total des patients inclus dans l'étude (10.9%).

Conclusions:

La crâniotomie en externe pour l'exérèse de tumeurs cérébrales est une option valable qui semble sûre et efficace chez des patients bien choisis. En plus d'économiser les ressources, cette approche peut être moins traumatique psychologiquement pour les patients par rapport à la crâniotomie standard pour une tumeur cérébrale. Des études prospectives bien structurées, incluant l'évaluation de la satisfaction, aideraient à éclairer ces aspects et constituent la prochaine étape à réaliser.

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Copyright

Corresponding author

Division of Neurosurgery, Toronto Western Hospital, Suite 2-405 McLaughlin Pavilion, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada

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