METHODS: In our retrospective review, we identified 1231 patients who underwent transpetrosal procedures by our multidisciplinary cranial base team between 1984 and 2005. Of the subgroup of 177 patients who had hydroxyapatite cement used during the closure of the procedure, 13 patients (7.3%) experienced delayed extrusion of hydroxyapatite cement.
RESULTS: Extrusion occurred in 3 patients
within 12 months and in 10 patients within 68 to 140 months. Twelve patients presented with draining fistulae and concomitant Staphylococcus GSK3326595 molecular weight aureus infection; I patient presented asymptomatically with a large temporal lobe abscess identified on surveillance magnetic resonance imaging. All 13 patients underwent reoperation, including 1 who underwent a second procedure.
CONCLUSION: Delayed extrusion of hydroxyapatite cement resulted in significant morbidity to Our patients and often presented in an indolent manner. We recommend serial examination and imaging studies in patients who have had transpetrosal closures with hydroxyapatite cement. Because of the complication rates associated
with hydroxyapatite cement, we have discontinued its use.”
“OBJECTIVE: We report the results Givinostat and complications associated with standardized intraoperative management designed for the prevention of hemodynamically relevant venous air embolism during surgery performed in the semisitting position.
METHODS: A protocol for preoperative evaluation and intraoperative monitoring was developed and applied in 187 find more consecutive patients who underwent surgery in the semisitting
position between 1999 and 2004. The protocol included preoperative transesophageal echocardiography examination (TEE), intraoperative TEE monitoring, catheterization of the right atrium and a combination Of fluid input, positive end expiratory pressure, and standardized positioning aiming at a positive pressure in the transverse and sigmoid sinuses. Data were collected retrospectively from the charts and intraoperative anesthesiological protocols of the patients for the incidence of clinically relevant air embolism (i.e., TEE-diagnosed air embolism plus a decrease in end tidal CO(2) or hemodynamic changes) and other complications related to the semisitting position.
RESULTS: Three cases (1.6%) of relevant venous air embolism occurred in 187 patients. Only 1 case (0.5%) was hemodynamically relevant, with temporary arterial blood pressure decrease and heart rate increase. Pneumatocephalus leading to lethargy was a frequent postoperative finding, which resolved spontaneously in all except I patient with epileptic seizure and oculomotor nerve palsy attributable to space-occupying subdurally trapped air, which had to be treated surgically. There was no permanent morbidity or mortality related to the semisitting position.