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Abstract	Background: Perioperative craniotomy practices depend mainly on neurosurgeon preferences. To investigate the variations in these preferences, we surveyed neurosurgeons in Poland regarding different aspects of their practices. Methods: Anonymous questionnaires were circulated in 2019 at the neurosurgery conferences in Poland. We then analyzed the responses, categorized in subgroups by sex, affiliation, and stage of training. Results: A total of 114 responses to the questionnaire were obtained. For surgical site exposure, regional hair shaving was the most common pattern (64.9%), followed by whole-scalp (19.3%) and strip line shaving (12.3%). Most respondents (65.8%) used clamp-based devices for bone flap fixation, and approximately one third (30.7%) reported using bone suturing. During cranioplasty, respondents most often used artificial bone implants (69.3%), followed by a preserved bone flap from the patient (24.5%). More than three quarters reported that they (77.2%) performed routine radiologic evaluation after uncomplicated brain tumor surgery. Most patients (64.0%) were discharged between the third and sixth postoperative days. Almost half of emergent surgeries (48.2%) and most elective surgeries (89.5%) were performed with the help of an assistant surgeon. No significant differences were found in practice between the sexes or by affiliation or training stage. We inferred an influence of regional economic status on some of the reported choices. Conclusions: Perioperative craniotomy practices among Polish neurosurgeons show a significant heterogeneity. Economic factors can explain some choices, but others trace to a conservative mindset. Further studies are needed to identify which factors are most relevant and to identify approaches to a standardized method of care.
MeSH term(s)	Adult ; Aged ; Craniotomy/methods ; Female ; Humans ; Male ; Middle Aged ; Neurosurgeons/statistics & numerical data ; Neurosurgery/statistics & numerical data ; Neurosurgical Procedures/methods ; Perioperative Period ; Poland ; Surgical Wound Infection/surgery ; Surveys and Questionnaires ; Sutures ; Young Adult
Language	English
Publishing date	2020-10-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2020.10.128
Database	MEDical Literature Analysis and Retrieval System OnLINE

Abstract

Background: Perioperative craniotomy practices depend mainly on neurosurgeon preferences. To investigate the variations in these preferences, we surveyed neurosurgeons in Poland regarding different aspects of their practices.
Methods: Anonymous questionnaires were circulated in 2019 at the neurosurgery conferences in Poland. We then analyzed the responses, categorized in subgroups by sex, affiliation, and stage of training.
Results: A total of 114 responses to the questionnaire were obtained. For surgical site exposure, regional hair shaving was the most common pattern (64.9%), followed by whole-scalp (19.3%) and strip line shaving (12.3%). Most respondents (65.8%) used clamp-based devices for bone flap fixation, and approximately one third (30.7%) reported using bone suturing. During cranioplasty, respondents most often used artificial bone implants (69.3%), followed by a preserved bone flap from the patient (24.5%). More than three quarters reported that they (77.2%) performed routine radiologic evaluation after uncomplicated brain tumor surgery. Most patients (64.0%) were discharged between the third and sixth postoperative days. Almost half of emergent surgeries (48.2%) and most elective surgeries (89.5%) were performed with the help of an assistant surgeon. No significant differences were found in practice between the sexes or by affiliation or training stage. We inferred an influence of regional economic status on some of the reported choices.
Conclusions: Perioperative craniotomy practices among Polish neurosurgeons show a significant heterogeneity. Economic factors can explain some choices, but others trace to a conservative mindset. Further studies are needed to identify which factors are most relevant and to identify approaches to a standardized method of care.

MeSH term(s)

Adult ; Aged ; Craniotomy/methods ; Female ; Humans ; Male ; Middle Aged ; Neurosurgeons/statistics & numerical data ; Neurosurgery/statistics & numerical data ; Neurosurgical Procedures/methods ; Perioperative Period ; Poland ; Surgical Wound Infection/surgery ; Surveys and Questionnaires ; Sutures ; Young Adult

Language

English

Publishing date

2020-10-28

Publishing country

United States

Document type

Journal Article

ZDB-ID

2534351-8

ISSN

1878-8769 ; 1878-8750

ISSN (online)

1878-8769

ISSN

1878-8750

DOI

10.1016/j.wneu.2020.10.128

Database

MEDical Literature Analysis and Retrieval System OnLINE

Article ; Online: Prophylactic use of dural tenting sutures in elective craniotomies in adults-is it necessary? A study protocol for a multicentre, investigator- and participant-blinded randomised, parallel-group, non-inferiority trial.

Kunert, Przemysław / Przepiórka, Łukasz / Fortuniak, Jan / Wiśniewski, Karol / Bobeff, Ernest Jan / Larysz, Patrycja / Kruk, Rafał / Kulesza, Bartłomiej / Szczepanek, Dariusz / Ładziński, Piotr / Żyłkowski, Jarosław / Kujawski, Sławomir / Łabędzka, Kamila / Jaskólski, Dariusz / Rola, Radosław / Trojanowski, Tomasz / Marchel, Andrzej

Trials

2021 Volume 22, Issue 1, Page(s) 273

Abstract: Background: In the early days of neurosurgery, extradural haemorrhages (EDHs) contributed to a high mortality rate after craniotomies. Almost a century ago, Walter Dandy reported dural tenting sutures as an effective way to prevent postoperative EDH. ... ...

Abstract	Background: In the early days of neurosurgery, extradural haemorrhages (EDHs) contributed to a high mortality rate after craniotomies. Almost a century ago, Walter Dandy reported dural tenting sutures as an effective way to prevent postoperative EDH. Over time, his technique gained in popularity and significance to finally become a neurosurgical standard. Yet, several retrospective reports and one prospective report have questioned the ongoing need for dural tenting sutures. Dandy's explanation that the haemostasis observed under hypotensive conditions is deceiving and eventually causes EDH may be obsolete. Today, proper intra- and postoperative care, including maintenance of normovolemia and normotension and the use of modern haemostatic agents, may be sufficient for effective haemostasis. Thus, there is a fundamental need to evaluate the necessity of dural tenting sutures in a solid, unbiased, evidence-based manner. Methods: This study is designed as a randomised, multicentre, double-blinded, controlled interventional trial with 1:1 allocation. About one half of the participants will undergo craniotomy without dural tenting sutures and will be considered an intervention group. The other half will undergo craniotomy with these sutures. Both groups will be followed clinically and radiologically. The primary outcome is reoperation due to extradural haematoma. Secondary outcomes aim to evaluate the impact of dural tenting sutures on mortality, readmission risk, postoperative headaches, size of extradural collection, cerebrospinal fluid leak risk and the presence of any new neurological deficit. The study protocol follows the SPIRIT 2013 statement. Discussion: It is possible that many neurosurgeons around the globe are tenting the dura in elective craniotomies which brings no benefit and only extends the operation. Unfortunately, there is not enough data to support or reject this technique in modern neurosurgery. This is the first study that may produce strong, evidence-based recommendations on using dural tenting sutures. Trial registration, ethics and dissemination: The Bioethics Committee of the Medical University of Warsaw approved the study protocol (KB/106/2018). The trial is registered at http://www.clinicaltrials.gov ( NCT03658941 ) on September 6, 2018. The findings of this trial will be submitted to a peer-reviewed neurosurgical journal. Abstracts will be submitted to relevant national and international conferences. Trial status: Protocol version and date: version 1.5, 14.01.2020 First recruitment: September 7, 2018 Estimated recruitment completion: September 1, 2021.
MeSH term(s)	Adult ; Craniotomy/adverse effects ; Elective Surgical Procedures ; Humans ; Multicenter Studies as Topic ; Pandemics ; Prospective Studies ; Randomized Controlled Trials as Topic ; Retrospective Studies ; Sutures/adverse effects ; Treatment Outcome
Language	English
Publishing date	2021-04-12
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-021-05201-z
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Perioperative Practice Patterns of Craniotomies-Results of a National Neurosurgical Survey in Poland.

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Article ; Online: Prophylactic use of dural tenting sutures in elective craniotomies in adults-is it necessary? A study protocol for a multicentre, investigator- and participant-blinded randomised, parallel-group, non-inferiority trial.

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Order via subito