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Intraoperative magnetic resonance imaging (iMRI) is a powerful tool used to verify maximal safe resection of gliomas. However, unsuspected new or incidental findings can present difficult clinical scenarios. Here we present a case of a large supratentorial glioma resection where new, incidental bilateral cerebellar hemispheric enhancement was noted on iMRI. A 52-year-old male with a large intra-axial mass spanning the right temporal and parietal lobes underwent a craniotomy for tumor resection utilizing iMRI. Imaging displayed new, remote, bilateral cerebellar enhancement. Upon completion of surgery, the patient was extubated and was at his neurological baseline. An immediate CT scan showed no abnormalities in the cerebellum, and the duration of his hospital stay was unaffected by this finding. An MRI 24 hours after the procedure demonstrated complete resolution of the enhancement. New, remote contrast enhancement in the cerebellum raises concerns for the potentially emergent, well-defined pathology known as remote cerebellar hemorrhage (RCH). However, here we describe a case where these findings turned out to be clinically insignificant, CT-negative, and self-limiting. Therefore, here we call this finding remote non-hemorrhagic cerebellar contrast enhancement (RNHCCE) to differentiate it from RCE, and we discuss nuances and management considerations for differentiating the two.

Locomotor activity can serve as a readout to identify discomfort and pain. Therefore, monitoring locomotor activity following interventions that induce potential discomfort may serve as a reliable method for evaluating animal health, complementing conventional methods such as body weight measurement. In this study, we used the digital ventilated cage (DVC®) system for the assessment of circadian locomotor activity, in addition to body weight monitoring, following intracranial stereotaxic surgery in an Alzheimer's disease mouse model (C57BL/6J/APPswe/PSEN1dE9). Stereotaxic surgery did not affect the organization of circadian locomotor activity of both 7-8-week-old and 19-21-week-old mice. However, we observed that both young and old mice exhibited a significant decrease in activity during the dark phase. Also, our study shows that changes in locomotor activity exhibit higher sensitivity in detecting alterations indicative of animal health compared to measuring body weight. In contrast to 7-8-week-old mice, where we observed no genotypic differences in locomotor activity, 19-21-week-old APP/PS1 mice showed increased locomotor activity compared to wild-type mice. Furthermore, our analyses revealed that a subset of the 7-8-week-old mice showed increased locomotor activity during the initial peak of the dark phase. One mouse experienced sudden death early in life, possibly due to epileptic seizures. Altogether, our findings affirm continuous activity measurements as used in the DVC® as a highly valuable objective method for post-surgical welfare monitoring. Its discerning capacity not only facilitates circadian locomotor rhythm assessment but also enables the identification of individual aberrant activity patterns, possibly indicative of epileptic seizures. [ABSTRACT FROM AUTHOR]

• The study estimates the proportion of newly diagnosed nonepileptic seizures. • A causal pathway could exist between brain resections and functional seizures. • The proportion of de novo functional seizures following intracranial surgery is 3 %. • We expect brain resections to impact functional seizure epidemiology. The epidemiology of psychogenic non-epileptic seizures (PNES) is still unclear. Although approximately 14 million people need neurosurgical care annually, there is a dearth of thorough analysis on PNES occurrence following surgery. This study seeks to estimate the proportion of newly diagnosed PNES. We conducted a literature search of the PubMed, Ovid, CINAHL, and Cochrane Library databases up to December 2023. We identified studies using an observational design on the occurrence of PNES in patients who underwent intracranial surgery, and confirmed diagnosis using video-EEG. Estimates are reported as proportions using random effects models. We reported both 95 % CIs and prediction intervals (PI). We assessed the risk of bias and identified the pooled odds ratio (OR) for mutually exclusive groups. The heterogeneity was investigated using the I² statistic and significance determined using Cochran's Q-test. Post-hoc Egger's regression test, and several sensitivity analyses were performed. This study was registered in PROSPERO (CRD42023488611). Of the 1766 unique studies identified, 86 were selected for full-text review. Eight studies (n = 3,699) were eligible for inclusion. Studies, spanning from 1995 to 2017, primarily focused on epilepsy surgeries. The pooled proportion was 3 % (95 % CI 2 %-5 %; 95 % PI 0 %-11 %). Temporal resections indicated twofold increase of PNES comparing to either resections (OR 2.05, 95 %CI 0.81–5.19). The risk of bias assessment indicated satisfactory quality for included studies, and heterogeneity in estimates was mainly explained by publication year of studies and their rounded sample size. Given the estimations, there is expected impact of intracranial procedures on functional seizures epidemiology. Further efforts need to understand the contribution of brain resections to PNES incidence. [ABSTRACT FROM AUTHOR]

Locomotor activity can serve as a readout to identify discomfort and pain. Therefore, monitoring locomotor activity following interventions that induce potential discomfort may serve as a reliable method for evaluating animal health, complementing conventional methods such as body weight measurement. In this study, we used the digital ventilated cage (DVC®) system for the assessment of circadian locomotor activity, in addition to body weight monitoring, following intracranial stereotaxic surgery in an Alzheimer’s disease mouse model (C57BL/6J/APPswe/PSEN1dE9). Stereotaxic surgery did not affect the organization of circadian locomotor activity of both 7–8-week-old and 19–21-week-old mice. However, we observed that both young and old mice exhibited a significant decrease in activity during the dark phase. Also, our study shows that changes in locomotor activity exhibit higher sensitivity in detecting alterations indicative of animal health compared to measuring body weight. In contrast to 7–8-week-old mice, where we observed no genotypic differences in locomotor activity, 19–21-week-old APP/PS1 mice showed increased locomotor activity compared to wild-type mice. Furthermore, our analyses revealed that a subset of the 7–8-week-old mice showed increased locomotor activity during the initial peak of the dark phase. One mouse experienced sudden death early in life, possibly due to epileptic seizures. Altogether, our findings affirm continuous activity measurements as used in the DVC® as a highly valuable objective method for post-surgical welfare monitoring. Its discerning capacity not only facilitates circadian locomotor rhythm assessment but also enables the identification of individual aberrant activity patterns, possibly indicative of epileptic seizures.

Abstract Inadequate antinociception during skull pin fixation may cause hemodynamic instability in intracranial surgery. The optimal concentration of remifentanil to provide adequate antinociception and stable hemodynamics during skull pin fixation under analgesia nociception index monitoring is unknown. This study is to assess the 90% effective concentration of remifentanil for skull pin fixation under hemodynamic and analgesia nociception index monitoring. Twenty-six patients were enrolled for intracranial surgery, anesthesia was induced and maintained under total intravenous anesthesia using target-controlled infusion for remifentanil and propofol under analgesia nociception index and bispectral index monitoring. Skull pin fixation was performed at different effect-site concentrations of remifentanil required for Dixon's up-and-down method with a step size of 0.5 ng/ml under bispectral index 40–60. Inadequate antinociception is defined when either ANI 20% in hemodynamic changes from baseline (e.g. heart rate > 100 beats/min, or blood pressure > 180/100 mmHg) and the effect-site concentration of remifentanil is considered as failure. It is considered success as ANI > 30 and

Background and Aims: Understanding of perioperative care practices and early postoperative outcomes helps minimize potentially preventable perioperative complications while supporting systemic and neurological well-being. The objective of this prospective study was to evaluate the perioperative care practices and early postoperative outcomes of cranial neurosurgery at a high-volume tertiary care neurosciences hospital in India. We also aimed to see if the care elements differed depending on the surgical approach. We hypothesized that care elements and outcomes are likely to be different between major surgical approaches. Material and Methods: This was a prospective observational study of consecutive adult neurosurgical patients who underwent elective surgeries for intracranial pathologies over a period of six months from October 2020 to March 2021 at a tertiary care neurosciences center in India. Perioperative data about intraoperative care elements and early postoperative outcomes till the third day after surgery were collected. Results: Incidence of blood loss >1 L was significantly (P = 0.07) higher after infratentorial surgery (26%, N = 17). Incidence of intraoperative and postoperative desaturation was more after transnasal surgery (6%, N = 2, P = 0.002, and 9%, N = 3, P = 0.01, respectively). Conclusion: This study informs the early perioperative care practices of neurosurgical patients from a dedicated neurosciences hospital in a developing world. We observed that transnasal surgery was associated with more perioperative adverse events and slower convalescence compared to supra- and infratentorial surgeries despite being a considerably less invasive surgery. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to evaluate the postoperative quality of life (QOL) after surgery for the treatment of intracranial meningioma in cats Methods: The study included 14 cases that underwent craniotomy from May 2009 to March 2021. Owners were contacted via telephone after a median time of 967 (range 227–4209) days after surgery and surveyed with a specially designed questionnaire that consisted of three domains, subdivided into different items. Physical behaviour, including general condition, food intake, mobility and overall impression, was evaluated from 0, reflecting the worst status, to 10, reflecting the best. The development of preoperative existing clinical signs, seizures and concurrent medication were evaluated individually for each patient. The time span necessary for the improvement of each item was recorded. Finally, satisfaction about the decision for surgery was ranked from 0 to 10. Results: Thirteen questionnaires were completed. Three cats were evaluated twice owing to revision surgery. Owners reported a statistically significant (P <0.001) improvement from immediately after the operation to 240 days after surgery. Preoperative clinical signs resolved in 95% of cases. All questioned owners would opt for surgery again. Conclusions and relevance: QOL after surgery for intracranial meningioma in cats seems encouraging regarding our study. Nevertheless, limitations, such as small sample size, recall bias, lack of a control group and validation of the questionnaire, need to be kept in mind when interpreting the results. [ABSTRACT FROM AUTHOR]

Background and Aims: Understanding of perioperative care practices and early postoperative outcomes helps minimize potentially preventable perioperative complications while supporting systemic and neurological well-being. The objective of this prospective study was to evaluate the perioperative care practices and early postoperative outcomes of cranial neurosurgery at a high-volume tertiary care neurosciences hospital in India. We also aimed to see if the care elements differed depending on the surgical approach. We hypothesized that care elements and outcomes are likely to be different between major surgical approaches. Material and Methods: This was a prospective observational study of consecutive adult neurosurgical patients who underwent elective surgeries for intracranial pathologies over a period of six months from October 2020 to March 2021 at a tertiary care neurosciences center in India. Perioperative data about intraoperative care elements and early postoperative outcomes till the third day after surgery were collected. Results: Incidence of blood loss >1 L was significantly (P = 0.07) higher after infratentorial surgery (26%, N = 17). Incidence of intraoperative and postoperative desaturation was more after transnasal surgery (6%, N = 2, P = 0.002, and 9%, N = 3, P = 0.01, respectively). Conclusion: This study informs the early perioperative care practices of neurosurgical patients from a dedicated neurosciences hospital in a developing world. We observed that transnasal surgery was associated with more perioperative adverse events and slower convalescence compared to supra- and infratentorial surgeries despite being a considerably less invasive surgery.

Locomotor activity can serve as a readout to identify discomfort and pain. Therefore, monitoring locomotor activity following interventions that induce potential discomfort may serve as a reliable method for evaluating animal health, complementing conventional methods such as body weight measurement. In this study, we used the digital ventilated cage (DVC ® ) system for the assessment of circadian locomotor activity, in addition to body weight monitoring, following intracranial stereotaxic surgery in an Alzheimer's disease mouse model (C57BL/6J/APPswe/PSEN1dE9). Stereotaxic surgery did not affect the organization of circadian locomotor activity of both 7-8-week-old and 19-21-week-old mice. However, we observed that both young and old mice exhibited a significant decrease in activity during the dark phase. Also, our study shows that changes in locomotor activity exhibit higher sensitivity in detecting alterations indicative of animal health compared to measuring body weight. In contrast to 7-8-week-old mice, where we observed no genotypic differences in locomotor activity, 19-21-week-old APP/PS1 mice showed increased locomotor activity compared to wild-type mice. Furthermore, our analyses revealed that a subset of the 7-8-week-old mice showed increased locomotor activity during the initial peak of the dark phase. One mouse experienced sudden death early in life, possibly due to epileptic seizures. Altogether, our findings affirm continuous activity measurements as used in the DVC ® as a highly valuable objective method for post-surgical welfare monitoring. Its discerning capacity not only facilitates circadian locomotor rhythm assessment but also enables the identification of individual aberrant activity patterns, possibly indicative of epileptic seizures., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Abdollahi Nejat, Stiedl, Smit and van Kesteren.)

Intraoperative magnetic resonance imaging (iMRI) is a powerful tool used to verify maximal safe resection of gliomas. However, unsuspected new or incidental findings can present difficult clinical scenarios. Here we present a case of a large supratentorial glioma resection where new, incidental bilateral cerebellar hemispheric enhancement was noted on iMRI. A 52-year-old male with a large intra-axial mass spanning the right temporal and parietal lobes underwent a craniotomy for tumor resection utilizing iMRI. Imaging displayed new, remote, bilateral cerebellar enhancement. Upon completion of surgery, the patient was extubated and was at his neurological baseline. An immediate CT scan showed no abnormalities in the cerebellum, and the duration of his hospital stay was unaffected by this finding. An MRI 24 hours after the procedure demonstrated complete resolution of the enhancement. New, remote contrast enhancement in the cerebellum raises concerns for the potentially emergent, well-defined pathology known as remote cerebellar hemorrhage (RCH). However, here we describe a case where these findings turned out to be clinically insignificant, CT-negative, and self-limiting. Therefore, here we call this finding remote non-hemorrhagic cerebellar contrast enhancement (RNHCCE) to differentiate it from RCE, and we discuss nuances and management considerations for differentiating the two., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)