Perioperative fluid and electrolyte management in children undergoing surgery for craniopharyngioma. A 10-year experience in a single institution.

In a retrospective study, the intra- and early postoperative data of 39 children with 46 operations for craniopharyngioma were analyzed. Diabetes insipidus (DI) occurred in 30 out of 32 cases without preoperative evidence of DI. We observed that all children who did not have a pituitary stalk preserved and 5 out of 7 patients with preserved pituitary stalk developed DI within 18 h of surgery. Short-term inappropriate secretion of antidiuretic hormone (SIADH) occurred in 2 children, but was quickly followed by DI. The time of onset of DI and SIADH did not correlate with sex, age, body weight, location of tumor, or duration or extent of surgery. Parenteral desmopressin was an effective treatment for intra- and postoperative DI. The duration of the clinical effect of desmopressin administration varied in different patients between 4 and 23 h. An approach to the immediate intra- and postoperative management of children with craniopharyngioma is presented.

[Cesarean section with subsequent craniotomy in the area of the posterior cranial fossa]. / Sectio Caesarea mit anschliessender Kraniotomie im Bereich der hinteren Schädelgrube.

We report on a 31-year old pregnant patient with von-Hippel-Lindau syndrome who presented to the emergency room with symptoms of increased intracranial pressure. She was found in premature labour with a normal foetus of 29 weeks' gestational age in breech presentation. We discuss an anaesthetic and neurosurgical management during emergent craniotomy and Caesarean section. Caesarean section and posterior fossa craniotomy with resection of an angioblastoma are performed in one setting. Following rapid sequence induction with thiopentone and succinylcholine, anaesthesia is maintained with fentanyl, flunitrazepam and pancuronium; nitrous oxide and volatile anaesthetics are avoided. The advantages of this technique include haemodynamic stability and maintenance of intracranial pressure. Neonatal depression is likely with this technique and requires resuscitative measures. The indications for rapid sequence induction in pregnant patients with raised intracranial pressure at risk for aspiration are discussed. Different options for monitoring during this procedure are described.

Hemispheric CBF-alterations in the time course of focal and diffuse brain injury.

Hemispheric CBF-alterations were studied in the time course of focal and diffuse-brain injury in a series of 25 head injured patients. Repeated 133 Xe CBF measurements with a mobile 10 detector system were performed in order to evaluate hemispheric CBF and cerebral vasoreactivity after change of PaCO2. Focal brain injury influenced hemispheric CBF varying in the time course: A hyperperfusion could be found within the first seven days after injury in 55 percent, whereas a hypoperfusion could be detected during the whole examination period in 18 percent. In diffuse injury we never saw such CBF abnormalities. On the other hand hemispheric CO2-reactivity was disturbed in focal and diffuse lesions, whereas a correlation between altered CBF at rest and CO2-reactivity could be only detected in 40% in focal injury. This investigations demonstrates no significant general, however, a partial influence of morphological damage upon cerebral microcirculation.