Concomitant use of computer image guidance, linear or sigmoid incisions after minimal shave, and liquid wound dressing with 2-octyl cyanoacrylate for tumor craniotomy or craniectomy: analysis of 225 consecutive surgical cases with antecedent historical control at one institution.
OBJECTIVE
Recent neurosurgical literature reflects rapidly evolving, technically enhanced methods that promise to improve neurosurgical outcomes. We review our experience with computer image guidance, linear or sigmoid incisions after minimal shaving, and liquid wound dressing with 2-octyl cyanoacrylate (Dermabond; Ethicon, Inc., Somerville, NJ) for tumor craniotomy or craniectomy in our attempt to optimize craniotomy or craniectomy for tumor.


METHODS
After institutional review board approval, we retrospectively reviewed patients who underwent craniotomy or craniectomy for tumor with or without the combination of techniques specified above. A prior cohort of patients who underwent craniotomy or craniectomy with traditional techniques served as a retrospective basis of comparison. Analysis included in- and outpatient chart reviews, which included the operative notes, pathology reports, discharge summaries, outpatient office records, and intraoperative nursing records. Data were entered into a statistical spreadsheet for analysis and comparison.


RESULTS
A total of 225 consecutive patients underwent a combination of less invasive techniques from July 2000 through October 2001. These patients were matched with 225 patients in a standard neurosurgical cohort that included patients who underwent operations from July 1994 through July 2000. Age, tumor type, radiation, reoperation rate, tumor location, and extent of resection were comparable for both groups. The overall wound complication rate was significantly lower in the minimally invasive group when compared with the control cohort of patients (0.9% versus 6.2%; P = 0.0298), even for early follow-up (0.9% versus 3.5%; P = 0.0427). Pedicle flap design was a variable that was significantly associated with wound complication.


CONCLUSIONS
Modern neurosurgical techniques are beneficial for patients undergoing craniotomy or craniectomy for tumor and seem to be superior to standard techniques. Although the study is multifactorial and retrospective, this conclusion is further supported by the enhanced self-image patients have during the postoperative period.
Cho
Joon
J
Department of Neurosurgery, Konkuk University, Seoul, South Korea.
Harrop
James
J
Veznadaroglu
Erol
E
Andrews
David W
DW
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D003399:Craniotomy / Q000295:instrumentation*; D003487:Cyanoacrylates / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D038361:Neuronavigation / Q000295:instrumentation*; D009779:Occlusive Dressings; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology
D003487:Cyanoacrylates; C100832:octyl 2-cyanoacrylate