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Related Concept Videos

Psychosurgery01:30

Psychosurgery

156
Psychosurgery, the surgical alteration or permanent removal of brain tissue to alleviate severe psychological conditions, stands as one of the most radical and controversial treatments in the history of mental health care. Its development and application have evolved significantly, marked by dramatic shifts in scientific understanding and ethical perspectives.
Historical Development of Psychosurgery
In the 1930s, Portuguese neurologist Antonio Egas Moniz introduced a surgical procedure designed...
156

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Related Experiment Video

Updated: Nov 4, 2025

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Surgical and Peri-Operative Considerations for Brain Metastases.

Saksham Gupta1, Hassan Dawood1, Alexandra Giantini Larsen2

  • 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.

Frontiers in Oncology
|May 24, 2021
PubMed
Summary

Patient frailty and infratentorial tumor location increase surgical risks for brain metastases. Optimizing frailty metrics and surveillance may improve outcomes for these complex neurosurgical cases.

Keywords:
brain metastasiscomplicationsmortalityreadmissionreoperationsurgical risk

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Area of Science:

  • Neurosurgery
  • Surgical Oncology
  • Geriatric Medicine

Background:

  • Brain metastases represent the most frequent primary brain tumors in adults.
  • Current management strategies for brain metastases are complex and require careful consideration.
  • Understanding risk factors for surgical complications and mortality is crucial for optimizing treatment decisions.

Purpose of the Study:

  • To analyze risk factors for surgical complications and mortality in adult patients undergoing craniotomy for brain metastasis resection.
  • To identify pre/peri-operative variables associated with adverse outcomes.

Main Methods:

  • Retrospective analysis of a nationwide, multicenter cohort from the 2012-2015 American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) databases.
  • Inclusion of adult patients who underwent craniotomy for resection of brain metastasis.
  • Analysis of 3500 cases, examining frailty, tumor location (infratentorial), and 30-day medical complications, reoperations, readmissions, and mortality.

Main Results:

  • 17% of patients were frail, and 24% had infratentorial tumors.
  • Common 30-day complications included pneumonia (4%) and venous thromboembolism (3%).
  • Frailty and infratentorial approaches were linked to reoperation and increased mortality, particularly post-discharge. A predictive model for mortality showed good discrimination (AUROC 0.75).

Conclusions:

  • Patient frailty is a significant risk factor for complications and mortality after brain metastasis surgery.
  • Infratentorial tumor location increases risks for reoperation and readmission.
  • Peri-operative strategies should focus on optimizing frailty metrics and enhancing surveillance for patients with infratentorial metastases.