Background: A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.Methods: In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King’s Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.Results: The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0–42.9), Glasgow coma scale scores of 3–8 (OR, 8.2; 95% CI, 1.7–38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6–8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6–7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62–10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003–26.1) were also included.Conclusions: SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.

Enhanced recovery after surgery (ERAS) protocols have reduced the length of hospital stay (LOS) and healthcare costs without increasing adverse outcomes. We describe the impact of adherence to an ERAS protocol for elective craniotomy among neuro-oncology patients at a single institution. This retrospective study enrolled adult patients who underwent elective craniotomy and the ERAS protocol at our institute between January 2020 and April 2021. The patients were divided into high- and low-adherence groups depending on their adherence to ≥9 or 7 days). Among the 100 patients assessed, median adherence was 8 items (range, 4–16), and 55 and 45 patients were classified into the high- and low-adherence groups, respectively. Age, sex, comorbidities, brain pathology, and operative profiles were comparable at baseline. The high-adherence group showed significantly better outcomes, including shorter median LOS (8 days vs. 11 days; p ​= ​0.002) and lower median hospital costs (131,657.5 baht vs. 152,974 baht; p ​= ​0.005). The groups showed no differences in 30-day postoperative complications or Karnofsky performance status. In the multivariable analysis, high adherence to the ERAS protocol (>50%) was the only significant factor preventing delayed discharge (OR ​= ​0.28; 95% CI ​= ​0.10 to 0.78; p ​= ​0.04). High adherence to ERAS protocols showed a strong association with short hospital stays and cost reductions. Our ERAS protocol was feasible and safe for patients undergoing elective craniotomy for brain tumors.

OBJECTIVE: Enhanced recovery after surgery, or the enhanced recovery protocol (ERP), introduces a contemporary concept for perioperative care within neurosurgery. In recent years, mounting evidence has highlighted the significant impact of this approach on brain tumor surgery. The authors conducted a systematic review and meta-analysis of current publications, with a primary focus on assessing the efficiency and safety of implementing ERP in the management of patients undergoing elective craniotomies for brain tumor resection. METHODS: This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in the PROSPERO database. A comprehensive search of the MEDLINE, Cochrane, Scopus, and Embase databases was performed, and two independent reviewers extracted the data, assessed bias, and resolved disagreements through discussion. Primary outcomes included hospital length of stay (LOS) and hospitalization cost. The secondary outcomes were complications, including death, reoperation, readmission, intracerebral hemorrhage, CNS infection, and deep vein thrombosis. A random-effects model was used to evaluate the effects of implementing the ERP using the mean difference (MD) for primary outcomes. Heterogeneity was assessed using I ² statistics, and statistical significance was defined as p < 0.05. RESULTS: Eight studies, including 3 randomized controlled trials, 3 prospective studies, and 2 retrospective studies, were included in this meta-analysis. The ERP group had significantly shorter LOS (MD −2.69, 95% CI −3.65 to −1.73; p < 0.00001, I ² = 87%) and lower hospitalization cost (MD −$1188 [US dollars] 95% CI −$1726 to −$650; p = 0.0008, I ² = 71%) than the non-ERP group. There were no significant differences in the incidence of perioperative complications between the two groups. CONCLUSIONS: This study demonstrated the effectiveness of the ERP in improving postoperative outcomes for patients undergoing elective craniotomies for brain tumors. This protocol has demonstrated the ability to reduce hospital stays and costs while maintaining a low complication rate. However, the study acknowledges the presence of clinical and statistical heterogeneity among the included articles, limiting the scope of its conclusions. Further high-quality comparative studies are necessary to substantiate these findings and establish their reliability.

Background: Remifentanil is favored for neurosurgical pain management, but its utilization in low- and middle-income countries (LMICs) is limited. Scalp block techniques are effective in LMICs, but cost-effectiveness is uncertain. This study compares costs and perioperative outcomes of scalp block versus fentanyl infusion in patients undergoing elective supratentorial craniotomy. Methods: A prospective double-blind randomized controlled trial was conducted with 36 patients aged 18– 65 years undergoing elective supratentorial craniotomy. Patients were randomly assigned to receive either scalp block with 0.5% bupivacaine (Group S) or fentanyl infusion (Group F), with normal saline placebo administered in both groups. The primary endpoint was the anesthetic costs, with secondary endpoints including perioperative opioid consumption, intraoperative hemodynamic changes, and perioperative complications. Results: The cost of fentanyl was significantly lower than that of local anesthetics (3.31 [3.31, 3.75] vs. 4.27 [4.27, 4.27] United States dollars, P < 0.001). However, the overall anesthetic cost did not differ significantly between groups. Group F demonstrated a significant reduction in mean arterial pressure immediately and 5 min after pin insertion compared to Group S (75.8 [13.9] vs. 92.5 [16.9] mmHg, P = 0.003 and 67.7 [6.4] vs. 78.5 [10.7] mmHg, P < 0.001, respectively). Conclusion: Fentanyl infusion presents cost advantages over scalp block in LMIC settings. However, prudent opioid use is imperative. This study underscores the need for ongoing research to optimize neurosurgical pain management and evaluate long-term safety implications.

Context: Primary central nervous system lymphoma (PCNSL) is an uncommon type of brain tumor that has an aggressive disease course. Its outcomes, including factor-related outcomes, are therefore not well established in our country. Aims: This study aims to investigate the outcome and prognostic factors in PCNSL patients at our institute. Settings and Design: Retrospective study in a single university hospital. Subjects and Methods: We reviewed consecutive cases of newly diagnosed PCNSL at Prince of Songkla University from 2005 to 2018. The data were collected to evaluate the treatment outcomes and prognostic factors. Statistical Analysis Used: The Kaplan–Meier method for survival analysis, and Cox regression for variable analysis. Results: Eighty-seven patients met the inclusion criteria. Patients were predominantly male, and their mean age was 58.8 ± 11.2 years. Only four patients were infected with HIV. Motor weakness was the most common presentation, and neuroimaging revealed multiple lesions in 56.3% of patients. The patients were divided into four groups according to treatment modality: palliative treatment, whole-brain radiotherapy (WBRT) alone, chemotherapy (CMT) alone, and combined WBRT and CMT groups. The median overall survival was 7 months. The 1-, 2-, and 5-year survival rates were 29%, 21.5%, and 4.6%, respectively. The age of >60 years was a significant poor prognostic factor. In addition, patients who received combined treatment exhibited the highest survival rate. Conclusions: PCNSL has a low survival rate, even in the present era. Older age is the most substantial factor associated with unfavorable outcomes. The most effective treatment is combined with WBRT and CMT.