The Preoperative Evaluation of the Neurosurgical Patient

Abstract

Neurosurgical operations include a wide array of surgeries ranging from craniotomies for tumors to embolization of cerebral vascular malformations in interventional radiology suites. Each neurosurgical procedure is associated with significantly different risks and anesthetic requirements, and the preanesthetic assessment of neurosurgical patients must include an assessment of the unique features of both the patient and the procedure. Despite the variety inherent to these neurosurgical cases, there are several essential elements that should be addressed during all preanesthetic evaluations. 1-3 In this chapter, we will provide a broad overview of the basic preanesthetic evaluation in addition to more detailed information for select conditions and procedures. ' Establishing the Surgical IssueNeurosurgical procedures probably vary in type, invasiveness, and timing more than many other surgeries within a specialty. Therefore the first step in the preoperative evaluation for cranial surgery is to establish the diagnosis and the extent of the planned procedure. This may be broadly done by distinguishing patients with neurovascular conditions (arteriovenous malformations, aneurysms), tumors (benign or malignant), and functional disorders. The next step is to establish the immediate urgency of the procedure: emergent, urgent or elective. Establishing the urgency is critical; the patient with a cerebral aneurysm presents a good example. The patient may present intubated, having suffered a subarachnoid hemorrhage (SAH) needing an emergency

Grundlagen und Praxis der Neuroanästhesie

“…Dieser kann einerseits durch einen erhöhten jugularvenösen Druck (extreme Kopfrotation, direkter Druck auf Jugularvenen, Hämatom nach einer akzidentiellen Punktion der A. carotis, Kopftieflagerung), andererseits durch einen hohen Atemwegsdruck (Bronchospasmus, Husten und Pressen des Patienten, hoher PEEP und Pneumothorax) beeinträchtigt werden. Osmotherapeutika und Steroide (letztere nur bei Hirntumoren) werden zur Verringerung des Flüssigkeitskompartiments eingesetzt [3].…”

Editorial: Potential clinical applications of circulating microRNAs in neurosurgery

“…Diagnosis plays a crucial role in making a prognosis and choosing the best therapy for brain tumors. Despite significant recent advances in the diagnosis of brain tumors using various modifications of imaging techniques followed by histopathological examination, tumor detection is still limited by its size and location, as well as by the heterogeneity of its tissue ( 1 ). In this regard, it is necessary to develop new diagnostic approaches that, together with the available methods, will improve the accuracy of diagnosis.…”

“…A promising approach is fluid biopsy, which involves finding and measuring the levels of various circulating molecules in human body fluids such as blood or cerebrospinal fluid (CSF). In addition, given that computed tomography angiography (CTA), magnetic resonance angiography (MRA), and selective cerebral angiography (SCA) are either unavailable or do not provide clear evidence of possible rupture of intracranial aneurysms (IAs), accurate and reliable analysis of the molecular profile in biological fluids can help in the early diagnosis and prognosis of rupture, as well as likely mortality and morbidity or prognostic outcome of patients with subarachnoid hemorrhage (SAH) to stratify patients admitted to hospitals ( 1 ). MicroRNAs (miRNAs) are promising candidates for the role of such biomarkers.…”