BOOK
Neurocritical Care Management of the Neurosurgical Patient E-Book
Monisha Kumar | Joshua Levine | James Schuster | W. Andrew Kofke
(2017)
Additional Information
Book Details
Abstract
Kumar and colleagues’ Neurocritical Care Management of the Neurosurgical Patient provides the reader with thorough coverage of neuroanatomical structures, operative surgical approaches, anesthetic considerations, as well as the full range of known complications relating to elective and non-elective neurosurgical procedures. Drawing upon the expertise of an interdisciplinary team of physicians from neurosurgery, neurology, anesthesiology, critical care, and nursing backgrounds, the text covers all aspects intensivists need to be aware of in order to provide optimal patient care.
- Over 100 world-renowned authors from multispecialty backgrounds (neurosurgeons, neuro-interventionalists, and neurointensivists) and top institutions contribute their unique perspectives to this challenging field.
- Six sections cover topics such as intraoperative monitoring, craniotomy procedures, neuroanesthesiology principles, spine and endovascular neurosurgery, and additional specialty procedures.
- Includes 300 tables and boxes, 70 line artworks, and 350 photographic images.
- Clinical pearls pulled out of the main text offer easy reference.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Neurocritical Care Management of the Neurosurgical Patient | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Foreword | ix | ||
| Preface | xi | ||
| List of Contributors | xiii | ||
| Acknowledgements | xxi | ||
| Dedications | xxiii | ||
| Section 1: Neuroanesthesia and Perioperative Care | 1 | ||
| Chapter 1: Effects of Anesthetics, Operative Pharmacotherapy, and Recovery from Anesthesia | 3 | ||
| Introduction | 3 | ||
| Respiratory Muscle Effects | 3 | ||
| Anesthetic Effect on Respiratory Control | 4 | ||
| Anesthetic Effects on Bronchial Tree, Mucociliary Function, and Surfactant Production | 4 | ||
| Anesthesia Effects on Respiratory Arousal from Sleep, Rapid Eye Movement Rebound, and Obstructive Sleep Apnea | 5 | ||
| Effects of Anesthetics and Surgery on Postoperative Nausea and Vomiting | 6 | ||
| Effects of Anesthetics and Surgery on Postoperative Glycemic Control | 7 | ||
| Effects of Anesthetics and Surgery on Temperature Regulation | 8 | ||
| Effects of Anesthetics and Surgery on Pain and Pain Control | 8 | ||
| Effects of Anesthetics and Surgery on Consciousness and Cognition | 9 | ||
| Summary | 10 | ||
| References | 11 | ||
| Chapter 2: Patient Positioning for Neurosurgical Procedures | 15 | ||
| Introduction | 15 | ||
| General Principles | 15 | ||
| Head Fixation and Positioning | 16 | ||
| Head Fixation | 16 | ||
| Head and Neck Positioning | 17 | ||
| Body Positioning | 17 | ||
| Supine Position | 17 | ||
| Lateral Position | 18 | ||
| Prone Position | 20 | ||
| Sitting Position | 21 | ||
| Summary | 23 | ||
| References | 23 | ||
| Chapter 3: Anesthetic Considerations for Craniotomy | 25 | ||
| Introduction | 25 | ||
| Preanesthesia Evaluation and Optimization | 25 | ||
| Goals of Anesthetic Management | 26 | ||
| Airway Management for Craniotomy | 27 | ||
| Choice of Anesthetic Agents | 27 | ||
| Hemodynamic Management under Anesthesia | 28 | ||
| Intraoperative Monitoring | 29 | ||
| Intracranial Pressure Management and Brain Relaxation | 29 | ||
| Glycemic Management | 30 | ||
| Temperature Management | 30 | ||
| Emergence from General Anesthesia | 30 | ||
| Immediate Postoperative Management | 31 | ||
| Summary | 32 | ||
| References | 32 | ||
| Chapter 4: Perioperative Anesthetic and ICU Considerations for Spinal Surgery | 35 | ||
| Introduction | 35 | ||
| Preoperative Planning: Surgical Spine Pathway | 35 | ||
| Pain Control | 35 | ||
| Acute Spine Injury: Preoperative Assessment and Optimization by the Neurointensivist and Anesthesiologist | 36 | ||
| Transfusion Threshold and Correction of Coagulopathy | 36 | ||
| Perioperative Concerns in Management of Patients Undergoing Spinal Surgery | 36 | ||
| Fluid and Hemodynamic Management | 37 | ||
| Intraoperative Emboli | 38 | ||
| Operative Duration and Complications | 38 | ||
| Positioning-Related Complications | 38 | ||
| Physiological Changes | 38 | ||
| Facial and Oropharyngeal Edema Requiring Postoperative Mechanical Ventilation | 38 | ||
| Peripheral Nerve and Skin Positioning Injuries | 39 | ||
| Postoperative Visual Loss | 39 | ||
| Specific Operative Procedures and Complications | 39 | ||
| Anterior Cervical Spine Procedures | 39 | ||
| Nerve Injuries | 40 | ||
| Recurrent Laryngeal Nerve Injury | 40 | ||
| Reintubation and Airway Obstruction from Edema or Hematoma | 41 | ||
| Pharyngeal and Esophageal Perforations | 43 | ||
| Dysphagia | 44 | ||
| Posterior Cervical Spine Procedures | 44 | ||
| Vertebral Artery Injuries | 44 | ||
| Thoracic and Lumbar Spine | 44 | ||
| Blood Loss | 44 | ||
| Postoperative Neurological Complications and Causes for Reoperation | 44 | ||
| Anterior-Posterior and Staged Spine Operations | 45 | ||
| Cervical Spine Fracture in the Elderly | 45 | ||
| Other Complications and Postoperative Management Issues | 45 | ||
| Resuscitation Management in the Neurology Intensive Care Unit | 45 | ||
| Postoperative Epidural Hematomas | 45 | ||
| Postoperative Visual Loss | 46 | ||
| Summary | 47 | ||
| References | 47 | ||
| Chapter 5: Anesthetic Considerations for Endovascular Neurosurgery | 49 | ||
| Introduction | 49 | ||
| The Interventional Neuroradiology Suite | 49 | ||
| Radiation exposure | 49 | ||
| Interventional Neuroradiology Procedures | 50 | ||
| Contrast dye | 50 | ||
| Anesthesia in the Neurointerventional Suite | 50 | ||
| Preoperative assessment | 50 | ||
| Monitoring | 51 | ||
| Anesthetic technique | 51 | ||
| Anticoagulation | 52 | ||
| Postprocedure Care of INR Patients | 52 | ||
| Common INR Procedures | 52 | ||
| Diagnostic cerebral angiogram | 52 | ||
| Coiling of intracranial aneurysms | 53 | ||
| Endovascular treatment of cerebral vasospasm | 55 | ||
| Arteriovenous malformations | 55 | ||
| Therapy for acute ischemic stroke | 56 | ||
| Endovascular carotid and cerebral artery stenting | 57 | ||
| Intracranial tumors | 57 | ||
| Arteriovenous fistulas | 57 | ||
| Summary | 58 | ||
| References | 58 | ||
| Chapter 6: Intraoperative Neuromonitoring for Specific Neurosurgical Procedures | 59 | ||
| Introduction | 59 | ||
| Evoked Potentials | 59 | ||
| Somatosensory evoked potentials | 59 | ||
| Motor evoked potentials | 62 | ||
| Auditory brainstem responses | 64 | ||
| Visual evoked potentials | 66 | ||
| Electromyography | 66 | ||
| Electroencephalography | 68 | ||
| Specific procedures requiring neuromonitoring | 68 | ||
| Conclusion | 69 | ||
| References | 70 | ||
| Chapter 7: Intraoperative Catastrophes | 71 | ||
| Exsanguination | 71 | ||
| Neuroanatomy and procedure | 71 | ||
| Perioperative considerations | 72 | ||
| Postoperative complications | 72 | ||
| Venous Air Embolism | 75 | ||
| Neuroanatomy and procedure | 75 | ||
| Perioperative considerations | 75 | ||
| Postoperative complications | 76 | ||
| Massive Brain Swelling | 76 | ||
| Neuroanatomy and procedure | 76 | ||
| Perioperative considerations | 77 | ||
| Postoperative complications | 77 | ||
| Cardiac Arrest | 77 | ||
| Neuroanatomy and procedure | 77 | ||
| Perioperative considerations | 78 | ||
| Postoperative complications | 79 | ||
| Summary | 80 | ||
| References | 80 | ||
| Section 2: Craniotomy | 83 | ||
| Chapter 8: Carotid Endarterectomy | 85 | ||
| Introduction | 85 | ||
| Neuroanatomy and Procedure | 85 | ||
| Carotid artery anatomy | 85 | ||
| Surgical planning | 85 | ||
| Surgical procedure | 87 | ||
| Perioperative Considerations | 88 | ||
| Postoperative Complications | 89 | ||
| Myocardial infarction | 89 | ||
| Hypertension | 90 | ||
| Hyperperfusion syndrome | 90 | ||
| Intracranial hemorrhage | 90 | ||
| Stroke | 90 | ||
| Neck hematoma | 91 | ||
| Seizure | 91 | ||
| Conclusion | 91 | ||
| References | 92 | ||
| Chapter 9: Aneurysm Surgery | 95 | ||
| Introduction | 95 | ||
| Neuroanatomy and Procedure | 95 | ||
| Microsurgery | 95 | ||
| Patient positioning and surgical approaches | 95 | ||
| Perioperative Considerations | 97 | ||
| Anesthesia and intraoperative medications | 97 | ||
| Intraoperative monitoring and temporary clipping | 97 | ||
| Intraoperative rupture | 98 | ||
| Intraoperative assessment of aneurysm occlusion | 98 | ||
| Emergence from anesthesia | 98 | ||
| Immediate postoperative period | 98 | ||
| Managing surgical drains, dressings, and wounds | 98 | ||
| Postoperative Complications | 99 | ||
| Death | 99 | ||
| Seizures | 99 | ||
| Hydrocephalus, cerebrospinal fluid diversion, and fenestration of the lamina terminalis | 100 | ||
| Postoperative imaging | 100 | ||
| Venous thromboembolism | 100 | ||
| Remote cerebellar hemorrhage | 101 | ||
| Frontal branch of facial nerve injury | 101 | ||
| Frontal sinus violation | 101 | ||
| Postoperative pain | 101 | ||
| Infections | 101 | ||
| Optic neuropathy | 102 | ||
| Conclusions | 102 | ||
| References | 102 | ||
| Chapter 10: Intracranial Arteriovenous Malformations and Dural Arteriovenous Fistulas | 105 | ||
| Introduction | 105 | ||
| Neuroanatomy and Procedure | 105 | ||
| Microsurgery | 108 | ||
| Perioperative Considerations | 110 | ||
| Normal Perfusion Pressure Breakthrough and Occlusive Hyperemia | 111 | ||
| Intraoperative/Postoperative Considerations | 111 | ||
| Conclusions | 113 | ||
| References | 113 | ||
| Chapter 11: Cavernous Malformations | 115 | ||
| Introduction | 115 | ||
| Neuroanatomy and Procedure | 115 | ||
| Perioperative Considerations | 117 | ||
| Postoperative Complications | 118 | ||
| Conclusion | 118 | ||
| References | 119 | ||
| Chapter 12: Bypass Surgeries for Moyamoya Disease | 121 | ||
| Introduction | 121 | ||
| Perioperative Considerations | 121 | ||
| Preoperative evaluation | 122 | ||
| Neuroanatomy and Procedure | 122 | ||
| Surgical treatment | 122 | ||
| Preoperative Preparation | 122 | ||
| Direct revascularization | 122 | ||
| STA-MCA Bypass | 122 | ||
| Indirect revascularization | 126 | ||
| Postoperative Complications | 126 | ||
| Postoperative care | 126 | ||
| Postoperative Hemodynamic Monitoring and Maintenance of Intravascular Volume | 127 | ||
| Postoperative complications | 127 | ||
| Postoperative ischemia | 127 | ||
| Ischemia Due to Failure of Cerebrovascular Reserve | 127 | ||
| Ischemia Due to Graft Occlusion | 127 | ||
| Contralateral Ischemia | 128 | ||
| Ischemia Due to Compression of Donor Vessel | 128 | ||
| Cerebral hyperperfusion syndrome | 128 | ||
| Subdural/epidural hematoma | 130 | ||
| Wound dehiscence | 130 | ||
| Systemic complications | 130 | ||
| Conclusion | 130 | ||
| Acknowledgments | 130 | ||
| Funding Disclosures | 131 | ||
| References | 131 | ||
| Chapter 13: Evacuation of Intracerebral Hemorrhages | 133 | ||
| Introduction | 133 | ||
| Neuroanatomy and Procedure | 133 | ||
| Anatomy and pathology | 133 | ||
| Neurosurgical interventions | 134 | ||
| Posterior fossa hemorrhage | 135 | ||
| Perioperative Considerations | 135 | ||
| Hemostasis | 136 | ||
| Postoperative ICU Management | 137 | ||
| ICP monitoring | 137 | ||
| Management of intracranial hypertension | 138 | ||
| Resumption of anticoagulation | 138 | ||
| Prognostication | 140 | ||
| Conclusions | 140 | ||
| References | 140 | ||
| Chapter 14: Pituitary Surgery | 143 | ||
| Introduction | 143 | ||
| Neuroanatomy and Procedure | 143 | ||
| Surgical approach | 144 | ||
| Transsphenoidal approach | 144 | ||
| Transcranial approach | 146 | ||
| Perioperative Considerations | 147 | ||
| Postoperative Complications | 148 | ||
| Postoperative Management | 148 | ||
| Conclusion | 150 | ||
| References | 150 | ||
| Chapter 15: Meningiomas | 153 | ||
| Introduction | 153 | ||
| Neuroanatomy and Procedure | 153 | ||
| Preoperative Planning | 154 | ||
| Surgery for Meningiomas | 155 | ||
| Specific Considerations | 157 | ||
| Perioperative Considerations | 157 | ||
| Intraoperative Complications | 158 | ||
| Postoperative Complications | 159 | ||
| Follow-up and Prognosis | 161 | ||
| Conclusions | 161 | ||
| References | 162 | ||
| Chapter 16: Gliomas | 163 | ||
| Introduction | 163 | ||
| Neuroanatomy and Procedure | 163 | ||
| Perioperative Considerations | 168 | ||
| Postoperative Complications | 169 | ||
| Conclusions | 174 | ||
| References | 174 | ||
| Chapter 17: Tumors of the Lateral Ventricle and the Pineal Region | 177 | ||
| Introduction | 177 | ||
| Neuroanatomy and Procedure | 177 | ||
| Lateral ventricle tumors | 177 | ||
| Frontal Horn | 177 | ||
| Medial/Lateral Atrium and Temporal Horn | 177 | ||
| Occipital Horn | 178 | ||
| Pineal tumors | 179 | ||
| Surgical Approach: An Overview | 179 | ||
| Infratentorial Supracerebellar Approach | 179 | ||
| Occipital Transtentorial Approach | 179 | ||
| Neuroendoscopy | 179 | ||
| Perioperative Considerations | 180 | ||
| Postoperative Complications | 182 | ||
| Hemorrhage | 182 | ||
| Weakness | 183 | ||
| Visual deficits | 183 | ||
| Seizures | 183 | ||
| Memory loss | 183 | ||
| Miscellaneous | 183 | ||
| Conclusion | 184 | ||
| References | 184 | ||
| Chapter 18: Skull-Base Tumors | 187 | ||
| Introduction | 187 | ||
| Neuroanatomy and Procedure | 187 | ||
| Anterior and Lateral Skull-Base Tumor Pathology | 187 | ||
| Anterior skull base | 187 | ||
| Lateral skull base | 187 | ||
| Surgical Approaches | 187 | ||
| Surgical treatment | 190 | ||
| Perioperative Considerations | 190 | ||
| Postoperative Management | 191 | ||
| ABCs | 192 | ||
| Blood pressure control | 193 | ||
| Nausea/vomiting and diet | 193 | ||
| Pain control | 193 | ||
| Neurologic Complications | 193 | ||
| Cranial neurologic deficit | 194 | ||
| Focal neurologic deficit | 194 | ||
| Global neurologic deficit | 194 | ||
| Cerebrospinal Fluid Leak | 195 | ||
| Seizures | 196 | ||
| Cerebral edema | 196 | ||
| Nonneurologic Complications | 196 | ||
| Infection | 196 | ||
| Orbital edema | 196 | ||
| Conclusion | 196 | ||
| References | 197 | ||
| Chapter 19: Cerebellopontine Angle Tumors | 199 | ||
| Introduction | 199 | ||
| Neuroanatomy and Procedure | 199 | ||
| Perioperative Considerations | 202 | ||
| Postoperative Complications | 202 | ||
| Vascular complications | 202 | ||
| Cranial nerve morbidity | 204 | ||
| Facial Nerve Morbidity | 204 | ||
| Lower Cranial Nerve Morbidity | 205 | ||
| Cerebrospinal fluid leakage | 205 | ||
| Summary | 206 | ||
| References | 206 | ||
| Chapter 20: Infratentorial and Cerebellar Tumors | 209 | ||
| Introduction | 209 | ||
| Neuroanatomy and Procedure | 209 | ||
| Vascular Anatomy | 209 | ||
| Bony Anatomy | 211 | ||
| Perioperative Considerations | 211 | ||
| Postoperative Complications | 212 | ||
| Conclusion | 215 | ||
| References | 215 | ||
| Chapter 21: Postoperative Management Following Craniotomy for ReSection of Metastatic Lesions | 217 | ||
| Introduction | 217 | ||
| Neuroanatomy | 217 | ||
| Perioperative Considerations | 218 | ||
| Postoperative Management | 218 | ||
| Communicating Expected Clinical Trajectory | 218 | ||
| Ventriculostomy | 220 | ||
| Seizure Prophylaxis and Postoperative Steroids | 221 | ||
| Blood Pressure Management | 221 | ||
| Pain Control | 222 | ||
| Maintaining Eunatremia | 222 | ||
| Venous Thromboembolism Prophylaxis | 222 | ||
| Antibiotics and Prevention of Wound Infection | 222 | ||
| Transition from the Intensive Care Unit | 222 | ||
| References | 223 | ||
| Chapter 22: Standard Temporal Lobectomy | 225 | ||
| Introduction | 225 | ||
| Neuroanatomy and Procedure | 225 | ||
| Operative Procedure | 226 | ||
| Postoperative Complications | 227 | ||
| Conclusions | 229 | ||
| References | 229 | ||
| Chapter 23: Postoperative Care of the Epilepsy Patient with Invasive Monitoring | 231 | ||
| Introduction | 231 | ||
| Neuroanatomy and Procedure | 231 | ||
| Neuroanatomy | 231 | ||
| Overview of surgical procedure | 231 | ||
| Perioperative Considerations | 234 | ||
| Postoperative Complications | 235 | ||
| Infection | 235 | ||
| Hemorrhage | 236 | ||
| Elevated Intracranial Pressure and Cerebral Edema | 237 | ||
| Cerebrospinal Fluid Leak | 238 | ||
| Conclusions | 238 | ||
| References | 239 | ||
| Chapter 24: Deep Brain Stimulation | 241 | ||
| Introduction | 241 | ||
| Neuroanatomy and Procedure | 241 | ||
| Stereotactic Placement of Deep Brain Stimulation Leads | 241 | ||
| Surgical Procedure | 242 | ||
| Placement of the Implantable Pulse Generator and Initiation of Stimulation | 244 | ||
| Perioperative Considerations | 244 | ||
| Anesthesia | 244 | ||
| Withdrawal of Dopamine Replacement Therapy in Patients with Parkinsons Disease | 244 | ||
| Perioperative and Postoperative Complications | 245 | ||
| Intracranial Hemorrhage | 245 | ||
| Ischemic Stroke | 247 | ||
| Neurological Deficits Not Due to Hemorrhage or Ischemia | 247 | ||
| Delirium | 247 | ||
| Seizure | 247 | ||
| Venous Air Embolus | 247 | ||
| Other Respiratory Complications | 248 | ||
| Infection | 248 | ||
| Misplaced Leads and Lead Migration | 248 | ||
| Long-Term Hardware Complications: Lead Fracture, Device Erosion, and Premature IPG Failure | 248 | ||
| Thermal Lesion | 249 | ||
| Conclusions | 249 | ||
| References | 250 | ||
| Chapter 25: Stereotactic Radiosurgery | 253 | ||
| Neuroanatomy and Procedure | 253 | ||
| Preoperative and Perioperative Management Considerations | 255 | ||
| Management of Intraoperative and Postoperative Complications | 255 | ||
| Acute complications | 255 | ||
| Early delayed complications | 256 | ||
| Late complications | 256 | ||
| Radiation Necrosis | 256 | ||
| Secondary Malignancy | 257 | ||
| Conclusion | 257 | ||
| References | 257 | ||
| Chapter 26: Hemorrhagic Mass Lesions | 261 | ||
| Introduction | 261 | ||
| Neuroanatomy and Procedure | 261 | ||
| Neuroanatomy of Traumatic Hemorrhagic Mass Lesions | 261 | ||
| Epidural Hematoma | 262 | ||
| Subdural Hematoma | 262 | ||
| Subarachnoid Hemorrhage | 262 | ||
| Contusion and Intraparenchymal Hemorrhage | 262 | ||
| Microhemorrhages and Diffuse Axonal Injury | 264 | ||
| Procedure | 264 | ||
| External Ventricular Drain/Intracranial Pressure and Oxygenation Monitors | 264 | ||
| Procedure | 265 | ||
| Craniotomy and Hemicraniectomy | 265 | ||
| Perioperative considerations | 265 | ||
| Initial Management from Trauma bay to Scanner to Operating Room | 266 | ||
| Immediate Interventions to Manage Intracranial Pressure | 267 | ||
| Management of Coagulopathy | 267 | ||
| Seizure Prophylaxis | 267 | ||
| Postoperative complications | 267 | ||
| Herniation/withdrawal of care/death | 267 | ||
| Contralateral bleed | 268 | ||
| Expansion of intraparenchymal hemorrhage | 268 | ||
| Hypotension | 268 | ||
| Seizure | 268 | ||
| Hydrocephalus | 268 | ||
| Hyponatremia and hypernatremia | 268 | ||
| External cerebral herniation | 269 | ||
| Deep venous thrombosis/pulmonary embolism | 269 | ||
| Wound infection | 269 | ||
| Anemia requiring transfusion | 269 | ||
| Trephination syndrome | 269 | ||
| Hemorrhage around external ventricular drain and intracranial pressure monitor | 270 | ||
| Subdural hygroma formation | 270 | ||
| Conclusions | 270 | ||
| References | 270 | ||
| Chapter 27: Penetrating Traumatic Brain Injury | 273 | ||
| Introduction | 273 | ||
| Neuroanatomy | 273 | ||
| Perioperative Considerations | 274 | ||
| Evaluation and resuscitation | 274 | ||
| Laboratory Studies | 274 | ||
| Preoperative Imaging | 274 | ||
| Procedure | 275 | ||
| Vascular injury | 276 | ||
| Postoperative Complications | 277 | ||
| Cerebral swelling and intracranial pressure | 277 | ||
| Cerebrospinal fluid leak | 277 | ||
| Infection | 277 | ||
| Vascular injury | 278 | ||
| Traumatic Intracranial Aneurysms | 278 | ||
| Vasospasm | 278 | ||
| Arterial DisSection s | 279 | ||
| Arteriovenous Fistula | 280 | ||
| Posttraumatic epilepsy | 280 | ||
| Outcome | 280 | ||
| Conclusions | 280 | ||
| References | 281 | ||
| Chapter 28: Depressed Skull and Facial Fractures | 283 | ||
| Introduction | 283 | ||
| Neuroanatomy and Procedure | 283 | ||
| Biomechanics of Traumatic Skull Fractures | 283 | ||
| Periprocedural and Anesthetic Considerations | 283 | ||
| Infectious Risk | 284 | ||
| Sinus Injury | 285 | ||
| Maxillofacial Trauma | 285 | ||
| Orbital Trauma | 285 | ||
| Cerebrospinal Fluid Fistulae, Meningitis, and Cranial Neuropathies | 285 | ||
| Preoperative Considerations | 286 | ||
| Perioperative Surgical Care | 287 | ||
| Depressed Skull Fractures | 287 | ||
| Management of Venous Sinus Thrombosis | 287 | ||
| Cerebrospinal Fluid Fistulae Repair | 288 | ||
| Skull-Base Fractures | 289 | ||
| Occipital Condylar Fractures | 289 | ||
| Facial Fractures | 289 | ||
| Postoperative Complications | 290 | ||
| Seizures | 290 | ||
| Hemorrhagic and Thrombotic Complications in the Intensive Care Unit | 290 | ||
| Adrenal Insufficiency | 290 | ||
| Delayed Return to Operating Room | 290 | ||
| Functional Outcome and Mortality | 291 | ||
| Conclusions | 291 | ||
| References | 291 | ||
| Chapter 29: Decompressive Craniectomy for the Treatment of Traumatic Brain Injury | 293 | ||
| Neuroanatomy and Procedure | 293 | ||
| Perioperative Considerations | 295 | ||
| Postoperative Complications | 296 | ||
| Immediate postoperative period | 296 | ||
| Postcraniectomy Intracranial Hypertension | 296 | ||
| Later complications | 297 | ||
| Conclusions | 298 | ||
| References | 299 | ||
| Section 3: Spinal Surgery | 301 | ||
| Chapter 30: Spine Trauma and Spinal Cord Injury | 303 | ||
| Introduction | 303 | ||
| Pathophysiology and Classification | 303 | ||
| Neurological Status | 306 | ||
| Management | 307 | ||
| Cervical Traction | 307 | ||
| Blood Pressure Management | 308 | ||
| Autonomic Derangements | 308 | ||
| Pulmonary/Airway Issues | 309 | ||
| Prevention of Venous Thromboembolism | 309 | ||
| Vertebral Artery Injury | 310 | ||
| Steroids | 310 | ||
| Traumatic Central Cord Syndrome | 311 | ||
| Contracture Prevention | 311 | ||
| Penetrating Spinal Cord Injury | 311 | ||
| Cervical Spine Clearance in the Comatose Patient | 312 | ||
| Prognosis | 312 | ||
| Hypothermia | 313 | ||
| References | 313 | ||
| Chapter 31: Anterior Cervical Spine Surgery Complications | 315 | ||
| Introduction | 315 | ||
| Neuroanatomy and details of the anterior approach | 315 | ||
| Cervical Spine Neuroanatomy | 315 | ||
| Neck Anatomy | 315 | ||
| Details of the Procedure | 316 | ||
| Perioperative considerations | 317 | ||
| Preoperative Considerations | 317 | ||
| Intraoperative Considerations | 317 | ||
| Postoperative Considerations | 318 | ||
| Complications | 318 | ||
| Conclusion | 320 | ||
| References | 321 | ||
| Chapter 32: Posterior Approaches to the Spine | 323 | ||
| Introduction | 323 | ||
| Neuroanatomy | 323 | ||
| Regional Considerations | 323 | ||
| Cervical spine | 323 | ||
| Thoracic spine | 325 | ||
| Lumbar spine and sacrum | 326 | ||
| General Perioperative and Postoperative Considerations | 327 | ||
| Perioperative Considerations | 328 | ||
| Postoperative Considerations/Complications | 329 | ||
| References | 330 | ||
| Chapter 33: Transthoracic and Transabdominal Approaches to the Spine | 333 | ||
| Introduction | 333 | ||
| Neuroanatomy and Procedure | 333 | ||
| Transthoracic approaches | 333 | ||
| General Considerations and Indications | 333 | ||
| Neuroanatomy | 333 | ||
| Procedure | 334 | ||
| Transabdominal approach: anterior approaches | 335 | ||
| General Considerations and Indications | 335 | ||
| Neuroanatomy | 336 | ||
| Procedure | 336 | ||
| Transabdominal approach: lateral approach | 337 | ||
| Neuroanatomy | 337 | ||
| Procedure | 337 | ||
| Perioperative Considerations | 337 | ||
| Transthoracic Approaches | 337 | ||
| Anterior Lumbar Interbody Fusion | 339 | ||
| Lateral Lumbar Interbody Fusion | 339 | ||
| Postoperative complications | 339 | ||
| Transthoracic Approaches | 339 | ||
| Anterior Lumbar Interbody Fusion | 340 | ||
| Lateral Lumbar Interbody Fusion | 341 | ||
| Conclusion | 341 | ||
| References | 341 | ||
| Section 4: Endovascular Neurosurgery | 343 | ||
| Chapter 34: Carotid and Intracranial Stent Placement | 345 | ||
| Neuroanatomy and Procedure | 345 | ||
| Cervical carotid artery stent placement | 345 | ||
| Intracranial stent placement | 345 | ||
| Perioperative Considerations | 349 | ||
| Cervical carotid artery stent placement | 349 | ||
| Intracranial stent placement | 350 | ||
| Considerations for antiplatelet medication treatment | 350 | ||
| Complications (Table 34.2) | 351 | ||
| Acute stroke after carotid stenting | 351 | ||
| Autonomic dysfunction | 352 | ||
| Background | 352 | ||
| Pathophysiology | 352 | ||
| Predictors of Dysautonomia after Carotid Artery Stenting | 352 | ||
| Outcomes | 352 | ||
| Management | 353 | ||
| Cerebral hyperperfusion syndrome | 353 | ||
| Acute coronary syndrome and myocardial infarction | 353 | ||
| Access site complications | 354 | ||
| References | 354 | ||
| Chapter 35: Endovascular Management of Intracranial Aneurysms | 357 | ||
| Neuroanatomy and Procedure | 357 | ||
| Anesthetic considerations/procedural considerations | 357 | ||
| Technique options | 357 | ||
| Perioperative Considerations | 358 | ||
| Peripheral vascular disease | 358 | ||
| Renal disease | 358 | ||
| Contrast allergy | 358 | ||
| Heparin-Induced Thrombocytopenia | 358 | ||
| Intraoperative and Postoperative Complications | 358 | ||
| Thromboembolic events | 359 | ||
| Hemorrhagic events | 360 | ||
| Heparin-induced thrombocytopenia | 361 | ||
| Vascular Access Complications | 361 | ||
| References | 362 | ||
| Chapter 36: Arteriovenous Malformation and Dural Arteriovenous Fistula Embolization | 365 | ||
| Neuroanatomy and Procedure | 365 | ||
| Cerebral arteriovenous malformations | 365 | ||
| Intracranial dural arteriovenous fistulas | 367 | ||
| Imaging and angiographic aspects | 369 | ||
| Perioperative Considerations | 370 | ||
| Postoperative Complications | 371 | ||
| Conclusion | 372 | ||
| References | 374 | ||
| Chapter 37: Acute Stroke Management | 377 | ||
| Introduction | 377 | ||
| Neuroanatomy and Procedure | 377 | ||
| Considerations and Indications for Endovascular Therapy | 380 | ||
| Perioperative Considerations | 382 | ||
| Blood Pressure Management | 382 | ||
| Hydration | 382 | ||
| Head of Bed | 383 | ||
| Antithrombotic Therapy Prior to Endovascular Therapy | 383 | ||
| Anesthesia | 383 | ||
| Antithrombotic Management: Intraprocedure | 384 | ||
| Neuroimaging and Monitoring | 384 | ||
| Blood Pressure: Postprocedure | 384 | ||
| Antithrombotic Therapy: Postprocedure | 385 | ||
| Postoperative Complications | 385 | ||
| Intracranial Hemorrhage | 385 | ||
| Air Emboli | 386 | ||
| Arterial DisSection | 386 | ||
| Carotid Cavernous Fistula | 386 | ||
| Emboli to New Vascular Territories and In Situ Thrombosis | 386 | ||
| Conclusion | 387 | ||
| References | 387 | ||
| Chapter 38: Tumor Embolization | 391 | ||
| Introduction | 391 | ||
| Tumor Vascular Supply | 391 | ||
| Tumors Frequently Requiring Embolization | 391 | ||
| Juvenile nasal angiofibroma | 391 | ||
| Paragangliomas | 391 | ||
| Meningiomas | 393 | ||
| Hemangiomas | 393 | ||
| Hemangioblastomas | 393 | ||
| Hemangiopericytomas | 393 | ||
| Details of Procedure | 394 | ||
| Perioperative Considerations | 395 | ||
| Choosing Embolic Material | 396 | ||
| Polyvinyl alcohol | 396 | ||
| Gelfoam | 396 | ||
| Embospheres | 396 | ||
| N-butyl cyanoacrylate | 396 | ||
| Alcohol | 396 | ||
| Onyx (ethylene vinyl alcohol) | 396 | ||
| Dangerous Anastomoses | 396 | ||
| Balloon Test Occlusion | 397 | ||
| Timing of Presurgical Embolization | 398 | ||
| Postoperative Complications | 399 | ||
| Summary | 400 | ||
| References | 400 | ||
| Chapter 39: Spinal Vascular Lesions | 401 | ||
| Neuroanatomy and Procedure | 401 | ||
| Embryology | 401 | ||
| Spinal Vascular Unit | 401 | ||
| Anatomical Variations of the Spinal Segments | 401 | ||
| Spinal Anastomosis | 401 | ||
| Extrinsic and Intrinsic Supply of the Spinal Cord | 401 | ||
| Spinal Venous System | 402 | ||
| Classification of Vascular Spinal Lesions | 402 | ||
| Perioperative Considerations: Endovascular Treatment | 407 | ||
| Postoperative Complications | 408 | ||
| Surgical Complications Specific to Spinal DAVFs | 410 | ||
| Surgical Complications Specific to Spinal Intramedullary AVMs | 411 | ||
| References | 412 | ||
| Section 5: Intracranial Monitors and Special Procedures | 413 | ||
| Chapter 40: Shunt Placement and Management | 415 | ||
| Introduction | 415 | ||
| Neuroanatomy and Procedure | 415 | ||
| Ventricular system anatomy | 415 | ||
| Diagnosis | 415 | ||
| Surgical approach for placement of ventricular catheter | 415 | ||
| Indications for external ventricular drainage | 416 | ||
| Treatment | 417 | ||
| Nonsurgical Options | 417 | ||
| Surgical: Nonshunting Options | 418 | ||
| Surgical: CSF Shunts | 419 | ||
| Components | 419 | ||
| Perioperative Considerations | 419 | ||
| Anesthetic considerations | 419 | ||
| Intracranial pressure and cerebrospinal fluid dynamics | 419 | ||
| Pathophysiology and need for csf diversion | 422 | ||
| Postoperative Complications | 422 | ||
| Shunt complications | 422 | ||
| Shunt infection | 423 | ||
| Shunt obstruction | 424 | ||
| Uncommon shunt complications | 426 | ||
| References | 426 | ||
| Chapter 41: Placement and Complications of Intracranial Monitors and Lumbar Drains | 429 | ||
| Neuroanatomy and Procedure | 429 | ||
| External Ventricular Drain | 429 | ||
| Intracranial Pressure Monitor | 430 | ||
| Lumbar Drain | 430 | ||
| Postoperative Complications of External Ventricular Drains and Intracranial Pressure Monitors | 431 | ||
| Infection | 431 | ||
| Hemorrhage | 432 | ||
| Misplacement | 433 | ||
| Postoperative Complications of Lumbar Drains | 433 | ||
| Intracranial Hemorrhage | 433 | ||
| Intracranial Hypotension | 434 | ||
| Infection | 434 | ||
| Minor Side Effects | 434 | ||
| Perioperative Considerations of Intracranial Monitoring and Lumbar Drainage | 434 | ||
| Adjunct Technologies for Catheter Placement | 435 | ||
| Catheter Selection | 435 | ||
| Percutaneous Tunneling | 435 | ||
| Prophylactic Antibiotics | 435 | ||
| Catheter Exchange | 435 | ||
| Routine Cerebrospinal Fluid Analysis | 436 | ||
| References | 436 | ||
| Chapter 42: Management of Flaps | 439 | ||
| Introduction | 439 | ||
| Anterior lateral thigh flap (Fig. 42.2) | 439 | ||
| Anatomy | 439 | ||
| Flap Elevation | 439 | ||
| Latissimus dorsi flap (Fig. 42.3) | 440 | ||
| Anatomy | 440 | ||
| Section 6: Specific Intensive Care Unit Complications | 467 | ||
| Chapter 45: Delayed Emergence after Neurosurgery | 469 | ||
| Introduction | 469 | ||
| Emergence from Neurosurgical Procedures | 469 | ||
| Approach to Delayed Emergence | 470 | ||
| Preoperative causes | 470 | ||
| Intraoperative causes | 471 | ||
| Anesthetic/Medication-Related Causes | 471 | ||
| Metabolic Causes | 472 | ||
| Hemodynamic Causes | 472 | ||
| Postoperative causes | 472 | ||
| Surgical Causes | 474 | ||
| Residual Anesthetic Drug Causes | 474 | ||
| Conclusion | 474 | ||
| References | 474 | ||
| Chapter 46: Management of Postoperative Hemorrhage | 477 | ||
| Introduction | 477 | ||
| Epidemiology | 477 | ||
| Index | 519 | ||
| Inside Back cover | ES3 |