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Pregnancy

Pathology of the central nervous system remains the leading cause of indirect maternal mortality. While some disease processes predate pregnancy, such as epilepsy, multiple sclerosis, benign intracranial lesions, and migraine, there are other conditions that have an increased incidence during pregnancy. These include cerebrovascular disorders, both hemorrhagic and vaso-occlusive strokes, and symptomatic disk herniation. Trauma during pregnancy, including head injury, is a leading cause of incidental…

Postoperative Cognitive Dysfunction

Introduction In the middle of the past century, Bedford in his retrospective study first described the adverse effect of anesthesia in elderly patients. Considering the extended lifespan and growing number of aged population, health professionals are now facing this problem in an extended way. Postoperative delirium (POD) is one of the common but sometimes unrecognized postoperative complications. Its incidence varies between 25% and 60% in elderly…

Geriatric Neuroanesthesia

Introduction The world is getting grayer as a result of the improvements in technology and health care facilities. The burden of disease has increased with the mean age of the population as has the stress on overstretched health care resources the world over. As a greater number of older patients (>65 years) come for a greater variety of neurosurgical diseases and surgeries, it becomes imperative to…

Fluid and Blood Transfusion in Pediatric Neurosurgery

Introduction Children can present for various intracranial surgeries, which include intracranial tumors, vascular malformations [arteriovenous (AV) malformations, Moyamoya disease], and spine surgeries (e.g., scoliosis, release of tethered cord, laminectomies, etc.). Neonates and infants can present for craniosynostosis correction, congenital hydrocephalus requiring shunt surgeries, etc. It should be kept in mind that children are not “small adults.” Their body physiology and response to fluids and blood loss…

Pediatric Neuroanesthesia

Overview Advances in neurosurgery and neuromonitoring have dramatically improved the outcome in neurologically injured patients. Most of these advanced technologies have been utilized in the adult population and have also been extrapolated to children with improved perioperative outcome. Pediatric neurosurgical patients present a set of inherent challenges because of their developing and maturing neurologic and physiologic status apart from the associated central nervous system (CNS) disease…

Antibiotics: Prophylactic and Therapeutics

Introduction Neurosurgical infections of the central nervous system (CNS) are not particularly common but have potentially serious consequences with poor outcomes including death. This chapter focuses on the antimicrobial treatment and prophylaxis of important infections associated with neurosurgical procedures and highlights some basic principles for the rational use of antibiotics in neurosurgery. Principles of Antimicrobial Therapy in Neurosurgery The appropriate antimicrobial therapy of CNS infections remains…

Neurological Critical Care

Introduction Neurological critical care has evolved rapidly over the past 25 years. A rational amalgamation of the science of critical care with developments in neurosciences has paved way for a modern neurological intensive care unit (ICU). Comprehensive general medical care combined with specialized neurological care through management of intracranial pressure (ICP) and blood flow dynamics, advanced neuromonitoring [e.g., electroencephalography (EEG), brain tissue oxygen (PbtO 2 ),…

Biomarkers in Traumatic Brain Injury

Introduction Traumatic brain injury (TBI) induces a complex array of immunological/inflammatory cellular responses. Primary and secondary insults activate the release of cellular mediators including proinflammatory cytokines, prostaglandins, free radicals, and complement activators. These processes induce chemokines and adhesion molecules, which in turn mobilize immune and glial cells in a parallel and synergistic fashion. The progression of tissue damage relates to direct release of neurotoxic mediators or…

Neurotrauma

Traumatic Brain Injury Introduction Traumatic brain injury (TBI) is among the most common of serious, disabling neurological disorders. The consequences of trauma to the brain may be a wide variety of pathophysiological effects, a range of severities, and a multitude of problems. It is a complex disease involving both primary and secondary injuries, with secondary injury involving complex biochemical cascades that lead to oxidative injury, excitotoxicity,…

Magnetic Resonance Imaging: Anesthetic Implications

Introduction: The Road From X-Ray to Magnetic Resonance Imaging The field of radiology and diagnostic imaging (as it is referred to now) has progressed through some revolutionary scientific innovations in the past century. With every breakthrough, while the diagnostic capabilities improved dramatically the practice of medicine also benefited significantly. The major imaging techniques that were invented/developed in the past century started with the plain X-ray, followed…

Anesthesia for Neuroradiology

Introduction Anesthesia for neuroradiology forms an important part of neuroanesthesia services. This entails adequate understanding of the 4 P s; patient, pathology, procedure, and periprocedural environment. Both the number and complexity of diagnostic and interventional cases performed in neuroradiology under anesthesia are increasing. In our hospital, neuroradiological procedures performed in the past year constituted a significant 34% of operation theater (OT) procedures under anesthesia (Annual report…

Awake Craniotomy

Introduction Awake craniotomy is a procedure in which the patient is awake for some period of time to allow for neurological testing. This concept is not new and developed along with the concept of brain mapping, which was initially used to localize the epileptic focus in patients undergoing epilepsy surgery. With the advancement in neurosurgical techniques, neuroimaging, intraoperative cortical mapping, and anesthesia, the scope of awake…

Anesthesia for Functional Neurosurgery

Introduction Functional neurosurgery is a neurosurgical procedure done for improvement of symptoms by making small well-circumscribed lesions or through neuromodulation by brain, spinal cord, or nerve stimulation. It involves surgical management of central nervous system (CNS) disorders that do not have any gross anatomical abnormality, and it is quite different from nonfunctional neurosurgery. As compared to functional neurosurgery, nonfunctional neurosurgery typically involves surgical ablation of anatomically…

Pressure Inside the Neuroendoscope

Introduction Endoscopy allows direct vision of brain structures without the need for large cranial openings. Neuroendoscopic transcortical intraventricular approach, adopted in the early 1920s thanks to Walter Dandy among all, has permitted neurosurgeons to access deep structures within both the cranial and spinal compartments thanks to its panoramic views, proximity to the surgical target, and minimization of tissue retraction and brain manipulation. The development of microneurosurgery…

Neuroendoscopy

Introduction History The endoscope was used for the first time in the treatment of hydrocephalus by L’Espinasse in 1910. Later, Dandy pioneered this technique and was named, “the father of neuroendoscopy.” Soon, the endoscope found its place for various neurosurgical indications. The first endoscopic third ventriculostomy was reported by Mixter in 1923. After an initial large gap of 50 years, the use of neuroendoscopy unfolded in…

Postoperative Visual Loss

Introduction Postoperative visual loss (POVL) after nonocular surgery is an uncommon but devastating complication. POVL is most common after cardiac surgery followed by prone spine and head and neck procedures, with a national incidence ranging from 0.03 to 0.28% in these higher risk surgeries. Specific institutions may see lower or higher rates, which may be related to the types of procedures performed, the patient population, or…

Spinal Surgery

Introduction Over the past few decades, spinal surgery has evolved into an extremely specialized field; highly complex instrumentation procedures are increasingly being performed, across all age groups, and often through minimally invasive approaches. Needless to say, successful outcome of these surgeries demands an equally intricate and well-planned anesthesia strategy, which is based on a comprehensive understanding of the causative pathology, along with a precise knowledge of…

Neuroendocrine Lesions

The neuroendocrine system is responsible for the maintenance of milieu interior and facilitation of reproduction through secretion of various hormones. These hormones are regulated by interactions and feedback loops between the central nervous system, the endocrine glands, and the target organs. The hypothalamus is the chief signaling station, producing neurohormones, which are then transported to the pituitary gland. The latter in turn, produces hormones that regulate…

Flow Arrest in Cerebrovascular Surgery

Deep Hypothermic Circulatory Arrest Historical Use of Hypothermic Circulatory Arrest in Neuroanesthesia In 1955, Lougheed et al. demonstrated that cerebral injury due to anoxia from arrest of cerebral circulation in animals could be reduced under hypothermic conditions. In the same year, a case report was published on the use of hypothermic circulatory arrest for excision of a large arteriovenous malformation in a 17-year-old male patient. However, despite…