Difference between revisions of "Craniotomy for extracranial-intracranial revascularization"
| Line 27: | Line 27: | ||
|Neurologic | |Neurologic | ||
| | | | ||
* Patients typically presenting with focal neurologic symptoms. Pre-existing deficits should be well characterized and documented. | |||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | | | ||
* Hypertension is a common adaptive response to maintain CPP. | * Hypertension is a common adaptive response to maintain CPP. A normal BP may be undesirable in the setting of severe cerebrovascular disease. | ||
* Patients may have generalized vascular disease, including CAD. | * Patients may have generalized vascular disease, including CAD. | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | | | ||
* Patients often on aspirin through day of surgery | |||
* Anticoagulants impacting PT/PTT typically discontinued 1 week prior to surgery | |||
|- | |- | ||
|Renal | |Renal | ||
| Line 60: | Line 56: | ||
* Chemistry panel | * Chemistry panel | ||
* Coagulation panel | * Coagulation panel | ||
* Cerebral angiography performed to identify cause of neurologic symptoms | |||
=== Operating room setup === | === Operating room setup === | ||
Revision as of 08:41, 10 February 2021
| File:EC-IC Bypass .jpg | |
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV x 2 |
| Monitors |
Standard ASA |
| Primary anesthetic considerations | |
| Preoperative |
Smooth induction |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 2 |
Extracranial-intracranial (EC-IC) revascularization (also referred to as EC-IC bypass) is a surgical procedure to increase cerebral blood flow. The procedure involves connecting a branch of the external carotid artery (typically the superficial temporal artery) to a branch of the internal carotid artery (typically the middle cerebral artery). The anastomosis can be achieved via a vein graft or a direct connection.
EC-IC bypass is generally indicated for severe stenosis or occlusion of intracranial arteries that is resulting in focal neurological symptoms. In children, this procedure is used to treat Moya-moya disease.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic |
|
| Cardiovascular |
|
| Hematologic |
|
| Renal | |
| Endocrine | |
| Other |
Labs and studies
- EKG
- Echo (if concern for cardiovascular disease)
- Coronary angiography (depending on cardiac risk factors)
- Complete blood count
- Chemistry panel
- Coagulation panel
- Cerebral angiography performed to identify cause of neurologic symptoms
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Chris Rishel and Barrett Larson