Difference between revisions of "Craniotomy for intracranial vascular malformations"
From WikiAnesthesia
Chris Rishel (talk | contribs) m |
Chris Rishel (talk | contribs) |
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| Line 2: | Line 2: | ||
| anesthesia_type = General | | anesthesia_type = General | ||
| airway = ETT | | airway = ETT | ||
| lines_access = Large bore IV x2 | | lines_access = Large bore IV x2 | ||
Art line | Art line | ||
±Central line (if arterial nidus) | ±Central line (if arterial nidus) | ||
| monitors = Standard | | monitors = Standard | ||
5-lead ECG | 5-lead ECG | ||
Core temp | Core temp | ||
UOP | UOP | ||
ABG | ABG | ||
±CVP (if arterial nidus) | ±CVP (if arterial nidus) | ||
Neuromonitoring | Neuromonitoring | ||
| considerations_preoperative = Characterize neurologic deficits | | considerations_preoperative = Characterize neurologic deficits | ||
| considerations_intraoperative = Smooth induction | | considerations_intraoperative = Smooth induction | ||
Hemodynamic goals vary | Hemodynamic goals vary | ||
Hypotension ↑ risk of steal | Hypotension ↑ risk of steal | ||
If arterial nidus: | If arterial nidus: | ||
*Hypertension ↑ risk of rupture | *Hypertension ↑ risk of rupture | ||
*Have adenosine available | *Have adenosine available | ||
*Decrease CRMO2 | *Decrease CRMO2 | ||
| considerations_postoperative = Avoid hypertension (risk of hyperemia) | | considerations_postoperative = Avoid hypertension after excision (risk of hyperemia) | ||
}} | }} | ||
Revision as of 23:20, 4 April 2022
Craniotomy for intracranial vascular malformations
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
Large bore IV x2 Art line ±Central line (if arterial nidus) |
| Monitors |
Standard 5-lead ECG Core temp UOP ABG ±CVP (if arterial nidus) Neuromonitoring |
| Primary anesthetic considerations | |
| Preoperative |
Characterize neurologic deficits |
| Intraoperative |
Smooth induction Hemodynamic goals vary Hypotension ↑ risk of steal If arterial nidus:
|
| Postoperative |
Avoid hypertension after excision (risk of hyperemia) |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A craniotomy for intracranial vascular malformations is a neurosurgical procedure performed to remove vascular malformations which are considered high risk for rupture or produce neurologic symptoms.
Overview
Background
- Intracranial vascular malformations are congenital defects
- Typically present in young adulthood (most commonly 15-40 years old)
- Wide anatomic variability[1]
- High-flow arteriovenous malformations (AVM)
- Low-flow angiographically occult vascular malformations (AOVM)
- Cavernous malformations
- "Cryptic" AVMs
- Capillary telangiectasias
- Transitional malformations
- Low-flow venous angiomas
Indications
- The Spetzler-Martin AVM grading system estimates morbidity and mortality of surgery[2]
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
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
- ↑ Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (6 ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404.CS1 maint: others (link)
- ↑ Spetzler, R. F.; Martin, N. A. (1986-10). "A proposed grading system for arteriovenous malformations". Journal of Neurosurgery. 65 (4): 476–483. doi:10.3171/jns.1986.65.4.0476. ISSN 0022-3085. PMID 3760956. Check date values in:
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Top contributors: Chris Rishel and Mitchel DeVita