Difference between revisions of "Craniotomy for intracranial aneurysm"
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Revision as of 11:39, 5 April 2022
Craniotomy for intracranial aneurysm
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV x2 Arterial line ± Central line |
| Monitors |
Standard ASA 5-lead EKG Core temp UOP ABG ±CVP Neuromonitoring |
| Primary anesthetic considerations | |
| Preoperative |
Characterize neurologic deficits Controlled hypotension |
| Intraoperative |
Smooth induction Controlled hypotension Have adenosine available Decrease CRMO2 Manage ICP |
| Postoperative |
PONV |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A craniotomy for an intracranial aneurysm is a neurosurgical procedure performed to surgically treat intracranial aneurysms to prevent or manage rupture, which can be life-threatening.
Overview
Background
- Intracranial aneurysms are defects of arterial walls which can occur at any of the major bifurcations of the Circle of Willis.
- Most are treated endovascularly
- The Hess and Hunt scale predicts mortality based upon neuro exam findings:
| Hunt-Hess Grading System for Aneurysmal Subarachnoid Hemorrhage[1] | ||
|---|---|---|
| Grade | Description | Mortality |
| I | Asymptomatic, mild headache, slight neck stiffness | 2% |
| II | Moderate-to-severe headache, neck stiffness, no neurologic deficit (other than cranial nerve palsy) | 5% |
| III | Drowsiness, confusion, mild focal neurologic deficit | 15-20% |
| IV | Stupor, moderate-to-severe hemiparesis | 30-40% |
| V | Coma, decerebrate posturing | 50-80% |
Indications
- Complex aneurysms which cannot be definitively treated endovascularly
Surgical procedure
- The procedure is performed through a craniotomy
- For cerebral aneurysms, approach is typically through the sylvian fissure to expose the circle of Willis
- Aneurysms are treated using microsurgical clip ligation, which attempts to isolate defective aneurysmal wall and preserve flow through the vessel[1]
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | If acute, consider RSI |
| Neurologic | Distinguish whether aneurysm has ruptured or not
Identify any neurologic deficits |
| Cardiovascular | Evaluate baseline blood pressure
If ruptured:
|
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
References
- ↑ 1.0 1.1 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)
- ↑ Ahmadian, A.; Mizzi, A.; Banasiak, M.; Downes, K.; Camporesi, E. M.; Thompson Sullebarger, J.; Vasan, R.; Mangar, D.; van Loveren, H. R.; Agazzi, S. (2013). "Cardiac manifestations of subarachnoid hemorrhage". Heart, Lung and Vessels. 5 (3): 168–178. ISSN 2282-8419. PMC 3848675. PMID 24364008.
Top contributors: Chris Rishel and Mitchel DeVita