Craniotomy for cerebral embolectomy

Craniotomy for cerebral embolectomy

Anesthesia type	General
Airway	RSI w/ETT
Lines and access	Large bore IV Arterial line
Monitors	Standard 5-lead ECG Temperature ABP Neuromonitoring
Primary anesthetic considerations
Preoperative	Avoid hypotension to maintain CPP
Intraoperative	Neuroprotection during arterial occlusion Consider mild hypothermia
Postoperative
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A craniotomy for cerebral embolectomy is a neurosurgical procedure performed to remove intravascular clots from intracranial vessels.

Overview

Indications

• Most intracranial clots are treated with intravenous and/or endovascular intraarterial thrombolysis
• Clots which require mechanical removal are most commonly treated with endovascular thrombectomy
• Some emboli are less amenable to endovascular therapy and require microsurgical removal via craniotomy
  • Large atherosclerotic plaques
  • Foreign bodies (e.g. balloons, microcoil)
• Best outcomes if embolectomy performed within 6-24 hours of symptom onset

Preoperative management

Patient evaluation

System	Considerations
Airway	Full stomach precautions
Neurologic	Neuro exam to identify deficits
Cardiovascular	Evaluate for HTN, CAD, Atrial fibrillation, PVD

Procedure variants

	Variant 1	Variant 2
Unique considerations
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