Difference between revisions of "Craniotomy for cerebral embolectomy"
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{{Infobox surgical | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
| airway = | | airway = RSI w/ETT | ||
| lines_access = | | lines_access = Large bore IV | ||
| monitors = | Arterial line | ||
| considerations_preoperative = | | monitors = Standard | ||
| considerations_intraoperative = | 5-lead ECG | ||
Temperature | |||
ABP | |||
Neuromonitoring | |||
| considerations_preoperative = Avoid hypotension to maintain CPP | |||
| considerations_intraoperative = Neuroprotection during arterial occlusion | |||
Consider mild hypothermia | |||
| considerations_postoperative = | | considerations_postoperative = | ||
}} | }} | ||
A '''craniotomy for cerebral embolectomy''' is a neurosurgical procedure performed to remove intravascular clots from intracranial vessels. | |||
== Overview == | |||
=== Indications<ref>{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=6|location=Philadelphia|oclc=1117874404}}</ref> === | |||
* 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 | |||
=== Surgical procedure === | |||
== Preoperative management == | == Preoperative management == | ||
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!System | !System | ||
!Considerations | !Considerations | ||
|- | |||
|Airway | |||
|Full stomach precautions | |||
|- | |- | ||
|Neurologic | |Neurologic | ||
| | |Neuro exam to identify deficits | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | |Evaluate for HTN, CAD, Atrial fibrillation, PVD | ||
|} | |} | ||
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== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
{| class="wikitable" | {| class="wikitable wikitable-horizontal-scroll" | ||
|+ | |+ | ||
! | ! | ||
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[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
<references /> | |||
[[Category:Neurosurgery]] | |||
[[Category:Intracranial neurosurgery]] | |||
Latest revision as of 12:40, 5 April 2022
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 | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A craniotomy for cerebral embolectomy is a neurosurgical procedure performed to remove intravascular clots from intracranial vessels.
Overview
Indications[1]
- 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
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Full stomach precautions |
| Neurologic | Neuro exam to identify deficits |
| Cardiovascular | Evaluate for HTN, CAD, Atrial fibrillation, PVD |
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)
Top contributors: Chris Rishel