Difference between revisions of "Craniotomy for intracranial aneurysm"

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{{Infobox surgical case reference
{{Infobox surgical case reference
| anesthesia_type =  
| anesthesia_type = General
| airway =  
| airway = ETT
| lines_access =  
| lines_access = PIV x2<br/>
| monitors =  
Art line<br/>
| considerations_preoperative =  
±Central line
| considerations_intraoperative =  
| monitors = Standard ASA<br/>
| considerations_postoperative =  
5-lead EKG<br/>
}}
Core temp<br/>
UOP<br/>
ABG<br/>
±CVP<br/>
Neuromonitoring
| considerations_preoperative = Characterize neurologic deficits<br />
Controlled hypotension
| considerations_intraoperative = Smooth induction<br />
Controlled hypotension<br />
Have adenosine available<br />
Decrease CRMO2<br />
Manage ICP<br />
| considerations_postoperative = PONV
}}A '''craniotomy for an intracranial aneurysm''' is a procedure performed to surgically treat intracranial aneurysms to prevent or manage rupture, which can be life-threatening.
==Overview==
===Indications===


Provide a brief summary of this surgical procedure and its indications here.
* Complex aneurysms which cannot be definitively treated endovascularly


== Preoperative management ==
===Surgical procedure===


=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
* The procedure is performed through a craniotomy
* Aneurysms can occur at any major arterial bifurcation
* 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<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>
 
==Preoperative management==
 
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===
{| class="wikitable"
{| class="wikitable"
|+
|+
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|-
|-
|Airway
|Airway
|
|If acute, consider RSI
|-
|-
|Neurologic
|Neurologic
|
|Distinguish whether aneurysm has ruptured or not
Identify any neurologic deficits
|-
|-
|Cardiovascular
|Cardiovascular
|
|Evaluate baseline blood pressure
|-
If ruptured:
|Pulmonary
 
|
* May be treated with vasodilator to maintain controlled hypotension
|-
* May present with ST and T-wave changes, wall motion abnormalities, and elevated troponin<ref>{{Cite journal|last=Ahmadian|first=A.|last2=Mizzi|first2=A.|last3=Banasiak|first3=M.|last4=Downes|first4=K.|last5=Camporesi|first5=E. M.|last6=Thompson Sullebarger|first6=J.|last7=Vasan|first7=R.|last8=Mangar|first8=D.|last9=van Loveren|first9=H. R.|last10=Agazzi|first10=S.|date=2013|title=Cardiac manifestations of subarachnoid hemorrhage|url=https://pubmed.ncbi.nlm.nih.gov/24364008|journal=Heart, Lung and Vessels|volume=5|issue=3|pages=168–178|issn=2282-8419|pmc=3848675|pmid=24364008}}</ref>
|Gastrointestinal
** Neurogenic stunned myocardium from catecholamines
|
** May be misdiagnosed as ACS
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}
|}


=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->===


=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->===


=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===


=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===


== Intraoperative management ==
==Intraoperative management==


=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===


=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===


=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===


=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===


=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===


== Postoperative management ==
==Postoperative management==


=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->===


=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->===


=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===


== 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). -->==


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|Pain management
| Pain management
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== References ==
==References==


[[Category:Surgical procedures]]
[[Category:Surgical procedures]]

Revision as of 12:15, 29 March 2022

Craniotomy for intracranial aneurysm
Anesthesia type

General

Airway

ETT

Lines and access

PIV x2
Art 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
Comprehensive
User likes
0

A craniotomy for an intracranial aneurysm is a procedure performed to surgically treat intracranial aneurysms to prevent or manage rupture, which can be life-threatening.

Overview

Indications

  • Complex aneurysms which cannot be definitively treated endovascularly

Surgical procedure

  • The procedure is performed through a craniotomy
  • Aneurysms can occur at any major arterial bifurcation
  • 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:

  • May be treated with vasodilator to maintain controlled hypotension
  • May present with ST and T-wave changes, wall motion abnormalities, and elevated troponin[2]
    • Neurogenic stunned myocardium from catecholamines
    • May be misdiagnosed as ACS

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

  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)
  2. ↑ 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

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