Difference between revisions of "Craniotomy for intracranial vascular malformations"

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{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = Large bore IV x2<br />
Art line<br />
±Central line (if arterial nidus)
| monitors = Standard<br />
5-lead ECG<br />
Core temp<br />
UOP<br />
ABG<br />
±CVP (if arterial nidus)<br />
Neuromonitoring<br />
| considerations_preoperative = Characterize neurologic deficits
| considerations_intraoperative = Smooth induction<br />
Hemodynamic goals vary<br />
Hypotension ↑ risk of steal<br />
If arterial nidus:
*Hypertension ↑ risk of rupture
*Have adenosine available
*Decrease CRMO2
| considerations_postoperative = Avoid hypertension (risk of hyperemia)
}}


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<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>
** 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<ref>{{Cite journal|last=Spetzler|first=R. F.|last2=Martin|first2=N. A.|date=1986-10|title=A proposed grading system for arteriovenous malformations|url=https://pubmed.ncbi.nlm.nih.gov/3760956|journal=Journal of Neurosurgery|volume=65|issue=4|pages=476–483|doi=10.3171/jns.1986.65.4.0476|issn=0022-3085|pmid=3760956}}</ref>
=== Surgical procedure ===
== 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"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
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|-
|Endocrine
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|-
|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. --> ===
=== 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. --> ===
=== 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 ==
=== 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. --> ===
=== 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. --> ===
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
== Postoperative management ==
=== 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. --> ===
=== 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). --> ==
{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
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|-
|Postoperative disposition
|
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|-
|Pain management
|
|
|-
|Potential complications
|
|
|}
== References ==
[[Category:Surgical procedures]]

Revision as of 18:26, 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:

  • Hypertension ↑ risk of rupture
  • Have adenosine available
  • Decrease CRMO2
Postoperative

Avoid hypertension (risk of hyperemia)

Article quality
Editor rating
Comprehensive
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

  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. ↑ 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: |date= (help)

Top contributors: Chris Rishel and Mitchel DeVita

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