Anesthesia for Minimally Invasive Cranial and Spinal Surgery

Abstract

The field of minimally invasive neurosurgery has evolved rapidly in its indications and applications over the last few years. New, less invasive techniques with low morbidity and virtually no mortality are replacing conventional neurosurgical procedures. Providing anesthesia for these procedures differs in many ways from conventional neurosurgical operations. Anesthesiologists are faced with the perioperative requirements and risks of newly developed procedures. This review calls attention to the anesthetic issues in various minimally invasive neurosurgical procedures for cranial and spinal indications. Among the procedures specifically discussed are endoscopic third ventriculostomy, endoscopic transsphenoidal hypophysectomy, endoscopic strip craniectomy, deep brain stimulation, video-assisted thorascopic surgery, vertebroplasty and kyphoplasty, cervical discectomy and foraminectomy, and laparoscopically assisted lumbar spine surgery.

Avoidance and management of perioperative complications of endoscopic third ventriculostomy: the Dhaka experience

“…22 Due to the unique surgical maneuvers involved in ETV, it is sometime associated with serious complications that are difficult to manage. Intraoperative management is directed toward providing optimal conditions for surgery and preventing technical complications.…”

“…22 The cardiovascular response may be due to an acute rise in intracranial pressure (ICP) caused by continuous use of high-speed irrigation or obstruction to the outflow of fluid, leading to impairment of cerebral perfusion. 3,14,20 Tachycardia and hypertension have been shown to correlate well with an acutely raised ICP during ETV.…”

“…22 Neuroendoscopy has many advantages, including speed, simplicity, avoidance of implants, and avoidance of brain retraction or dissection. However, a variety of perioperative complications have been reported in ETV, attributed mostly to the unique surgical technique, which causes alterations in cerebral flow dynamics and injuries to vital brain areas.…”

“…Previously reported complication rates range from 5% to 30%, and operative mortality is between 0% and 1%. 22 Serious hemodynamic variations, temperature alterations, electrolyte imbalances, and delayed emergence from anesthesia after surgery are some of the complications that may adversely affect outcome. 1 Sometimes difficult or unfavorable anatomy may result in procedure abandonment.…”

“…This potential for a basilar artery injury highlights the importance of a correctly placed fenestration on the third ventricle floor. 15,[20][21][22] Minor bleeding can occur from injury to the cortical vessels, septal veins, thalamostriate veins, veins from the ventricular floor, or other minor veins. During episodes of bleeding that obscure the vision of the endoscopes, we tried several maneuvers.…”