Anesthesia for intracranial neurovascular procedures in adults
- Laurel E Moore, MD
Laurel E Moore, MD
- Clinical Associate Professor of Anesthesiology
- University of Michigan School of Medicine
- Magnus K Teig, BMedSc (Hons.), MBChB, MRCP, FRCA, EDIC, FFICM
Magnus K Teig, BMedSc (Hons.), MBChB, MRCP, FRCA, EDIC, FFICM
- Clinical Assistant Professor
- University of Michigan Department of Anesthesiology
- Vijaykumar Tarnal, MD, FRCA
Vijaykumar Tarnal, MD, FRCA
- Clinical Assistant Professor of Anesthesiology
- The University of Michigan School of Medicine
Intracranial vascular lesions are relatively common abnormalities that may require elective or emergent intervention. This topic will discuss anesthetic management for craniotomy for unruptured and ruptured intracranial aneurysm clipping, resection of arteriovenous malformations, extracranial-to-intracranial bypass procedures, and interventional radiologic treatment of intracranial neurovascular lesions.
Epidemiology, evaluation, and management of subarachnoid hemorrhage and the diagnosis and management of unruptured aneurysms and brain atriovenous malformations (AVMs) are discussed separately. (See "Clinical manifestations and diagnosis of aneurysmal subarachnoid hemorrhage" and "Unruptured intracranial aneurysms" and "Brain arteriovenous malformations" and "Treatment of cerebral aneurysms".)
Intracranial aneurysms may be treated with clipping via craniotomy, endovascular intervention, or with a combination of surgical and endovascular techniques. (See "Treatment of cerebral aneurysms".)
Anesthesia for craniotomy is discussed more fully separately. (See "Anesthesia for craniotomy".)
The anesthetic concerns specific to craniotomy for aneurysm clipping are discussed here.
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- INTRACRANIAL ANEURYSMS
- Planning the anesthetic
- Anesthetic management for craniotomy for aneurysm
- - Preparation for anesthesia
- Preoperative evaluation
- Vasoactive medications
- Venous access
- Blood pressure goals
- - Premedication
- - Induction of anesthesia
- - Maintenance of anesthesia
- Stages of surgery
- - Skull pinning and incision
- - Dissection
- - Temporary clipping
- - Adenosine-induced temporary flow arrest
- - Post-aneurysm clip
- Glycemic management
- Temperature management
- Patient immobility
- Indocyanine green
- - Intraoperative aneurysm rupture
- Rupture with aneurysm exposed
- Rupture prior to aneurysm exposure
- - Emergence and postoperative care
- Endovascular therapy for intracranial aneurysm
- - Preparation for anesthesia
- - Induction and maintenance for endovascular therapy
- Anesthesia for vasospasm treatment
- BRAIN ARTERIOVENOUS MALFORMATIONS
- Normal perfusion pressure breakthrough
- Embolization for brain arteriovenous malformation
- EXTRACRANIAL-INTRACRANIAL BYPASS
- Extracranial-intracranial bypass procedures
- Anesthesia for extracranial-intracranial bypass
- SUMMARY AND RECOMMENDATIONS