Neurosurgery

This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy); insertion of ventriculo-peritoneal (VP) shunt; evacuation of traumatic intracranial haematoma; pituitary surgery; posterior fossa surgery; and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage (SAH)). The management of venous air embolism is described, along with a discussion of the particular circumstance of resuscitation during neurosurgery.

Over Use of Ionisation Radiation Imaging With Paediatric Head Trauma

Purpose: Is to determinate the incidence of paediatric head trauma age 0-17 years in our region in central Europe and the number of radiographic images done for paediatric patients to make a data base for further researches, to be effective in investigating, controlling, and preventing head trauma in our population and to study the real need of radiographic images: Methods: This is a retrospective study from the records of children with head trauma seen at the trauma clinics during the year 2018 Results: There were 3261 attendees recorded in paediatric age groups 0-17 years in 2018. 1168 paediatric patients presented with trauma to the head. 831 (36%) with simple injuries of the head, 295 (23.3%) with wounds in head area, 17 (1.5%) children had fractures, 23 (2%) had concussion and 2 (0.2%) patients had intracranial haematoma. 1097 (93.9%) children with head trauma were imaged by X ray (1032 patients) and CT scan (65 patients) in accordance with local guidelines for head trauma management. The percentage of patients in need of radiation is only 3.42%.Conclusion: Most head trauma in children was minor and not associated with brain injury. The radiation is over used in diagnosis of paediatric head trauma

Spontaneous intracranial haematoma

Spontaneous intracranial haematomas remain a challenging pathology with high morbidity and mortality (60–80% of long-term disability). Despite decades of the search for specific treatments no evidence has yet been found for neither conservative nor surgical treatment in randomized controlled studies. While patients with space occupying infratentorial haematomas are more likely to benefit from surgery treatment of supratentorial haemorrhages remains controversial. Recent studies suggest that minimally invasive surgery including endoscopy to evacuate intracranial haematoma may be more effective than conservative treatment or standard surgical craniotomy (MISTIE II). Future studies (i.e. MISTIE III, MISTICH, SWITCH) will hopefully demonstrate evidence for individualized treatments.

Neurosurgery

This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy), insertion of ventriculo-peritoneal shunt, evacuation of traumatic intracranial haematoma, pituitary surgery, posterior fossa surgery, and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage). The management of venous air embolism is described, along with a discussion of the neurological determination of death and organ retrieval from a beating-heart donor.

Neurosurgery

This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy), insertion of ventriculo-peritoneal shunt, evacuation of traumatic intracranial haematoma, pituitary surgery, posterior fossa surgery, and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage). The management of venous air embolism is described, along with a discussion of the neurological determination of death and organ retrieval from a beating-heart donor.