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Marano M, Barbieri FR, Sucapane P, Pagano S, Marruzzo D, DI Lazzaro V, Ricciuti R. Screw bubbling with air embolism, an unusual complication of a frameless deep brain stimulation. J Neurosurg Sci 2024; 68:501-502. [PMID: 38757971 DOI: 10.23736/s0390-5616.24.06241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Massimo Marano
- Neurology, Neurobiology, Neurophysiology and Psychiatry, Campus Bio-Medico University, Rome, Italy -
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy -
| | | | | | - Serena Pagano
- Neurosurgery Unit, Belcolle Hospital, ASL of Viterbo, Viterbo Italy
| | - Daniele Marruzzo
- Neurosurgery Unit, Belcolle Hospital, ASL of Viterbo, Viterbo Italy
| | - Vincenzo DI Lazzaro
- Neurology, Neurobiology, Neurophysiology and Psychiatry, Campus Bio-Medico University, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Gey L, Mingaud H, Sahuc P, Esnault P, Dagain A, Joubert C. Cerebral venous sinus air embolism following removal of intracranial pressure monitoring device: About an exceptional and fatal complication. Neurochirurgie 2021; 68:249-251. [PMID: 33989643 DOI: 10.1016/j.neuchi.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- L Gey
- Department of Neurology, Sainte Anne Military Hospital, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - H Mingaud
- Intensive care unit, Sainte Anne Military Hospital, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - P Sahuc
- Department of Neurology, Sainte Anne Military Hospital, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - P Esnault
- Intensive care unit, Sainte Anne Military Hospital, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - A Dagain
- Department of Neurosurgery, Sainte Anne Military Hospital, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - C Joubert
- Department of Neurosurgery, Sainte Anne Military Hospital, 2, boulevard Sainte-Anne, 83000 Toulon, France.
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Cossu G, Sensi M. Deep Brain Stimulation Emergencies: How the New Technologies Could Modify the Current Scenario. Curr Neurol Neurosci Rep 2017; 17:51. [PMID: 28497305 DOI: 10.1007/s11910-017-0761-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
After 25 years of deep brain stimulation (DBS) for the treatment of Parkinson's disease, it has become increasingly recognized that a range of postoperative urgent situations and emergencies may occur. In this review we describe the possible scenarios of DBS-related emergencies: perioperative (intraoperative and early postoperative) and postoperative settings and issues from suboptimal control of motor and nonmotor symptoms in the early programming phase and during long-term follow-up. We also outline potential advantages in the management of these emergencies offered by the newest devices, emerging technologies, and new possibilities in programming.
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Affiliation(s)
- Giovanni Cossu
- Movement Disorders Unit, Department of Neurology, Brotzu General Hospital, Piazzale Ricchi 1, 09134, Cagliari, Italy.
| | - Mariachiara Sensi
- Department of Neurology, Azienda Ospedaliera Universitaria Arcispedale Sant'Anna, Ferrara, Italy
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Shi L, Zhang CC, Li JJ, Zhu GY, Chen YC, Zhang JG. Could cough be an intraoperative indicator for venous air embolism in deep brain stimulation surgeries?: experiences from a large case series. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wan Hassan WMN, Yeap BT, Ab Mukmin L, Ghani ARI, Mohd Zaini RH. An unusual case of repeated venous air embolism during awake bilateral deep brain stimulation surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2016. [DOI: 10.1080/22201181.2016.1223925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ooba H, Abe T, Momii Y, Fujiki M. Venous air embolism (VAE) associated with stereotactic biopsies. Acta Neurochir (Wien) 2014; 156:433-7. [PMID: 24105046 DOI: 10.1007/s00701-013-1903-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/27/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Venous air embolism (VAE) is a serious potential complication of neurosurgical procedures. Stereotactic biopsies can also cause VAE; therefore, we evaluated VAE patients to call attention to the risk of VAE associated with stereotactic biopsies. METHODS In this report, symptomatic VAE was defined as paroxysmal coughing with associated symptoms. Air in the dural sinus, cortical vein and/or pterygoid plexus on postoperative computed tomography (CT) scans was considered to be a radiographic VAE. RESULTS Three patients developed symptomatic VAE following 36 stereotactic biopsies, and the incidence of symptomatic VAE was 8.3 % (3/36). There were five patients with evidence of radiographic VAE on postoperative CT scans, with an incidence of 13.8 % (5/36). A high angle of the head seemed to be associated with VAE, allowing air to flow into the central venous system. CONCLUSIONS The present report emphasizes that VAE should be recognized as an important adverse effect of stereotactic biopsies because VAE occasionally requires additional treatment and/or termination of surgery. Surgeons must be aware of the possibility of VAE, especially when it is necessary to position the patient's head at a high angle.
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Affiliation(s)
- Hiroshi Ooba
- Department of Neurosurgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasamamachi, Oita, 879-5593, Japan,
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Shinoura N, Midorikawa A, Yamada R, Hana T, Saito A, Hiromitsu K, Itoi C, Saito S, Yagi K. Awake craniotomy for brain lesions within and near the primary motor area: A retrospective analysis of factors associated with worsened paresis in 102 consecutive patients. Surg Neurol Int 2013; 4:149. [PMID: 24381792 PMCID: PMC3872643 DOI: 10.4103/2152-7806.122003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/19/2013] [Indexed: 11/04/2022] Open
Abstract
Background: We analyzed factors associated with worsened paresis in a large series of patients with brain lesions located within or near the primary motor area (M1) to establish protocols for safe, awake craniotomy of eloquent lesions. Methods: We studied patients with brain lesions involving M1, the premotor area (PMA) and the primary sensory area (S1), who underwent awake craniotomy (n = 102). In addition to evaluating paresis before, during, and one month after surgery, the following parameters were analyzed: Intraoperative complications; success or failure of awake surgery; tumor type (A or B), tumor location, tumor histology, tumor size, and completeness of resection. Results: Worsened paresis at one month of follow-up was significantly associated with failure of awake surgery, intraoperative complications and worsened paresis immediately after surgery, which in turn was significantly associated with intraoperative worsening of paresis. Intraoperative worsening of paresis was significantly related to preoperative paresis, type A tumor (motor tract running in close proximity to and compressed by the tumor), tumor location within or including M1 and partial removal (PR) of the tumor. Conclusions: Successful awake surgery and prevention of deterioration of paresis immediately after surgery without intraoperative complications may help prevent worsening of paresis at one month. Factors associated with intraoperative worsening of paresis were preoperative motor deficit, type A and tumor location in M1, possibly leading to PR of the tumor.
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Affiliation(s)
- Nobusada Shinoura
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Akira Midorikawa
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Ryoji Yamada
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Taijun Hana
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Akira Saito
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Kentaro Hiromitsu
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Chisato Itoi
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Syoko Saito
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Kazuo Yagi
- Department of Radiologic Technology, Tokyo Metropolitan University of Health Sciences, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8553, Japan
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Erickson KM, Cole DJ. Anesthetic considerations for awake craniotomy for epilepsy and functional neurosurgery. Anesthesiol Clin 2012; 30:241-268. [PMID: 22901609 DOI: 10.1016/j.anclin.2012.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The two most common neurosurgical procedures that call for an awake patient include epilepsy surgery and functional neurosurgery. Monitoring patients in the awake state allows more aggressive resection of epileptogenic foci in functionally important brain regions. Careful patient selection and preparation combined with attentive monitoring and anticipation of events are fundamental to a smooth awake procedure. Current pharmacologic agents and techniques at the neuroanesthesiologist's disposal facilitate an increasing number of procedures performed in awake patients.
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Affiliation(s)
- Kirstin M Erickson
- Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SE, Rochester, MN 55901, USA.
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Chang EF, Cheng JS, Richardson RM, Lee C, Starr PA, Larson PS. Incidence and Management of Venous Air Embolisms during Awake Deep Brain Stimulation Surgery in a Large Clinical Series. Stereotact Funct Neurosurg 2011; 89:76-82. [DOI: 10.1159/000323335] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/28/2010] [Indexed: 11/19/2022]
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Nazzaro JM, Lyons KE, Honea RA, Mayo MS, Cook-Wiens G, Harsha A, Burns JM, Pahwa R. Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery. Acta Neurochir (Wien) 2010; 152:2047-52. [PMID: 20862499 DOI: 10.1007/s00701-010-0776-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 08/12/2010] [Indexed: 12/31/2022]
Abstract
PURPOSE The objective of the present study was to evaluate the risk of pneumocephalus, venous air embolism (VAE), and intracranial hemorrhage in subthalamic nucleus (STN) deep brain stimulation (DBS) patients operated in the strict supine (head and body flat) position. METHODS This was a retrospective review of clinical records and brain imaging of patients who underwent STN DBS between January 2007 and June 2009 at the University of Kansas Medical Center. RESULTS A total of 61 patients underwent 114 lead implantations (53 staged bilateral and 8 unilateral). No case involved a transventricular route. Intracranial air volumes ranged from 0 to 7.02 cm³ (mean 0.98 ± 1.42 cm³). Pneumocephalus volumes were highly skewed with no air present after 44 (38.6%) lead implantations, >0 to 1 cm³ in 35 (30.7%), >2 to 3 cm³ in 17 (14.9%), and >3 cm³ (average 4.97 cm³) in 9 (7.9%). There was no incidence of clinically apparent VAE or symptomatic intracranial hemorrhage. There was no association between age, degree of atrophy, sagittal angle of surgical approach, number of microelectrode runs (MERs), distance of gyrus from inner skull bone at the entry point, or surgical side and pneumocephalus. However, the majority of lead implantations (100 leads; 88%) required only one MER and there were minimal measurable distances between entered gyrus and adjacent bone. CONCLUSIONS Our data suggest that strict supine positioning during STN DBS surgery results in minimal intracranial air and is not associated with VAE or symptomatic intracranial hemorrhage when the operative method described is used.
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Affiliation(s)
- Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, 66160, USA.
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Shinoura N, Yamada R, Tabei Y, Saito K, Suzuki Y, Yagi K. Advantages and disadvantages of awake surgery for brain tumours in the primary motor cortex: institutional experience and review of literature. Br J Neurosurg 2010; 25:218-24. [PMID: 20854057 DOI: 10.3109/02688697.2010.505671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients undergoing awake surgery for resection of brain tumours in the primary motor cortex (M1) are at high risk of developing new motor deficits. Thus, use of this procedure requires consideration of several important points, including the optimal modality to localise M1 on the affected side and the overall advantages and disadvantages of the procedure. In our experience with awake surgery for 21 brain tumours located in the M1 from January 2004 through October 2008, we found that functional magnetic resonance imaging was the most reliable modality in terms of localising the M1 and that the anatomic relationship between motor tracts and brain tumours is a critical determinant of postoperative motor function. Other considerations, including potential complications of this procedure and relative efficacy and safety versus surgery under general anaesthesia for patients with brain tumours in the M1, are discussed.
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Affiliation(s)
- Nobusada Shinoura
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan.
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Morishita T, Foote KD, Burdick AP, Katayama Y, Yamamoto T, Frucht SJ, Okun MS. Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies. Parkinsonism Relat Disord 2010; 16:153-62. [PMID: 19896407 PMCID: PMC2829374 DOI: 10.1016/j.parkreldis.2009.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/23/2009] [Accepted: 10/01/2009] [Indexed: 10/20/2022]
Abstract
Deep brain stimulation (DBS) has been increasingly utilized for the therapeutic treatment of movement disorders, and with the advent of this therapy more postoperative urgencies and emergencies have emerged. In this paper, we will review, identify, and suggest management strategies for both intra- and postoperative urgencies and emergencies. We have separated the scenarios into 1--surgery/procedure related, 2--hardware related, 3--stimulation-induced difficulties, and 4--others. We have included ten illustrative (and actual) case vignettes to augment the discussion of each issue.
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Affiliation(s)
- Takashi Morishita
- Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kelly D. Foote
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
| | - Adam P. Burdick
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
| | - Yoichi Katayama
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
- Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan
| | - Takamitsu Yamamoto
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
- Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan
| | - Steven J. Frucht
- Department of Neurology, Columbia University College of Physicians and Surgeons/Columbia-Presbyterian Medical Center, New York, NY
| | - Michael S. Okun
- Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
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Review article: anesthetic management of patients undergoing deep brain stimulator insertion. Anesth Analg 2010; 110:1138-45. [PMID: 20142347 DOI: 10.1213/ane.0b013e3181d2a782] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Deep brain stimulation is used for the treatment of patients with neurologic disorders who have an alteration of function, such as movement disorders and other chronic illnesses. The insertion of the deep brain stimulator (DBS) is a minimally invasive procedure that includes the placement of electrodes into deep brain structures for microelectrode recordings and intraoperative clinical testing and connection of the DBS to an implanted pacemaker. The anesthetic technique varies depending on the traditions and requirements of each institution performing these procedures and has included monitored anesthesia with local anesthesia, conscious sedation, and general anesthesia. The challenges and demands for the anesthesiologist in the care of these patients relate to the specific concerns of the patients with functional neurologic disorders, the effects of anesthetic drugs on microelectrode recordings, and the requirements of the surgical procedure, which often include an awake and cooperative patient. The purpose of this review is to familiarize anesthesiologists with deep brain stimulation by discussing the mechanism, the effects of anesthetic drugs, and the surgical procedure of DBS insertion, and the perioperative assessment, preparation, intraoperative anesthetic management, and complications in patients with functional neurologic disorders.
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Poon C, Irwin M. Anaesthesia for deep brain stimulation and in patients with implanted neurostimulator devices. Br J Anaesth 2009; 103:152-65. [DOI: 10.1093/bja/aep179] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Kumar R, Goyal V, Chauhan RS. Venous air embolism during microelectrode recording in deep brain stimulation surgery in an awake supine patient. Br J Neurosurg 2009; 23:446-8. [PMID: 19637020 DOI: 10.1080/02688690902775538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Venous air embolism (VAE) is a potentially serious complication in neurosurgery. It occurs most commonly during craniotomy in the sitting position. Diagnosis is difficult in awake patients on spontaneous ventilation due to different clinical manifestations. Prompt diagnosis and treatment are essential. We report venous air embolism in an awake patient undergoing deep brain stimulation for Parkinson's disease and discuss the pathogenesis, prevention and management of VAE.
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Affiliation(s)
- Rajinder Kumar
- Assistant Professor of Neurosurgery, Department of Neurosurgery, All India Institute of Medical Sciences New Delhi, India.
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Abstract
Direct brain control of a prosthetic system is the subject of much popular and scientific news. Neural technology and science have advanced to the point that proof-of-concept systems exist for cortically-controlled prostheses in rats, monkeys, and even humans. However, realizing the dream of making such technology available to everyone is still far off. Fortunately today there is great public and scientific interest in making this happen, but it will only occur when the functional benefits of such systems outweigh the risks. In this article, the authors briefly summarize the state of the art and then highlight many issues that will directly limit clinical translation, including system durability, system performance, and patient risk. Despite the challenges, scientists and clinicians are in the desirable position of having both public and fiscal support to begin addressing these issues directly. The ultimate challenge now is to determine definitively whether these prosthetic systems will become clinical reality or forever unrealized.
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Affiliation(s)
- Stephen I Ryu
- Department of Neurosurgery, Palo Alto Medical Foundation, Palo Alto, California 94301, USA.
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Enoxaparin induced intracerebral haemorrhage after deep brain stimulation surgery. Eur J Anaesthesiol 2009; 26:617-8. [DOI: 10.1097/eja.0b013e328320a68b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jain V, Prabhakar H, Rath GP, Sharma D. Tension pneumocephalus following deep brain stimulation surgery with bispectral index monitoring. Eur J Anaesthesiol 2006; 24:203-4. [PMID: 17038217 DOI: 10.1017/s0265021506001736] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2006] [Indexed: 11/06/2022]
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Schubert A, Deogaonkar A, Lotto M, Niezgoda J, Luciano M. Anesthesia for Minimally Invasive Cranial and Spinal Surgery. J Neurosurg Anesthesiol 2006; 18:47-56. [PMID: 16369140 DOI: 10.1097/01.ana.0000189993.14862.d1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Armin Schubert
- Department of General Anesthesiology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA.
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