A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm.

Introduction: To describe the perioperative care of patients with aneurysmal subarachnoid hemorrhage (aSAH) who undergo microsurgical repair of a ruptured intracerebral aneurysm.

Methods: An English language survey examined 138 areas of the perioperative care of patients with aSAH. Reported practices were categorized as those reported by <20%, 21% to 40%, 41% to 60%, 61% to 80%, and 81% to 100% of participating hospitals.

Role of High-Sensitivity Troponin-T And N-Terminal Pro B-Type Natriuretic Peptide as an Early Predictor of Myocardial Dysfunction in Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Study.

Background: Acute cardiac complications are commonly seen in aneurysmal subarachnoid hemorrhage (aSAH) patients and may vary from subclinical electrocardiographic abnormalities, or reduced ejection fraction on echocardiography, elevated levels of cardiac markers (cardiac troponin and Brain natriuretic peptide) to heart failure.

Objective: This study was done to evaluate the role of cardiac markers (high-sensitive Troponin-T and N-terminal pro-B-type natriuretic peptide) in early identification of cardiac complications and hence dysfunction.

Methods: All consecutive patients with aSAH without any previous cardiac history were included.

Prospective Analysis of Role of hsTnT and NT-proBNP in Prediction of Neurogenic Stress Cardiomyopathy in Patients with Aneurysmal Subarachnoid Haemorrhage.

Background: Neurogenic stress cardiomyopathy (NSC), also known as stress-induced cardiomyopathy (SIC), is a significant complication of aneurysmal subarachnoid hemorrhage and an important contributor to morbidity mortality.

Objective: This prospective observational study assessed whether the high sensitive troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NTproBNP) helps in the prediction of NSC after SAH.

Methods: The consecutive patients with aSAH without any cardiac history were included prospectively over 12 months.

Intra-operative cerebral blood flow assessment by indocyanine green video-angiography after temporary arterial occlusion in aneurysm surgery and its clinical implications: a prospective study.

Objective: Indocyanine green video angiography (ICG-VA) is a routine while performing vascular surgery to assess patency of perforators, completeness of clipping and/or to assess patency of anastomosis. Its usefulness in assessing cerebral blood flow and perfusion is not well studied. This study is aimed to assess the cerebral blood flow and perfusion after temporary clipping and to correlate with the risk of ischemia.

Microvascular Decompression for Trigeminal Neuralgia: Experience of a Tertiary Care Center in India and a Brief Review of Literature.

Background: Trigeminal neuralgia (TN) is a devastating condition causing significant patient discomfort and morbidity hampering quality of life. Of the many treatment options available, microvascular decompression (MVD) of the trigeminal nerve is widely performed. However, the procedure is not risk-free.

Endovascular Nuances in Management of Multiple Intracranial Aneurysms.

Background: Endovascular treatment of aneurysm is the accepted standard of treatment. Multiple intracranial aneurysms are frequently detected due to advances in imaging.

Objective: The purpose of this study was to determine aneurysm properties, management strategies, and outcome of patients with multiple intracranial aneurysms managed by endovascular approach.

Comparison of Efficacy of Intraoperative Indocyanine Green Videoangiography in Clipping of Anterior Circulation Aneurysms with Postoperative Digital Subtraction Angiography.

Introduction: The aim of this study is to assess the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) using postoperative digital subtraction angiography (DSA) in clipped anterior circulation aneurysms.

Materials And Methods: A prospective study was conducted for 1 year which included thirty patients of anterior circulation aneurysm treated by clipping of aneurysm. Intraoperative ICG-VA was performed on all the patients.

Assessment of surgical risk factors in the development of ventilator-associated pneumonia in neurosurgical intensive care unit patients: Alarming observations.

Background: Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in patients receiving mechanical ventilation (MV) and contributes to a longer intensive care unit (ICU) stay, duration of MV, and a high morbidity and mortality.

Objective: The purpose of study was to determine the incidence of VAP in neurosurgery ICU patients and to assess the probable contributing neurosurgical risk factors like the site and nature of the lesion in the brain, the duration of surgery, blood loss during surgery, and infection elsewhere in the body, in the development of VAP.

Materials And Methods: The prospective clinical study included patients with a Glasgow Coma Scale (GCS) score>8 undergoing a neurosurgical procedure and postoperatively receiving MV for> 48 hours, who were followed for the development of VAP.

Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective.

Background: Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period.

Methods: Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications.

A study of correlation of angioarchitecture of intracranial blood vessels with difficulty during endovascular coiling of aneurysms.

Objective: The duration and complications of coiling are dependent on several factors. These include experience with the armamentarium and the expertise of the operator. Also, the angioarchitecture of the blood vessel can play an important role in the duration of the procedure and outcome.

Perioperative concerns in neurosurgical patients with human immunodeficiency virus infection.

Background: The perioperative management of human immunodeficiency virus (HIV) infected patients undergoing neurosurgery is challenging due to the presence of HIV-related multi-system derangements, opportunistic infections and malignancies, history of substance abuse, and adverse effects of anti-retroviral therapy (ART), together with the inherent risks of neurosurgery. The possible adverse impact of HIV disease on the anesthetic outcome due to the associated co-morbidities, and conversely, the role of surgery and anesthesia in HIV disease progression due to their immunosuppressive effects, and also, the fear of HIV transmission among the attending medical personnel are the important perioperative concerns in such surgeries.

Aim: To present our experience in the perioperative management of HIV-infected patients who underwent neurosurgery at our institute in the past 5 years and highlight the relevant perioperative issues.

Post-operative acute circulatory collapse following craniofacial surgery: Rare event and rarer cause.

We are presenting a case of a 13-year-old female patient diagnosed and operated for maxillary odontogenic myxoma extending to the anterior cranial base. The postoperative complication occurred in the form of acute circulatory collapse. The patient was bailed out with cardiopulmonary resuscitation and return of spontaneous circulation occurred.

Intrafistula pressure measurement in traumatic carotid cavernous fistulas--key to increasing safety and effectiveness of endovascular coiling.

Background: Very few diseases demostrate the tremendous variation and capricious results common with the clinical ensemble of carotid cavernous fistulas (CCFs). The treatment modality for CCFs has changed from surgical to endovascular therapy. Many options exist in endovascular therapy ranging from balloons to coils and liquid embolization agents like Onyx.

Armoured brain of unknown etiology.

Armoured brain is a rare condition where dense calcification occurs over the brain. It can result in mass effect and raised intracranial pressure. Most often, it happens due to trauma, subdural effusion, infection, or after VP shunt.

Ischemic complications after pituitary surgery: a report of two cases.

Background: Cerebral ischemic complications after pituitary surgery are not frequently reported. These vascular complications may be related to (1) direct trauma to the vessel wall, (2) compression of the internal carotid artery (ICA) due to pituitary apoplexy, (3) vasospasm secondary to subarachnoid hemorrhage or vasoactive tumor extract, or (4) hypothalamic injury.

Patients: We describe two cases where major vessel infarcts occurred after removal of pituitary tumor.

Unusual perioperative cardiac emergency in a healthy young woman.

Serious cardiac complications occurring during noncardiac surgery in a young and otherwise normal person can be quite alarming for the anesthesiologist. We report here the case of a young, healthy woman who immediately after an uncomplicated spinal surgery developed a clinical picture suggestive of an acute myocardial infarction (MI) with positive relevant investigations. However, she had an abrupt and full clinical recovery and complete normalization of her cardiac investigations within a few days of this event and thereafter continued to lead a normal, symptom-free life unlike the usual course in an MI; her coronary angiography was also normal.

Surgery for brain abscess in children with cyanotic heart disease: An anesthetic challenge.

Context: Patients with cyanotic congenital heart disease (cCHD) are prone to develop frequent brain abscesses. Surgery for these abscesses is often limited to aspiration under local anesthesia because excision under general anesthesia (GA) is considered a riskier option. Perioperative hemodynamic instability, cyanotic spells, coagulation defects, electrolyte and acid base imbalance, and sudden cardiac arrest are among the major anesthetic concerns.

Endoscopic observations of blocked ventriculoperitoneal (VP) shunt: a step toward better understanding of shunt obstruction and its removal.

Objectives: Most of our understanding of ventriculoperitoneal (VP) shunt blockage (ventricular end) is based on in vitro studies of blocked VP shunts. Not much information is available regarding the in vivo changes that occur in the tube and in the surrounding ventricle. The primary aim of our study was to observe and analyse these changes, directly, through the endoscope, in patients with blocked shunts undergoing an endoscopic third ventriculostomy (ETV).

Perioperative challenges in patients with giant occipital encephalocele with microcephaly and micrognathia.

Meninigo-encepahlocoele (MEC) is a common neurosurgical operation. The size of MEC may vary which has bearing with its management. The association of MEC with micrognathia and microcephaly is rarely reported.

Ostomy closure and the role of repeat endoscopic third ventriculostomy (re-ETV) in failed ETV procedures.

Background: Endoscopic third ventriculostomy (ETV) has replaced shunt surgery for several indications. Failure of ETV secondary to restenosis can result in recurrence of symptoms of raised intracranial pressure.

Objective: To analyze the rates of restenosis due to ostomy closure and factors resulting in failures and to assess the role of re-ETV in such cases.

Rescue endoscopic third ventriculostomy for repeated shunt blockage.

The role of endoscopic third ventriculostomy (ETV) is getting more popular for all types of hydrocephalus. It has several advantages and is also being considered for malfunctioning of ventriculo-peritoneal shunt. A 16-year-old child had fourteen shunt revisions in his life.