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  • Print publication year: 2011
  • Online publication date: December 2011

20 - Post-operative care of neurosurgical patients

from Section 4 - Neurointensive care


This chapter discusses the role of structural imaging using CT and MRI, conventional angiography and CT angiography, and physiological imaging using CT perfusion, 131Xenon CT, MRI and magnetic resonance spectroscopy (MRS), single-photon emission computed tomography (SPECT) and positron emission tomography (PET) in the assessment, management and prediction of outcome neurological injury. Acute CT is useful in identifying those individuals in whom deterioration is as a result of a mass lesion and can demonstrate extradural, subdural or intracranial haemorrhage and midline shift, or subarachnoid haemorrhage and ventricular abnormality. Contrast-enhanced CT imaging is also used to produce CT angiography and perfusion imaging. MRI data are produced using powerful static magnetic fields and intermittent oscillating radiofrequency electromagnetic fields that elicit signals from the nuclei of certain atoms. Single-photon emission CT uses conventional gamma-emitting nuclear medicine isotopes with multiple detectors to generate tomographic images.

Further reading

Ackerman, L. L. and Traynelis, V. C. (2002). Treatment of delayed-onset neurological deficit after aortic surgery with lumbar cerebrospinal fluid drainage. Neurosurgery 51, 1414–21.
Adams, H. P. Jr, Adams, R. J., Brott, T. et al. (2003). Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke 34, 1056–83.
Andrews, R. J. and Bringas, J. R. (1993). A review of brain retraction and recommendations for minimizing intraoperative brain injury. Neurosurgery 33, 1052–63.
Asgari, S., Rohrborn, H. J., Engelhorn, T., Fauser, B. and Stolke, D. (2003). Intraoperative measurement of cortical oxygen saturation and blood volume adjacent to cerebral arteriovenous malformations using near-infrared spectroscopy. Neurosurgery 52, 1298–304.
Barker, F. G. II (2007). Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery 60, 887–94.
Basali, A., Mascha, E. J., Kalfas, I. and Schubert, A. (2000). Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology 93, 48–54.
Brain Trauma Foundation (2007). Guidelines for the management of severe traumatic brain injury. J Neurotrauma 24 (Suppl. 1), S1–106.
Broderick, J. P., Adams, H. P. Jr, Barsan, W. et al. (1999). Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 30, 905–15.
Bruder, N. J. (2002). Awakening management after neurosurgery for intracranial tumours. Curr Opin Anaesthesiol 15, 477–82.
Devlin, J. W., Fong, J. J., Fraser, G. L. and Riker, R. R. (2007). Delirium assessment in the critically ill. Intensive Care Med 33, 929–40.
Eberhart, L. H. J., Morin, A. M., Kranke, P. et al. (2007). Prevention and control of postoperative nausea and vomiting in post-craniotomy patients. Best Pract Res Clin Anaesthesiol 21, 575–93.
Finfer, S., Chittock, D. R., Su, S. Y. et al. (2009). Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360, 1283–97.
Foy, P. M., Copeland, G. P. and Shaw, M. D. (1981). The incidence of postoperative seizures. Acta Neurochi (Wien) 55, 253–64.
Glantz, M. J., Cole, B. F., Forsyth, P. A. et al. (2000). Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 54, 1886–93.
Howell, S. J. (2007). Carotid endarterectomy. Br J Anaesth 99, 119–31.
Jiang, W. J., Srivastava, T., Gao, F. et al. (2006). Perforator stroke after elective stenting of symptomatic intracranial stenosis. Neurology 66, 1868–72.
Johnson, M. H. (2001). Assessing confused patients. J Neurol Neurosurg Psychiatry 71 (Suppl. 1), i7–12.
Komotar, R. J., Mocco, J., Ransom, E. R. et al. (2005) Herniation secondary to critical postcraniotomy cerebrospinal fluid hypovolemia. Neurosurgery 57, 286–92.
Korinek, A. M. (1997) Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidemiologie Hygiene et Prevention. Neurosurgery 41, 1073–9.
Magni, G., La Rosa, I., Gimignani, S. et al. (2007) Early postoperative complications after intracranial surgery: comparison between total intravenous and balanced anesthesia. J Neurosurg Anesthesiol 19, 229–34.
Miller, J. A., Dacey, R. G. Jr and Diringer, M. N. (1995) Safety of hypertensive hypervolemic therapy with phenylephrine in the treatment of delayed ischemic deficits after subarachnoid hemorrhage. Stroke 26, 2260–6.
Nemergut, E. C., Dumont, A. S., Barry, U. T. and Laws, E. R. (2005) Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesth Analg 101, 1170–81.
Nemergut, E. C., Durieux, M. E., Missaghi, N. B. and Himmelseher, S. (2007) Pain management after craniotomy. Best Pract Res Clin Anaesthesiol 21, 557–73.
Oddo, M., Schmidt, J. M., Mayer, S. A. and Chiolero, R. L. (2008) Glucose control after severe brain injury. Curr Opin Clin Nutr Metab Care 11, 134–9.
Pfister, D., Strebel, S. P. and Steiner, L. A. (2007) Postoperative management of adult central neurosurgical patients: systemic and neuro-monitoring. Best Pract Res Clin Anaesthesiol 21, 449–63.
Prakash, A. and Matta, B. F. (2008) Hyperglycaemia and neurological injury. Curr Opin Anaesthesiol, 21 565–9.
Robertson, C. S., Contant, C. F., Gokaslan, Z. L., Narayan, R. K. and Grossman, R. G. (1992) Cerebral blood flow, arteriovenous oxygen difference, and outcome in head injured patients. J Neurol Neurosurg Psychiatry 55, 594–603.
Rose, J. C. and Mayer, S. A. (2004) Optimizing blood pressure in neurological emergencies. Neurocritic Care 1, 287–99.
Sawaya, R., Hammoud, M., Schoppa, D. et al. (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42, 1044–55.
Smith, M. and Elwell, C. (2009) Near-infrared spectroscopy: shedding light on the injured brain. Anesth Analg 108, 1055–7.
Steiner, T., Kaste, M., Forsting, M. et al. (2006) Recommendations for the management of intracranial haemorrhage – part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis 22, 294–316.
Waydhas, C. (1999) Intrahospital transport of critically ill patients. Crit Care 3, R83–9.
Wijdicks, E. F., Bamlet, W. R., Maramattom, B. V., Manno, E. M. and McClelland, R. L. (2005) Validation of a new coma scale: the FOUR score. Ann Neurol 58, 585–93.
Zetterling, M. and Ronne-Engstrom, E. (2004) High intraoperative blood loss may be a risk factor for postoperative hematoma. J Neurosurg Anesthesiol 16, 151–5.