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This chapter explores the management issues surrounding a hemorrhagic stroke of the cerebellum, one of the most common sites for intracerebral hemorrhage, and one where proper management can have a profound impact on outcome. It presents a case study of a 75-year-old female with a history of hypertension and end-stage renal disease requiring dialysis. Examination consistently revealed appropriate, symmetric limb movements and limited cranial nerve exams. Computed tomography scans showed satisfactory decompression of the posterior fossa and absence of hydrocephalus. Intracerebral hemorrhage is most commonly associated with chronic hypertension, amyloid angiopathy, anticoagulation, trauma or underlying pathology such as tumor or vascular malformation. As ventricular obstruction may occur when the patient is positioned, prepared or opened, allowing access for an emergency external ventricular drainage device is desirable in preparing and draping the patient.
This chapter presents a case study of a 60-year-old right-handed male with a WHO Grade II astrocytoma diagnosed and treated with gross total resection at that time. This case demonstrates some common adversities faced in epilepsy surgery during awake craniotomy. Gross total resection of the tumor was adequately achieved and the lesion was sent for frozen and permanent pathology. At this point, the patient was sedated and the wound was closed in the normal anatomic layers. The addition of dexmedetomidine to propofol decreases the amount of propofol needed for sedation and allows the maintenance of spontaneous respiration. The other benefit of dexmedetomidine is its inhibitory effect on hypercarbia-induced cerebral vasodilation and consequently intracranial hypertension. Patient education and a thorough discussion of the risks and benefits of such a procedure are important prior to surgical intervention being offered because of the potential complications that can be encountered during this procedure.