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This chapter discusses the different strategies of neuroprotection applied to prevent ischemic damage to the brain during surgical clip ligation of cerebral aneurysms. It presents a case study of a 44-year-old male presented to hospital with acute subarachnoid hemorrhage (SAH); diagnostic cerebral angiogram was performed emergently that demonstrated an anterior communicating artery (ACOM) aneurysm. The ACOM artery aneurysm was deemed to be the cause of the SAH based on its morphology and the distribution of blood in the subarachnoid space. An interdisciplinary approach to the management of cerebrovascular disease is necessary for optimal patient outcome. Another method that has been reported to have some benefit in case of an unforeseen hemorrhage during clip ligation of a cerebral aneurysm is the use of adenosine to induce temporary cardiac arrest. Larger multicenter studies and more translational research are needed to demonstrate the efficacy of currently employed cerebral protective measures.
Sodium disturbances are common in patients presenting with neurologic disease. However, postoperative development of sodium dysregulation may be seen after transphenoidal surgery. This chapter presents a case study of a 45-year-old male with a 1-year history of right temporal anopsia and impotence underwent a successful transphenoidal resection of a 21 mm suprasellar mass under general anesthesia. Due to the clinical suspicion of central diabetes insipidus (DI), he was treated conservatively with liberal access to oral intake of water and intravenous fluids. Perioperative central DI is a common finding in patients undergoing pituitary surgery. Preoperative DI can be part of a panhypopituitarism syndrome in patients with large pituitary prolactinomas or nonprolactinomas. The clinical manifestation of central DI ranges from mild thirst to significant polyuria, polydipsia, dehydration and, if severe, hypotension. Serum sodium has to be followed during vasopressin administration because the excessive retention of free water can lead to hyponatremia.