Our Summary

This research paper discusses the increasing use of intraoperative neuromonitoring during major blood vessel surgeries to reduce the chances of stroke and paralysis. Intraoperative neuromonitoring involves observing the nervous system during surgery to detect any possible injuries. Various techniques such as electroencephalography (which records brain waves), evoked potential measurements (tests that measure electrical activity in the brain in response to stimulation), transcranial Doppler (a test that evaluates blood flow in the brain), and near-infrared spectroscopy (a technique that uses light to measure oxygen in the brain) are used. The paper emphasizes the importance of understanding these techniques, especially how they interact with anesthesia, to get the most out of them. Considering that every individual is unique in terms of anatomy, physiological reserves, and severity of diseases, neuromonitoring can be a valuable tool to check the health of the nervous system during and after surgeries. The paper reviews the uses, effectiveness, and limitations of these techniques in major surgeries involving the carotid (neck) and aortic (heart) arteries.

FAQs

  1. What is intraoperative neuromonitoring and how does it help in major vascular interventions?
  2. What are some of the modalities used in intraoperative neuromonitoring to detect neural injuries?
  3. How does understanding the interaction between these modalities and anaesthesia contribute to their effectiveness during surgery?

Doctor’s Tip

A doctor might tell a patient undergoing brain surgery to follow all pre-operative instructions carefully, including any fasting guidelines, to reduce the risk of complications during the procedure. They may also advise the patient to continue taking any prescribed medications as directed, unless otherwise instructed by their healthcare provider. Additionally, the doctor may recommend getting plenty of rest and staying hydrated in the days leading up to the surgery to help optimize recovery.

Suitable For

Patients who are typically recommended for brain surgery include those with:

  1. Brain tumors: Surgery may be recommended to remove a tumor that is causing symptoms or to obtain a tissue sample for diagnosis.

  2. Aneurysms: Surgery may be recommended to repair a weakened blood vessel in the brain to prevent it from rupturing.

  3. Arteriovenous malformations (AVMs): Surgery may be recommended to remove abnormal tangles of blood vessels in the brain that can cause bleeding.

  4. Epilepsy: Surgery may be recommended for patients with severe epilepsy that has not responded to medications, to remove the part of the brain causing seizures.

  5. Traumatic brain injuries: Surgery may be recommended to remove blood clots, repair skull fractures, or reduce pressure on the brain following a head injury.

  6. Hydrocephalus: Surgery may be recommended to insert a shunt to drain excess cerebrospinal fluid from the brain.

  7. Parkinson’s disease: Deep brain stimulation surgery may be recommended to implant electrodes in the brain to help control movement symptoms.

  8. Trigeminal neuralgia: Surgery may be recommended to relieve severe facial pain caused by compression of the trigeminal nerve.

It is important for patients to undergo a thorough evaluation by a neurosurgeon to determine if they are a candidate for brain surgery and to discuss the potential risks and benefits of the procedure.

Timeline

Before brain surgery:

  1. Patient consults with neurosurgeon and undergoes preoperative evaluation and imaging studies.
  2. Patient may undergo preoperative testing, such as blood tests, electroencephalography, and neuropsychological testing.
  3. Patient meets with anaesthesiologist to discuss anesthesia options and potential risks.
  4. Patient is admitted to the hospital on the day of surgery and prepared for the procedure.

After brain surgery:

  1. Patient is monitored closely in the intensive care unit or recovery room.
  2. Patient may experience pain, swelling, and discomfort at the surgical site.
  3. Patient may have restrictions on activities and movement to prevent complications.
  4. Patient undergoes postoperative imaging studies to assess the success of the surgery.
  5. Patient may work with physical and occupational therapists to regain strength and function.
  6. Patient follows up with neurosurgeon for postoperative care and monitoring of recovery progress.

What to Ask Your Doctor

  1. What specific type of brain surgery are you recommending for me?
  2. What are the potential risks and complications associated with this type of surgery?
  3. How experienced are you in performing this type of brain surgery?
  4. What is the success rate for this type of surgery?
  5. How long will the surgery take, and how long will I need to stay in the hospital?
  6. What is the recovery process like after brain surgery?
  7. Will I need any additional treatments or therapies after the surgery?
  8. What kind of follow-up care will I need after the surgery?
  9. What can I do to prepare for the surgery and improve my chances of a successful outcome?
  10. Are there any alternative treatment options to consider before proceeding with brain surgery?

Reference

Authors: So VC, Poon CC. Journal: Br J Anaesth. 2016 Sep;117 Suppl 2:ii13-ii25. doi: 10.1093/bja/aew218. PMID: 27566804