Our Summary

This research paper looks at recent developments in same-day neurosurgery, which is a type of surgery on the brain or spinal cord that allows a patient to go home on the same day as the procedure. The paper discusses which patients are suitable for this type of surgery, how to prepare for it, and how safe it is.

According to recent studies, same-day neurosurgery is safe and viable. Some procedures, such as awake craniotomy (a type of brain surgery where the patient is awake), can have better results than other types, resulting in fewer neurological issues and better survival rates for patients with specific types of brain lesions.

The paper also discusses different types of anesthesia (drugs to make you unconscious or numb an area of your body). It found that monitored anesthesia care (where the patient is sedated but can still respond to instructions) has a lower failure rate, takes less time and requires a shorter hospital stay than a technique that involves putting the patient to sleep, waking them up then putting them back to sleep. However, this asleep-awake-asleep technique has a lower risk of seizures during surgery.

The study also compared two types of anesthesia, propofol and dexmedetomidine, and found they were similar in terms of the length of the procedure, any problems that occurred during surgery, and how happy patients were. However, surgeons were happier when they used dexmedetomidine.

In spinal surgery, regional anesthesia (which numbs a large area of the body) was associated with less blood loss during surgery and a lower chance of feeling sick or vomiting 24 hours after surgery compared to general anesthesia (which makes you unconscious).

The paper concludes that same-day neurosurgery has great potential. It can be well tolerated, efficient, and cost-effective in carefully chosen cases.

FAQs

  1. What is the safety and feasibility of same-day neurosurgery?
  2. What are the benefits and drawbacks of monitored anesthesia care and the asleep-awake-asleep technique during awake craniotomy?
  3. How does the use of regional anesthesia compare to general anesthesia in spine surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about craniotomy is to discuss the possibility of an awake craniotomy procedure. This technique, where the patient is awake during parts of the surgery, may be beneficial in cases where the lesion is in an eloquent area of the brain, as it can help minimize neurological deficits and improve survival outcomes. Additionally, discussing the different anesthesia options, such as monitored anesthesia care or the asleep-awake-asleep technique, can help ensure the best possible outcome for the patient. Overall, staying informed and discussing all options with your healthcare provider can help make the craniotomy process as smooth and successful as possible.

Suitable For

Patients who are typically recommended for craniotomy include those with brain tumors, vascular malformations, traumatic brain injuries, and refractory epilepsy. Additionally, patients with lesions in eloquent areas of the brain may benefit from awake craniotomy to help preserve neurological function. The decision to undergo a craniotomy is made on a case-by-case basis, taking into consideration the patient’s overall health, the location and type of lesion, and the potential benefits and risks of surgery.

Timeline

Before craniotomy:

  1. Initial consultation: The patient meets with a neurosurgeon to discuss the need for a craniotomy and the risks and benefits of the procedure.
  2. Preoperative evaluations: The patient undergoes various tests and evaluations, such as blood tests, imaging studies, and possibly a neurological examination, to ensure they are a suitable candidate for surgery.
  3. Preoperative preparations: The patient may need to stop certain medications, fast before surgery, and follow other preoperative instructions provided by the healthcare team.

After craniotomy:

  1. Immediate postoperative care: The patient is monitored closely in the recovery room for any signs of complications, such as bleeding or infection.
  2. Hospital stay: The patient may need to stay in the hospital for a few days to a week for further monitoring and recovery.
  3. Rehabilitation: Depending on the reason for the craniotomy, the patient may need to undergo rehabilitation to regain strength, coordination, and cognitive function.
  4. Follow-up appointments: The patient will have follow-up appointments with their neurosurgeon to monitor their progress and address any concerns.
  5. Long-term recovery: The patient may continue to experience improvements in their condition over the following weeks and months, with regular check-ups to ensure the success of the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about craniotomy include:

  1. What is the specific reason for recommending a craniotomy in my case?
  2. What are the potential risks and complications associated with the craniotomy procedure?
  3. What is the expected recovery time and rehabilitation process after the craniotomy?
  4. Will I need any additional treatments or therapies after the craniotomy?
  5. What is the expected outcome or prognosis following the craniotomy?
  6. Are there any alternative treatment options to consider before proceeding with a craniotomy?
  7. What experience do you have with performing craniotomies, and what is your success rate?
  8. Will I need to undergo any additional testing or imaging before the craniotomy?
  9. How long will the craniotomy procedure take, and what type of anesthesia will be used?
  10. How long will I need to stay in the hospital after the craniotomy, and what will the post-operative care involve?

Reference

Authors: Ajayan N, Hrishi AP, Rath GP. Journal: Curr Opin Anaesthesiol. 2023 Oct 1;36(5):500-509. doi: 10.1097/ACO.0000000000001291. Epub 2023 Jul 6. PMID: 37552019