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Anesthesiology pp 563-571 | Cite as

Anesthetic Management of Cerebral Aneurysm Surgery (Intracranial Vascular Surgeries)

  • Mohammed Asif Arshad
  • Paul Southall
Chapter

Abstract

Cerebral aneurysms have a prevalence of 3.2%. The majority are diagnosed incidentally and are asymptomatic. However they can be a focus for seizures and are at risk of rupture causing subarachnoid haemorrhage.

Incidental asymptomatic aneurysms can be managed conservatively or can be treated by endovascular coiling or neurosurgical clipping. Risks of rupture whilst being managed conservatively need to be weighed up against the perioperative risks of coiling or clipping.

Treated unruptured aneurysms have a good prognosis. However subarachnoid haemorrhage following aneurysm rupture is associated with significant morbidity and mortality (50% within 4 weeks). Re-bleeding, vasospasm, hydrocephalus, cardiovascular instability and electrolyte abnormalities are all potential complications.

Treatment of ruptured aneurysms focusses on rapidly securing the aneurysm whilst minimising and treating these complications. Aneurysms can be secured via interventional coiling or surgical clipping. Coiling is associated with reduced risk of mortality and dependency but with a higher risk of rebleeding.

Anaesthetic considerations for coiling or clipping include reducing risk of aneurysm rupture/rebleed, reducing the risk of secondary brain damage, management of aneurysm rupture if it does occur and optimising surgical operating conditions with brain relaxation.

Keywords

Cerebral aneurysm Vasospasm Subarachnoid haemorrhage Rebleeding Clipping Coiling 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Queen Elizabeth HospitalBirminghamUK

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