Skip to main content
SpringerLink
Log in

Perioperative Care in Neurosurgery — Intraoperative Monitoring

  • Conference paper
Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.

  • 967 Accesses

Abstract

Intraoperative monitoring of neuronal function, cerebral haemodynamics and cerebral oxygenation provides information to guide anaesthetic and surgical procedures in individual patients. The aim of neuroanaesthesia is to provide optimal intracranial operating conditions, maintain cerebral perfusion pressure (CPP), protect against ischaemic insults and prevent postoperative complications. The anaesthetic techniques and the anaesthetics used in neuroanaesthesia are all geared to these objectives. A neurophysiologically monitored surgical approach can decrease neuronal injury and neurological deficit related to cerebral ischaemia and improve long-term neurological outcome. Traditionally, electrocardiography, arterial blood pressure, pulse oximetry, end-tidal CO2 (ETCO2), body temperature and urine output are monitored during neuroanaesthesia in the operating room.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Himmelseher S, Pfenninger E, Werner C et al (2001) Intraoperative monitoring in neuroanesthesia: a national comparison between two surveys in Germany in 1991 and 1997. Anesth Analg 92:166–171

    Article  PubMed  CAS  Google Scholar 

  2. The American Society of Anesthesiologists. Standards for basic anesthetic monitoring. ASA directory of members (Approved by House of Delegates on October 21, 1986, and last amended on October 21, 1998)

    Google Scholar 

  3. Fabregas N, Gomar C (2001) Monitoring in neuroanaesthesia: update of clinical usefulness. European J Anaesth 18:423–439

    Article  CAS  Google Scholar 

  4. Rothoerl RD, Schebesch KM, Woertgen C et al (2003) Internal carotid artery volume flow correlates to rCBF measurements. Acta Neurochir 145:943–947

    Article  CAS  Google Scholar 

  5. Friedmam JA, Anderson RE, Meyer FB (2000) Techniques of intraoperative cerebral blood flow measurement. Neurosurg Focus 15:9

    Google Scholar 

  6. Moppett IK and Mahajan RP (2004) Transcranial Doppler ultrasonography in anaesthesia and intensive care. Br J Anaesth 93:710–724

    Article  PubMed  CAS  Google Scholar 

  7. Conti A, Iacopino DG, Fodale V et al (2006) Cerebral haemodynamic changes during propofol-remifentanil or sevoflurane anaesthesia: transcranial Doppler study under bispectral index monitoring. Br J Anaesth 97:333–339

    Article  PubMed  CAS  Google Scholar 

  8. Ackerstaff RG, Chuck JW, van de Vlasakker CJ (1998) Monitoring of brain function during carotid endoarterectomy: an analysis of contemporary methods. J Cardiothorac Vasc Anesth 12:341–347

    Article  PubMed  CAS  Google Scholar 

  9. Ackerstaff RG, Moons KG, van de Vlasakker CJ et al (2000) Association of intraoperative transcranial Doppler monitoring variables with stroke from carotid endarterectomy. Stroke 31:1817–1823

    PubMed  CAS  Google Scholar 

  10. Muller M, Reiche W, Langenscheidt P et al (2000) Ischemia after carotid endoarterectomy: comparison between transcranial Doppler sonography and diffusion-weighted MR imaging. Am J Neuroradiol 21:47–54

    PubMed  CAS  Google Scholar 

  11. Dunne VG, Besser M, Ma WJ (2001) Transcranial Doppler in carotid endoarterectomy. J Clin Neurosci 8:140–145

    Article  PubMed  CAS  Google Scholar 

  12. Matta BF, Lam AM, Winn HR (1995) The intraoperative use of transcranial Doppler ultrasonography during resection of arteriovenous malformations. Br J Anaesth 75:242

    Google Scholar 

  13. Firsching R, Synowitz HJ, Hanebeck J (2000) Practicability of intraoperative microvascular Doppler sonography in aneurysm surgery. Minim Invasive Neurosurg 43:144–148

    Article  PubMed  CAS  Google Scholar 

  14. Stendel R, Pietila T, Al Hassan AA et al (2000) Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurol Neurosurg Psychiatry 68:29–35

    Article  PubMed  CAS  Google Scholar 

  15. Amin-Hanjani S, Meglio G, Gatto R et al (2007) The utility of intraoperative blood flow measurement during aneurysm surgery using an ultrasonic perivascular flow probe. Neurosurgery 58: ONS–305

    Article  Google Scholar 

  16. Charbel FT, Zhao M, Amin-Hanjani S et al (2004) A patient-specific computer model to predict outcomes to the balloon occlusion test. J Neurosurg 101:977–988

    PubMed  Google Scholar 

  17. Scienza R, Pavesi G, Pasqualin A et al (2003) Flowmetry-assisted aneurysm clipping. A Cooperative Study. In The Proceedings of the 12 European Congress of Neurosurgery, 309–314

    Google Scholar 

  18. Sloan TB (1996) Evoked potentials monitoring. Int Anesthesiol Clin 34:109–136

    Article  PubMed  CAS  Google Scholar 

  19. Lopez JR (1996) Intraoperative neurophysiologic monitoring. Int Anesthesiol Clin 34:33–54

    Article  PubMed  CAS  Google Scholar 

  20. Guerit JM (1998) Neuromonitoring in the operating room: why, when and how to monitor? Electroencephalogr Clin Neurophysiol 106:1–21

    PubMed  CAS  Google Scholar 

  21. Kumar A, Bhattacharya A, Makhija N (2000) Evoked potential monitoring in anaesthesia analgesia. Anaesthesia 55:225–241

    Article  PubMed  CAS  Google Scholar 

  22. Wiedemayer H, Sandalcioglu IE, Armbruster W et al (2004) False negative findings in intraoperative SEP monitoring: analysis of 658 consecutive neurosurgical cases and review of published reports. J Neurol Neurosurg Psychiatry 75:280–286

    PubMed  CAS  Google Scholar 

  23. Florence G, Guerit JM, Gueguen B (2004) Electroencephalography (EEG) and somatosensory evoked potentials (SEP) to prevent cerebral ischaemia in the operating room. Neurophysiol Clin 34:17–32

    Article  PubMed  Google Scholar 

  24. Nuwer MR (1993) Intraoperative electroencephalography. J Clin Neurophysiol 10:437–444

    Article  PubMed  CAS  Google Scholar 

  25. Kearse LA, Martin D, McPeck K et al (1993) Computer-derived spectral array in detection of mild analog electroencephalographic ischemic pattern changes during carotid endarterectomy. J Nuerosurg 78:884–890

    Google Scholar 

  26. Rampil IJ, Correll JW, Rosenbaum SH et al (1983) Computerized electroencephalogram monitoring and carotid artery shunting. Neurosurgery 13:276–279

    Article  PubMed  CAS  Google Scholar 

  27. Minicucci C, Cursi M, Fornara C et al (2000) Computer-assisted EEG monitoring during carotid endarterectomy. J Clin Neurophysiol 17:101–107

    Article  PubMed  CAS  Google Scholar 

  28. Chiappa KH (1983) Evoked potentials in clinical medicine. New York

    Google Scholar 

  29. Halliday HL (1983) Evoked potentials in clinical testing. Edinburgh, Churchill Livingstone

    Google Scholar 

  30. Grundy BL (1985) Intraoperative application of evoked responses. In: Owen JH, Davis H (eds) Evoked potential testing: clinical applications. Orlando, Grune & Stratton, pp 159–212

    Google Scholar 

  31. Liu EH, Wong HK, Chia CP et al (2005) Effects of isoflurane and propofol on cortical somatosensory evoked potentials during comparable depth of anaesthesia as guided by bispectral index. Br J Anaesth 94:193–197

    Article  PubMed  CAS  Google Scholar 

  32. Prior PF (1988) EEG monitoring and evoked potentials in brain ischemia. Br J Anaesth 57:63–81

    Article  Google Scholar 

  33. Holland NR (1998) Subcortical strokes from intracranial aneurysm surgery: implications for intraoperative neuromonitoring. J Clin Neurophysiol 15:439–446

    Article  PubMed  CAS  Google Scholar 

  34. Neuloh G, Pechstein U, Cedzich C et al (2004) Monitoring of motor evoked potentials compared with somatosensory evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurosurg 100:389–399

    PubMed  Google Scholar 

  35. Romstock J, Fahlbush R, Ganslandt O et al (2002) Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somotosensory evoked potentials. J Neurol Neurosurg Psychiatry 72:221–229

    Article  PubMed  CAS  Google Scholar 

  36. Keles GE, Lundin DA, Lamborn KR et al (2004) Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg 100:369–375

    PubMed  Google Scholar 

  37. Romstock J, Strauss C, Fahlbush R (2000) Continuous electromyography monitoring of cranial nerves during cerebellopontine angle surgery. J Neurosurg 93:586–593

    PubMed  CAS  Google Scholar 

  38. Macmillan CS, Andrews PJ (2000) Cerebrovenous oxygen saturation monitoring: practical considerations and clinical relevance. Intensive Care Med 26:1028–1036

    Article  PubMed  CAS  Google Scholar 

  39. Matta BF, Lam AM, Mayberg TS et al (1994) The influence of arterial oxygenation on cerebral venous oxygen saturation during hyperventilation. Can J Anaesth 41:1041–1046

    Article  PubMed  CAS  Google Scholar 

  40. De Deyne C, Van Aken J, Decruyenaere J et al (1998) Jugular bulb oximetry: review on a cerebral monitoring technique. Acta Anaesthesiol Belg 49:21–31

    PubMed  Google Scholar 

  41. Calderon-Arnulphi M, Alaraj A, Amin-Hanjani S et al (2007) Detection of cerebral ischemia in neurovascular surgery using quantitative frequency-domain near-infrared spectroscopy. J Neurosurg 106:283–290

    Article  PubMed  CAS  Google Scholar 

  42. Gelabert-Gonzales M, Fernandez-Villa JM, Ginesta-Galan V (2002) Intra-operative monitoring of brain tissue O2 (PtiO2) during aneurysm surgery. Acta Neurochir 144:863–867

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacology and Anaesthesiology, Anaesthesia and Intensive Care Unit, University of Padua, Padua, Italy

    C. Ori, M. Munari & S. Volpin

Authors
  1. C. Ori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Munari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Volpin
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Anaesthesia and Intensive Care Head, Postgraduated School of Anaesthesia and Intensive Care, Catania University Hospital, Catania, Italy

    Antonino Gullo M.D. (Head) (Head)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag Italia

About this paper

Cite this paper

Ori, C., Munari, M., Volpin, S. (2008). Perioperative Care in Neurosurgery — Intraoperative Monitoring. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-0773-4_30

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-0773-4_30

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0772-7

  • Online ISBN: 978-88-470-0773-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation