Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2003
Case ReportsCarotid artery injury during transsphenoidal resection of pituitary tumor: anesthesia perspective.
The authors describe two patients who suffered carotid artery injury during transsphenoidal resection of a pituitary tumor. Anesthesiologists were involved in resuscitation after initial hemorrhage, in securing the airway, in initiating cerebral protection strategies, and in transporting these patients. Anesthesia was provided for resection of the tumors, removal of packs from the pituitary fossae, and diagnostic and therapeutic radiologic procedures. ⋯ It was treated by trapping the internal carotid artery. The other patient developed a carotid-cavernous fistula, which was treated by balloon embolization. Both patients were discharged after dealing with these complications.
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J Neurosurg Anesthesiol · Oct 2003
Clinical TrialTreatment of refractory fever in the neurosciences critical care unit using a novel, water-circulating cooling device. A single-center pilot experience.
Fever after acute brain injury affects neuronal function and recovery. Standard therapies have proven to be inadequate in treating hyperthermia in this patient population. We report on safety/efficacy pilot data collected using a noninvasive, novel, water-circulating cooling device in febrile acute brain injury patients. ⋯ Core temperature remained "locked" during the remainder of the treatment (36.6 degrees C, P=0.5; 36.6 degrees C, P=0.9; and 36.5 degrees C, P=0.9 at 180, 300, and 600 minutes, respectively). Skin integrity under the pads was preserved in all study subjects. Our results indicate that use of this novel technique is safe, rapidly effective, and able to maintain sustained normothermia following fever in a cohort of critically ill neurologic/neurosurgical patients.
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J Neurosurg Anesthesiol · Oct 2003
Case ReportsUnilateral visual loss after cervical spine surgery.
This is a case report of a patient who underwent an uneventful surgery for atlanto-axial dislocation in the prone position, after which he developed painless, unilateral loss of vision in the immediate postoperative period. Based on the ophthalmologic findings a probable diagnosis of ischemic optic neuropathy (ION) was made. Although he recovered his visual acuity completely in 1 month, the visual field defects and color vision abnormalities persisted. ⋯ However, this healthy young man had an uneventful surgery with no such intraoperative complications. ION in this patient could have been due to a combination of factors, such as a malpositioned horseshoe headrest and surgery performed in the prone position, both of which have the potential to raise the intraocular pressure and lower the perfusion pressure of the optic nerve/nerve head. Variations in the blood supply of the optic nerve due to the presence of watershed zones could be another explanation for this dreaded complication.
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J Neurosurg Anesthesiol · Oct 2003
Case ReportsUse of activated recombinant Factor VII (NovoSeven) during neurosurgery.
Diffuse bleeding during neurosurgical operations is a major complication that can be difficult to control. In extreme circumstances, it may be necessary to clamp cerebral blood vessels or resect additional tissue. Both of these procedures can result in brain damage and, ultimately, in disability for the patient. ⋯ All three patients recovered with no further bleeding. In our initial experience, rFVIIa appears to be efficacious for terminating bleeding during neurosurgical procedures. The use of rFVIIa made it unnecessary to resort to procedures carrying a risk of long-term sequelae.