Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2013
Review Meta AnalysisAwake craniotomy for brain tumor resection: the rule rather than the exception?
Awake craniotomy (AC) has seen an expanded role in brain tumor surgery over the past few decades. AC allows intraoperative cortical mapping and the continuous assessment of neurophysiological parameters, which are otherwise unattainable under general anesthesia (GA). The ability of AC to analyze eloquent brain areas makes it a powerful method for reducing the risks associated with tumor resection, especially in motor and language cortex. We present a review of the literature to examine the benefits and limits of using AC over GA. ⋯ Given the effectiveness of AC for resection of eloquent tumors, the data suggests an expanded role for AC in brain tumor surgery regardless of tumor location.
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J Neurosurg Anesthesiol · Jul 2013
ReviewSupratentorial intracerebral hemorrhage: a review of the underlying pathophysiology and its relevance for multimodality neuromonitoring in neurointensive care.
Supratentorial intracerebral hemorrhage (ICH) is a devastating condition with high morbidity and mortality. There are currently no proven pharmacological therapies for ICH, and the role of surgery is controversial. In the neurointensive care setting, management currently focuses on optimization of systemic physiology to offer neuroprotection by maintenance of adequate cerebral perfusion and substrate delivery, using targets derived principally from traumatic brain injury. ⋯ Here, we review the developments in neuromonitoring and their application to ICH, highlighting the importance of multimodality neuromonitoring to comprehensively assess cerebral perfusion, oxygenation, and metabolic status as well as offer an extended window for the prevention, early detection, and treatment of secondary neuronal injury and complications such as hematoma expansion. Technical advances will likely lead to the development of noninvasive monitors that deliver continuous measurement of cerebral hemodynamics, oxygenation, and metabolism over multiple regions of interest simultaneously. A key future priority will be to provide high-quality robust evidence that multimodality monitoring-guided treatment can lead to improved outcome.