Anesthesia for minimally invasive neurosurgery

Abstract

IntroductionAdvances in imaging, computing and optics have encouraged the application of minimally invasive surgical approach to a variety of neurosurgical procedures. The advantages include accurate localization of lesions usually inaccessible to conventional surgery, less trauma to healthy brain, blood vessels and nerves, shorter operating time, reduced blood loss, and early recovery and discharge. Nevertheless minimally invasive neurosurgical (MIN) procedures still have potential intra- and post-operative complications that can cause morbidity and mortality. ObjectivesThe aim of this study was to review and analyze published literature describing experiences in the anesthetic management of the most commonly performed MIN procedures. Materials and methodsNeurosurgical and neuroanesthesia literature (1990–2013) was reviewed and description of anesthetic technique/management and perioperative morbidity/mortality was reported. We also compared the different authors’ experience with MIN procedures. ResultsThe neurosurgical literature dealing with MIN has expanded, but there are few references in relation to anesthetic management. Anesthesia goals remain the same: careful pre-operative assessment and planning, and meticulous cerebral hemodynamic control to ensure adequate cerebral perfusion pressure. The degree of postoperative care depends on local practice, patient factors and postoperative brain imaging.