Complications of brain stem surgery: Prevention and treatment

Abstract

With experienced neurosurgical, neuroanesthetic, and intensive care teams, postoperative recovery after brain stem surgery may be uneventful in patients without severe preoperative neurological deficits. The primary goal of postoperative intensive care is to ensure adequate monitoring and maintenance of homeostasis in an effort to prevent systemic and cerebral complications. Nevertheless, systemic complications and postoperative neurological deterioration are common. Respiratory failure, dysphagia, and pulmonary aspiration are possible life-threatening postoperative complications that may occur days or weeks after surgery. Impaired respiratory drive may result in progressive carbon dioxide retention and hypoxia, leading to respiratory arrest. Glossopharyngeal and vagal nerve dysfunction may be associated with high rates of postoperative morbidity and mortality. Damage to these nerves impairs swallowing and protective and coughing reflexes and may result in dysphagia, vocal cord paralysis, and gastric stasis. A comprehensive assessment (qualitative and quantitative) of possible swallowing deficits is important before and after extubation, particularly at early extubation trials, in an effort to prevent major postoperative complications. If a swallowing deficit is underestimated, dramatic episodes of aspiration may occur with acute respiratory failure or pulmonary edema. Continuous subclinical pulmonary inhalation predisposes the patient to sepsis and multiple organ failure. Treatment of dysphagia is complex and requires a multidisciplinary team to evaluate the most feasible therapeutic option for the patient to ensure adequate and safe separation of airways and food passages. Expert medical and nursing care consists of experienced, dedicated, and professional personnel who are aware of the strict relationship among intensive care treatment, prevention of complications, and the possibility of recovery.