Understanding Basic Techniques and Procedures in Interventional Neuroradiology

Abstract

Interventional neuroradiology represents a large and growing subset of neurosurgical practice. While the technical aspects of the procedures differ greatly from open neurosurgery, the principles of neuroanesthesia are the same. However, since the signs of complication such as hemorrhage or wire perforation are not directly visualized, the operator relies heavily on astute anesthesiology colleagues to identify even subtle changes in a patient’s monitored hemodynamic state at critical moments. The environment of the neuroangiography suite presents unique challenges in the arrangement of equipment, integration of the anesthesiology team, and safety. The fluoroscopic equipment is exquisitely sensitive to patient movement, which can severely hamper the ability of the operator to gain sufficiently detailed angiographic images to provide desired and safe patient care. As such, discussion among all team members about the plan for sedation and possible neuromuscular blockade should precede the induction of anesthesia. All team members should be cognizant of the dangers of radiation exposure and minimize these through the use of lead aprons, glasses, and shielding equipment.