Basics of Neurosurgical Techniques and Procedures

Abstract

Neurosurgical procedures require collaborative effort between surgical, anesthesiology, and nursing teams. Positioning is critical and approaches are generally designed to minimize retraction and manipulation of surrounding tissue and to provide the shortest distance possible from the surgeon’s hands to the surgical target. Positioning is also used to minimize blood loss (with the head or back above the level of the patient’s heart) which requires that the surgeon and anesthesiologist balance benefits of a dry surgical field with the risk of creating a situation that may increase the patient’s risk of venous air embolus. Positioning of the patient’s head is determined by the anatomic location of the lesion and the approach and exposure selected by the neurosurgeon. Similarly, approaches to the spine are dependent on the target of interest and are typically posterior, anterior, lateral, or some combination of the three. The specifics of the procedure drive decisions about positioning, mode of intubation, agents used by the anesthesiology team, as well as the need for supplementary monitoring techniques.