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Postoperative Care of Neurosurgical Patients

  • Neuroanesthesia (M Smith, Section Editor)
  • Published:
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Abstract

Anaesthesiologists should be aware of the potential complications that can arise after intracranial neurosurgery so that they can anticipate and manage them appropriately, and also identify those patients who might benefit from postoperative admission to an intensive care unit. Complications after intracranial neurosurgery are common, occurring in almost 24 % of patients. The main issues remain major neurologic events such as postoperative intracranial bleeding and seizures. Risks factors for the development of complications have been identified, and their avoidance minimizes the risk of morbidity and mortality after elective and emergency neurosurgery. If complications do arise, timely identification and treatment are essential. Repeated clinical examination is the rule for neurological monitoring in the postoperative period. General care after intracranial procedures includes pain management, postoperative nausea and vomiting prophylaxis and thromboprophylaxis, after any surgery. Specific treatment, such as corticosteroids, antiepileptic agents and hormone replacement, may also be required in certain circumstances. Multidisciplinary care and cooperation between nurses, anaesthesiologists, intensivists and neurosurgeons are critical for the optimal postoperative management of neurosurgical patients.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. •• Rolston JD, Han SJ, Lau CY, Berger MS, Parsa AT. Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011. J Neurosurg. 2014;120:736–45. Recent Epidemiologic analysis on American database.

  2. Solheim O, Jakola AS, Gulati S, Johannesen TB. Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study. J Neurosurg. 2012;116:825–34.

    Article  PubMed  Google Scholar 

  3. Manninen PH, Raman SK, Boyle K, el-Beheiry H. Early postoperative complications following neurosurgical procedures. Can J Anaesth = J Can d’anesth. 1999;46:7–14.

    Article  PubMed  CAS  Google Scholar 

  4. Ziai WC, Varelas PN, Zeger SL, Mirski MA, Ulatowski JA. Neurologic intensive care resource use after brain tumor surgery: an analysis of indications and alternative strategies. Crit Care Med. 2003;31:2782–7.

    Article  PubMed  Google Scholar 

  5. Rhondali O, Genty C, Halle C, Gardellin M, Ollinet C, Oddoux M, Carcey J, Francony G, Fauvage B, Gay E, et al. Do patients still require admission to an intensive care unit after elective craniotomy for brain surgery? J Neurosurg Anesthesiol. 2011;23:118–23.

    Article  PubMed  Google Scholar 

  6. Bui JQ, Mendis RL, van Gelder JM, Sheridan MM, Wright KM, Jaeger M. Is postoperative intensive care unit admission a prerequisite for elective craniotomy? J Neurosurg. 2011;115:1236–41.

    Article  PubMed  Google Scholar 

  7. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology. 2000;93:48–54.

    Article  PubMed  CAS  Google Scholar 

  8. Gottschalk A, Berkow LC, Stevens RD, Mirski M, Thompson RE, White ED, Weingart JD, Long DM, Yaster M. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg. 2007;106:210–6.

    Article  PubMed  CAS  Google Scholar 

  9. Biswas BK, Bithal PK: Preincision 0.25% bupivacaine scalp infiltration and postcraniotomy pain: a randomized double-blind, placebo-controlled study. J Neurosurg Anesthesiol. 2003;15:234–39.

  10. Ayoub C, Girard F, Boudreault D, Chouinard P, Ruel M, Moumdjian R. A comparison between scalp nerve block and morphine for transitional analgesia after remifentanil-based anesthesia in neurosurgery. Anesth Analg. 2006;103:1237–40.

    Article  PubMed  CAS  Google Scholar 

  11. •• Puntis M, Garner A. Management of pain following craniotomy. Br J Nurs. 2015;24:740–44. New approaches and data of management of pain in neurosurgery with Regional analgesia.

  12. Verchere E, Grenier B, Mesli A, Siao D, Sesay M, Maurette P. Postoperative pain management after supratentorial craniotomy. J Neurosurg Anesthesiol. 2002;14:96–101.

    Article  PubMed  Google Scholar 

  13. Ferber J, Juniewicz H, Glogowska E, Wronski J, Abraszko R, Mierzwa J. Tramadol for postoperative analgesia in intracranial surgery. Its effect on ICP and CPP. Neurol Neurochir Pol. 2000;34:70–9.

    PubMed  CAS  Google Scholar 

  14. Jeffrey HM, Charlton P, Mellor DJ, Moss E, Vucevic M. Analgesia after intracranial surgery: a double-blind, prospective comparison of codeine and tramadol. Br J Anaesth. 1999;83:245–9.

    Article  PubMed  CAS  Google Scholar 

  15. Morad AH, Winters BD, Yaster M, Stevens RD, White ED, Thompson RE, Weingart JD, Gottschalk A. Efficacy of intravenous patient-controlled analgesia after supratentorial intracranial surgery: a prospective randomized controlled trial. Clinical article. J Neurosurg. 2009;111:343–50.

    Article  PubMed  Google Scholar 

  16. •• Titsworth WL, Abram J, Guin P, Herman MA, West J, Davis NW, Bushwitz J, Hurley RW, Seubert CN. A prospective time-series quality improvement trial of a standardized analgesia protocol to reduce postoperative pain among neurosurgery patients. J Neurosurg. 2016;11:1–10. Protocol for pain management and multimodal analgesia.

  17. Fabling JM, Gan TJ, El-Moalem HE, Warner DS, Borel CO. A randomized, double-blinded comparison of ondansetron, droperidol, and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy. Anesth Analg. 2000;91:358–61.

    PubMed  CAS  Google Scholar 

  18. Galicich JH, French LA, Melby JC. Use of dexamethasone in treatment of cerebral edema associated with brain tumors. Lancet. 1961;81:46–53.

    CAS  Google Scholar 

  19. Szabo GC, Winkler SR. Withdrawal of glucocorticoid therapy in neurosurgical patients. Surg Neurol. 1995;44:498.

    Article  PubMed  CAS  Google Scholar 

  20. Hockey B, Leslie K, Williams D. Dexamethasone for intracranial neurosurgery and anaesthesia. J Clin Neurosci. 2009;16:1389–93.

    Article  PubMed  CAS  Google Scholar 

  21. Glantz MJ, Cole BF, Forsyth PA, Recht LD, Wen PY, Chamberlain MC, Grossman SA, Cairncross JG. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;54:1886–93.

    Article  PubMed  CAS  Google Scholar 

  22. Komotar RJ, Raper DM, Starke RM, Iorgulescu JB, Gutin PH. Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection: a systematic analysis of efficacy. J Neurosurg. 2011;115:483–90.

    Article  PubMed  Google Scholar 

  23. Fuller KL, Wang YY, Cook MJ, Murphy MA, D’Souza WJ. Tolerability, safety, and side effects of levetiracetam versus phenytoin in intravenous and total prophylactic regimen among craniotomy patients: a prospective randomized study. Epilepsia. 2013;54:45–57.

    Article  PubMed  CAS  Google Scholar 

  24. •• Pulman J, Greenhalgh J, Marson AG. Antiepileptic drugs as prophylaxis for post-craniotomy seizures. Cochrane Database Syst Rev. 2013;2:CD007286. Review and meta-analysis for the interest of antiepileptic prophylaxis treatment.

  25. Suri A, Mahapatra AK, Bithal P. Seizures following posterior fossa surgery. Br J Neurosurg. 1998;12:41–4.

    Article  PubMed  CAS  Google Scholar 

  26. Siomin V, Angelov L, Li L, Vogelbaum MA. Results of a survey of neurosurgical practice patterns regarding the prophylactic use of anti-epilepsy drugs in patients with brain tumors. J Neurooncol. 2005;74:211–5.

    Article  PubMed  CAS  Google Scholar 

  27. Temkin NR. Antiepileptogenesis and seizure prevention trials with antiepileptic drugs: meta-analysis of controlled trials. Epilepsia. 2001;42:515–24.

    Article  PubMed  CAS  Google Scholar 

  28. •• Cote LP, Greenberg S, Caprini JA, Stone J, Arcelus JI, Lopez-Jimenez L, Rosa V, Schellong S, Monreal M, Investigators R. Outcomes in neurosurgical patients who develop venous thromboembolism: a review of the RIETE registry. Clin Appl Thromb Hemost.2014;20:772–78. Review and meta-analysis of thromboembolic events.

    Article  Google Scholar 

  29. Iorio A, Agnelli G. Low-molecular-weight and unfractionated heparin for prevention of venous thromboembolism in neurosurgery: a meta-analysis. Arch Intern Med. 2000;160:2327–32.

    Article  PubMed  CAS  Google Scholar 

  30. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e227S–77S.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. •• Salmaggi A, Simonetti G, Trevisan E, Beecher D, Carapella CM, DiMeco F, Conti L, Pace A, Filippini G. Perioperative thromboprophylaxis in patients with craniotomy for brain tumours: a systematic review. J Neurooncol. 2013;113:293–03. Recent data of thromboembolic events for brain tumours neurosurgery.

    Article  PubMed  CAS  Google Scholar 

  32. Korinek AM, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L: Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 2006, 59:126–33; discussion 126–33.

    Article  PubMed  Google Scholar 

  33. Barker FG, 2nd: Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery 2007, 60:887–894; discussion 887–94.

    Article  PubMed  Google Scholar 

  34. •• Lin N, Han R, Zhou J, Gelb AW. Mild sedation exacerbates or unmasks focal neurologic dysfunction in neurosurgical patients with supratentorial brain mass lesions in a drug-specific manner. Anesthesiology. 2016;124:598–607. Interest of low sedation and optimal anesthesia for neurosurgical patient and clinical monitoring for postoperative neurological dyfunction.

    Article  PubMed  CAS  Google Scholar 

  35. Thal GD, Szabo MD, Lopez-Bresnahan M, Crosby G: Exacerbation or unmasking of focal neurologic deficits by sedatives. Anesthesiology 1996, 85:21–25; discussion 29A–30A.

    Article  PubMed  CAS  Google Scholar 

  36. Lazar RM, Fitzsimmons BF, Marshall RS, Berman MF, Bustillo MA, Young WL, Mohr JP, Shah J, Robinson JV. Reemergence of stroke deficits with midazolam challenge. Stroke. 2002;33:283–5.

    Article  PubMed  CAS  Google Scholar 

  37. Bealer SL, Little JG, Metcalf CS, Brewster AL, Anderson AE. Autonomic and cellular mechanisms mediating detrimental cardiac effects of status epilepticus. Epilepsy Res. 2010;91:66–73.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Frontera JA, Parra A, Shimbo D, Fernandez A, Schmidt JM, Peter P, Claassen J, Wartenberg KE, Rincon F, Badjatia N, et al. Cardiac arrhythmias after subarachnoid hemorrhage: risk factors and impact on outcome. Cerebrovasc Dis. 2008;26:71–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Grenier B, Verchere E, Mesli A, Dubreuil M, Siao D, Vandendriessche M, Cales J, Maurette P. Capnography monitoring during neurosurgery: reliability in relation to various intraoperative positions. Anesth Analg. 1999;88:43–8.

    PubMed  CAS  Google Scholar 

  40. Constantini S, Cotev S, Rappaport Z, Pomeranz S, Shalit M. Intracranial pressure monitoring after elective intracranial surgery. A retrospective study of 514 consecutive patients. J Neurosurg. 1988;69:540–4.

    Article  PubMed  CAS  Google Scholar 

  41. Cardim D, Robba C, Bohdanowicz M, Donnelly J, Cabella B, Liu X, Cabeleira M, Smielewski P, Schmidt B, Czosnyka M: Non-invasive Monitoring of Intracranial Pressure Using Transcranial Doppler Ultrasonography: Is It Possible? Neurocrit Care 2016.

  42. Bejjani GK, Sekhar LN, Yost AM, Bank WO, Wright DC: Vasospasm after cranial base tumor resection: pathogenesis, diagnosis, and therapy. Surg Neurol 1999, 52:577–83; discussion 583–574.

    Article  PubMed  CAS  Google Scholar 

  43. Rovlias A, Kotsou S: The influence of hyperglycemia on neurological outcome in patients with severe head injury. Neurosurgery 2000, 46:335–42; discussion 342–333.

    Article  PubMed  CAS  Google Scholar 

  44. McGirt MJ, Woodworth GF, Ali M, Than KD, Tamargo RJ, Clatterbuck RE. Persistent perioperative hyperglycemia as an independent predictor of poor outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2007;107:1080–5.

    Article  PubMed  CAS  Google Scholar 

  45. Ahmed N, Davalos A, Eriksson N, Ford GA, Glahn J, Hennerici M, Mikulik R, Kaste M, Lees KR, Lindsberg PJ, et al. Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR). Arch Neurol. 2010;67:1123–30.

    Article  PubMed  Google Scholar 

  46. Bilotta F, Caramia R, Paoloni FP, Delfini R, Rosa G. Safety and efficacy of intensive insulin therapy in critical neurosurgical patients. Anesthesiology. 2009;110:611–9.

    Article  PubMed  CAS  Google Scholar 

  47. Rosso C, Corvol JC, Pires C, Crozier S, Attal Y, Jacqueminet S, Deltour S, Multlu G, Leger A, Meresse I, et al. Intensive versus subcutaneous insulin in patients with hyperacute stroke: results from the randomized INSULINFARCT trial. Stroke. 2012;43:2343–9.

    Article  PubMed  Google Scholar 

  48. Oddo M, Schmidt JM, Carrera E, Badjatia N, Connolly ES, Presciutti M, Ostapkovich ND, Levine JM, Le Roux P, Mayer SA. Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study. Crit Care Med. 2008;36:3233–8.

    Article  PubMed  CAS  Google Scholar 

  49. Vespa P, McArthur DL, Stein N, Huang SC, Shao W, Filippou M, Etchepare M, Glenn T, Hovda DA. Tight glycemic control increases metabolic distress in traumatic brain injury: a randomized controlled within-subjects trial. Crit Care Med. 2012;40:1923–9.

    Article  PubMed  CAS  Google Scholar 

  50. Oppenheimer S. Cerebrogenic cardiac arrhythmias: cortical lateralization and clinical significance. Clin Auton Res. 2006;16:6–11.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Soros P, Hachinski V. Cardiovascular and neurological causes of sudden death after ischaemic stroke. Lancet Neurol. 2012;11:179–88.

    Article  PubMed  Google Scholar 

  52. Samuels MA. The brain-heart connection. Circulation. 2007;116:77–84.

    Article  PubMed  Google Scholar 

  53. Kim DH, Haney CL, Van Ginhoven G. Reduction of pulmonary edema after SAH with a pulmonary artery catheter-guided hemodynamic management protocol. Neurocrit Care. 2005;3:11–5.

    Article  PubMed  Google Scholar 

  54. Mutoh T, Kazumata K, Ajiki M, Ushikoshi S, Terasaka S. Goal-directed fluid management by bedside transpulmonary hemodynamic monitoring after subarachnoid hemorrhage. Stroke. 2007;38:3218–24.

    Article  PubMed  Google Scholar 

  55. Bruder N, Stordeur JM, Ravussin P, Valli M, Dufour H, Bruguerolle B, Francois G. Metabolic and hemodynamic changes during recovery and tracheal extubation in neurosurgical patients: immediate versus delayed recovery. Anesth Analg. 1999;89:674–8.

    Article  PubMed  CAS  Google Scholar 

  56. Wong AY, O’Regan AM, Irwin MG. Total intravenous anaesthesia with propofol and remifentanil for elective neurosurgical procedures: an audit of early postoperative complications. Eur J Anaesthesiol. 2006;23:586–90.

    Article  PubMed  CAS  Google Scholar 

  57. Giraldo EA, Fugate JE, Rabinstein AA, Lanzino G, Wijdicks EF. Posterior reversible encephalopathy syndrome associated with hemodynamic augmentation in aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2011;14:427–32.

    Article  PubMed  Google Scholar 

  58. Arima H, Anderson CS, Wang JG, Huang Y, Heeley E, Neal B, Woodward M, Skulina C, Parsons MW, Peng B, et al. Lower Treatment Blood Pressure Is Associated With Greatest Reduction in Hematoma Growth After Acute Intracerebral Hemorrhage. Hypertension. 2010;56:852–8.

    Article  PubMed  CAS  Google Scholar 

  59. Grillo P, Bruder N, Auquier P, Pellissier D, Gouin F: Esmolol blunts the cerebral blood flow velocity increase during emergence from anesthesia in neurosurgical patients. Anesth Analg 2003, 96:1145–49, table of contents.

  60. Heuer GG, Smith MJ, Elliott JP, Winn HR, LeRoux PD. Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2004;101:408–16.

    Article  PubMed  Google Scholar 

  61. Fukamachi A, Koizumi H, Nukui H. Postoperative intracerebral hemorrhages: a survey of computed tomographic findings after 1074 intracranial operations. Surg Neurol. 1985;23:575–80.

    Article  PubMed  CAS  Google Scholar 

  62. Kalfas IH, Little JR. Postoperative hemorrhage: a survey of 4992 intracranial procedures. Neurosurgery. 1988;23:343–7.

    Article  PubMed  CAS  Google Scholar 

  63. Lassen B, Helseth E, Ronning P, Scheie D, Johannesen TB, Maehlen J, Langmoen IA, Meling TR: Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 2011, 68:1259–68; discussion 1268–1259.

    Article  PubMed  Google Scholar 

  64. Palmer JD, Sparrow OC, Iannotti F: Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 1994, 35:1061–64; discussion 1064–1065.

    Article  PubMed  CAS  Google Scholar 

  65. Taylor WA, Thomas NW, Wellings JA, Bell BA. Timing of postoperative intracranial hematoma development and implications for the best use of neurosurgical intensive care. J Neurosurg. 1995;82:48–50.

    Article  PubMed  CAS  Google Scholar 

  66. Seifman MA, Lewis PM, Rosenfeld JV, Hwang PY. Postoperative intracranial haemorrhage: a review. Neurosurg Rev. 2011;34:393–07.

    Article  PubMed  Google Scholar 

  67. Bruder N, Pellissier D, Grillot P, Gouin F. Cerebral hyperemia during recovery from general anesthesia in neurosurgical patients. Anesth Analg. 2002;94:650–4.

    Article  PubMed  Google Scholar 

  68. Friedman JA, Piepgras DG, Duke DA, McClelland RL, Bechtle PS, Maher CO, Morita A, Perkins WJ, Parisi JE, Brown RD Jr. Remote cerebellar hemorrhage after supratentorial surgery. Neurosurgery. 2001;49:1327–40.

    Article  PubMed  CAS  Google Scholar 

  69. Marquardt G, Setzer M, Schick U, Seifert V: Cerebellar hemorrhage after supratentorial craniotomy. Surg Neurol 2002, 57:241–51; discussion 251–242.

    Article  PubMed  Google Scholar 

  70. Korinek AM: Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidemiologie Hygiene et Prevention. Neurosurgery 1997, 41:1073–79; discussion 1079–1081.

    Article  PubMed  CAS  Google Scholar 

  71. Dashti SR, Baharvahdat H, Spetzler RF, Sauvageau E, Chang SW, Stiefel MF, Park MS, Bambakidis NC. Operative intracranial infection following craniotomy. Neurosurg Focus. 2008;24:E10.

    Article  PubMed  Google Scholar 

  72. Lietard C, Thebaud V, Besson G, Lejeune B. Risk factors for neurosurgical site infections: an 18-month prospective survey. J Neurosurg. 2008;109:729–34.

    Article  PubMed  Google Scholar 

  73. Korinek AM, Golmard JL, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L. Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg. 2005;19:155–62.

    Article  PubMed  Google Scholar 

  74. Altemeier W: Review of postoperative wound infections. In Control of operative room airborne bacteria; Washington, DC: The national research council: 1974:11–27.

  75. Schade RP, Schinkel J, Roelandse FW, Geskus RB, Visser LG, van Dijk JM, Voormolen JH, Van Pelt H, Kuijper EJ. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg. 2006;104:101–8.

    Article  PubMed  Google Scholar 

  76. Viola GM. Extreme hypoglycorrhachia: not always bacterial meningitis. Nat Rev Neurol. 2010;6:637–41.

    Article  PubMed  Google Scholar 

  77. Viallon A, Desseigne N, Marjollet O, Birynczyk A, Belin M, Guyomarch S, Borg J, Pozetto B, Bertrand JC, Zeni F. Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis. Crit Care. 2011;15:R136.

    Article  PubMed  PubMed Central  Google Scholar 

  78. North JB, Penhall RK, Hanieh A, Hann CS, Challen RG, Frewin DB. Postoperative epilepsy: a double-blind trial of phenytoin after craniotomy. Lancet. 1980;1:384–6.

    Article  PubMed  CAS  Google Scholar 

  79. Shaw MD, Foy PM. Epilepsy after craniotomy and the place of prophylactic anticonvulsant drugs: discussion paper. J R Soc Med. 1991;84:221–3.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  80. van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol. 2007;6:421–30.

    Article  PubMed  Google Scholar 

  81. Tellez-Zenteno JF, Dhar R, Hernandez-Ronquillo L, Wiebe S. Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects. Brain: a journal of neurology. 2007;130:334–45.

    Article  Google Scholar 

  82. Toung TJ, McPherson RW, Ahn H, Donham RT, Alano J, Long D. Pneumocephalus: effects of patient position on the incidence and location of aerocele after posterior fossa and upper cervical cord surgery. Anesth Analg. 1986;65:65–70.

    Article  PubMed  CAS  Google Scholar 

  83. Di Lorenzo N, Caruso R, Floris R, Guerrisi V, Bozzao L, Fortuna A. Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: a prospective study. Acta Neurochir. 1986;83:112–5.

    Article  PubMed  Google Scholar 

  84. Schirmer CM, Heilman CB, Bhardwaj A. Pneumocephalus: case illustrations and review. Neurocrit Care. 2010;13:152–8.

    Article  PubMed  Google Scholar 

  85. Ishiwata Y, Fujitsu K, Sekino T, Fujino H, Kubokura T, Tsubone K, Kuwabara T. Subdural tension pneumocephalus following surgery for chronic subdural hematoma. J Neurosurg. 1988;68:58–61.

    Article  PubMed  CAS  Google Scholar 

  86. Palmer BF. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends in endocrinology and metabolism: TEM. 2003;14:182–7.

    Article  PubMed  CAS  Google Scholar 

  87. Audibert G, Steinmann G, de Talance N, Laurens MH, Dao P, Baumann A, Longrois D, Mertes PM. Endocrine response after severe subarachnoid hemorrhage related to sodium and blood volume regulation. Anesth Analg. 2009;108:1922–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France

    Lionel Velly, Pierre Simeone & Nicolas Bruder

  2. Institut de Neurosciences de la Timone UMR 7289, Aix Marseille Université,CNRS, 13385, Marseille, France

    Lionel Velly

  3. Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire Timone, 264 rue saint Pierre, 13005 CEDEX 5, Marseille, France

    Lionel Velly

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  1. Lionel Velly
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Velly, L., Simeone, P. & Bruder, N. Postoperative Care of Neurosurgical Patients. Curr Anesthesiol Rep 6, 257–266 (2016). https://doi.org/10.1007/s40140-016-0175-4

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