Neurosurgical anesthesia

Neurosurgical anesthesiology is a subspecialty of anesthesiology devoted to the anesthetic management of people with disease of the central nervous system (CNS) including the brain and the spine. The field has undergone extensive development since the late 1960s and early 1970s correlating with the ability to measure intracranial pressure (ICP), cerebral blood flow (CBF), and cerebral metabolic rate (CMR).[1]

Practice

Neurosurgical anesthesiologists specialize in the care of patients with diverse conditions including but not limited to aneurysms, arteriovenous malformations, intracranial tumors, head injuries, stereotactic procedures, neuroradiological procedures, pediatric neurosurgery and spine surgery.

Pediatric Deep Brain Stimulation

In addition to standard anesthesthetic management of patients undergoing surgery, neurosurgical procedures require the anesthesiologist to have a strong knowledge base of neuroanatomy, neurophysiology, and understand advanced monitoring techniques including neuromonitoring of the brain and spinal cord. It is impossible to routinely "monitor" the effects of drugs on CBF (cerebral blood flow), CMR, or ICP (intra-cranial pressure) as there is no neuroanesthetic equivalent of the pulmonary artery catheter or the transesophageal echocardiograph that permits a wide range of cerebral physiologic and pharmacologic effects to be followed easily.[2]

Tumor removal from posterior fossa

Training

After satisfactory completion of Accreditation Council for Graduate Medical Education (ACGME) accredited residency program in anesthesiology formal advanced training in Neurosurgical Anesthesia is available as a 1 or 2 -year fellowship integrating research, teaching and clinical experience. Although fellowships differ slightly at various institutions, they generally involve the fellow in participating in 12-24 months of research (either clinical or basic sciences), participation in advanced cases in the neurosurgical O.R.s and interventional radiology suites, and develop experience in performance and interpretation of neuromonitoring. Neurosurgical anesthesia fellows may also rotate in neurosurgical intensive care unit and gain experience with transcranial doppler, basic EEG interpretation and Licox/Microdialysis interpretation.Some institutions also allow the fellow to participate in education and teaching efforts for neurosurgical departments in developing countries.

References
  1. David E. Longnecker, David L. Brown, Mark F. Newman, Warren M. Zapol; Anesthesiology 2008. Mcgraw-Hill
  2. Michael M. Todd, MD, David S. Warner, MD, PhD, Mazen A. Maktabi, MD, and Kamila Vagnerova, MD; Neuroanesthesia; Anesthesiology 2008. Mcgraw-Hill
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