From the Guidelines
Craniotomy and Deep Brain Stimulation (DBS) procedures should be approached with careful consideration of the patient's condition, with craniotomy potentially beneficial for lobar clots within 1 cm of the surface in patients with mild deficits, as suggested by the International Surgical Trial in Intracerebral Haemorrhage (STICH) 1. When considering craniotomy, it is essential to weigh the benefits and risks, particularly for patients with supratentorial intracerebral hemorrhage (ICH). The STICH trial found that surgery, including craniotomy, may be helpful in treating lobar clots within 1 cm of the surface in patients with mild deficits (GCS score 9-12) 1. However, for patients presenting in deep coma (GCS score 5-8), medical management may be more beneficial.
Key Considerations for Craniotomy
- Patients with lobar clots within 1 cm of the surface and mild deficits may benefit from craniotomy 1
- Craniotomy may not be helpful in treating most supratentorial ICH and may be harmful in patients presenting in coma 1
- Careful perioperative management is crucial to minimize complications and maximize functional outcomes
Recommendations for DBS Procedures
- Anticonvulsants should be continued at therapeutic levels during DBS procedures
- Parkinson's medications are typically held the morning of surgery to allow for accurate intraoperative neurological testing
- Local anesthesia with conscious sedation is preferred for DBS to enable patient participation during electrode placement
Postoperative Management
- Careful blood pressure management is crucial to prevent hemorrhage, maintaining systolic pressure below 140 mmHg
- Patients should be monitored for signs of increased intracranial pressure, seizures, and infection
- Early mobilization is encouraged to prevent venous thromboembolism, with mechanical prophylaxis during immobility and pharmacological prophylaxis starting 24-48 hours after confirming absence of intracranial bleeding. In contrast to the provided example answers, the most recent and highest quality study 1 does not provide specific recommendations for DBS procedures, but rather focuses on the management of supratentorial ICH. Therefore, the recommendations for DBS procedures are based on general principles of neurosurgical management.
From the Research
Considerations for Craniotomy and Deep Brain Stimulation (DBS)
- Craniotomy and DBS are surgical procedures used to treat various neurological conditions, including Parkinson's disease, chronic pain, and movement disorders 2, 3, 4, 5, 6.
- The procedures involve implanting an electrode in a specific area of the brain to stimulate nerve cells and alleviate symptoms.
Recommendations for Craniotomy and DBS
- Patients undergoing craniotomy and DBS should be carefully selected and evaluated to minimize the risk of complications 2, 3, 4.
- The use of advanced surgical equipment and techniques, such as stereotactic navigation and microelectrode recording, can improve the accuracy and safety of the procedure 2, 5.
- Anesthesiological management is critical during craniotomy and DBS, and techniques such as the asleep-awake-asleep technique or awake-awake-awake technique can be used to minimize patient discomfort and ensure optimal outcomes 5.
Potential Complications of Craniotomy and DBS
- Complications of craniotomy and DBS can include intracerebral hemorrhage, seizures, hardware-related complications, and neuropsychiatric complications 2, 3, 4.
- The risk of complications can be minimized by careful patient selection, advanced surgical techniques, and close monitoring during and after the procedure 2, 3, 4.