From the Guidelines
Neurosurgical procedures, such as decompressive craniectomy and suboccipital craniectomy, are effective in treating conditions like cerebral and cerebellar infarctions with swelling, and should be considered in patients who deteriorate neurologically despite medical therapy 1.
Common Neurosurgical Procedures
Neurosurgical procedures encompass a range of operations that treat conditions affecting the brain, spine, and peripheral nerves. Some common procedures include:
- Craniotomy, where surgeons remove part of the skull to access the brain for tumor removal, aneurysm clipping, or hematoma evacuation
- Minimally invasive alternatives like endoscopic surgery, which use small incisions and cameras to reduce recovery time
- Spinal procedures, such as discectomy to remove herniated discs, laminectomy to relieve spinal stenosis, and spinal fusion to stabilize vertebrae using hardware like titanium screws and rods
- Deep brain stimulation, which involves implanting electrodes to manage movement disorders like Parkinson's disease
- Shunt placement, which treats hydrocephalus by diverting excess cerebrospinal fluid
- Stereotactic radiosurgery, which uses precisely targeted radiation to treat tumors and other lesions
Indications for Neurosurgical Interventions
According to recent guidelines, neurosurgical interventions, such as external ventricular drainage, should be performed in patients with severe traumatic brain injury who have persisting intracranial hypertension despite sedation and correction of secondary brain insults 1.
Treatment of Moyamoya Disease and Moyamoya Syndrome
Surgical revascularization procedures, such as direct anastomosis and indirect revascularization, are widely used for moyamoya syndrome, particularly for patients with cognitive decline or recurrent or progressive symptoms 1.
Postoperative Care
These procedures typically require general anesthesia and specialized postoperative care, including:
- Neurological monitoring
- Pain management with medications like opioids and NSAIDs
- Physical therapy for rehabilitation Recovery times vary significantly, from weeks for minimally invasive procedures to months for complex brain or spine surgeries, with outcomes depending on the condition's severity, patient health, and surgical approach. Decompressive craniectomy with dural expansion is effective in patients < 60 years of age with unilateral MCA infarctions that deteriorate neurologically within 48 hours despite medical therapy, and should be strongly considered 1.
From the Research
Common Neurosurgical Procedures
- Decompressive craniectomy (DC) is a surgical procedure that involves removing a large section of the skull to reduce intracranial pressure (ICP) in traumatic brain injury (TBI), stroke, and other pathologies with elevated ICP 2, 3.
- Craniotomy is a surgical procedure that involves removing a portion of the skull to access the brain for tumor resection, aneurysm clipping, or other neurosurgical procedures 4, 5, 6.
- Transcranial minimally invasive neurosurgery is a technique used for tumor removal, which combines a keyhole craniotomy with neuroendoscopy to avoid the disadvantages associated with a standard craniotomy 4.
- Cranioplasty is a surgical procedure that involves replacing the removed portion of the skull with a prosthetic or bone graft, often performed after decompressive craniectomy 2, 3.
Indications and Outcomes
- Decompressive craniectomy is typically performed for traumatic brain injury, stroke, and other conditions with elevated ICP, and can be effective in reducing mortality and improving outcomes 2, 3.
- Craniotomy for tumor resection is a common neurosurgical procedure, and blood transfusions are often required due to risks of anemia, ischemic brain injury, and hemorrhage 5.
- Day surgery craniotomy for unruptured cerebral aneurysms is a feasible option, but careful selection of patients and postoperative assessment for complications is necessary 6.
Surgical Techniques and Considerations
- The Kempe incision is a surgical technique used for decompressive craniectomy and craniotomy, which involves a T-shaped incision and can be a safe and effective alternative to the standard trauma flap 2.
- Minimally invasive neurosurgery techniques, such as keyhole craniotomy and neuroendoscopy, can be used to reduce the risks and complications associated with traditional craniotomy 4.
- Blood transfusions in craniotomy for tumor resection are associated with higher risks of major morbidity, mortality, longer hospital stays, and unplanned reoperations 5.