17 - Anaesthesia for neurosurgery without craniotomy

Summary

This chapter explains anaesthetic procedures for selected neurosurgeries without craniotomy. It discusses neurosurgeries that include the transsphenoidal pituitary surgery, ventriculoperitoneal shunts and allied procedures, third ventriculostomy, stereotactic neurosurgery, functional neurosurgery, and deep brain stimulation (DBS). In contrast to most neuro anaesthetic procedures, the anaesthetist can be required to increase intracranial pressure (ICP) in order to facilitate exposure and surgical excision of the pituitary tumour. The chapter describes various anaesthetic techniques, including local anaesthesia with or without conscious sedation on an awake patient and methods that involve general anaesthesia, either throughout the entire procedure or temporarily as in an asleep-awake-asleep technique. The decision for general anaesthesia is best made before surgery after careful pre-operative assessment, as the presence of a stereotactic head frame can complicate airway management, and any unplanned conversion to general anaesthesia in the midst of the procedure carries significant risk.