This chapter provides some of the key neuroanatomical considerations that may impact on neuroanaesthesia and neurointensive care. There are multiple factors that require consideration when planning an operative approach. A good grasp of neuroanatomy is essential both in the operating room as well as the pre-operative stage in terms of assessing the relative likelihood of pathology causing the clinical symptoms and signs. The chapter discusses the functional significance of the cerebral and cerebellar hemispheres. The frontal lobes are the cerebral hemispheres anterior to the Rolandic fissure. The cerebral circulation is made up of two components. The anterior circulation is fed by the internal carotid arteries, while the posterior circulation derives from the vertebral arteries. Flow of cerebrospinal fluid (CSF) across the ventricular wall into the brain extracellular space is not an important mechanism under physiological conditions.

This chapter reviews the history, evolution and organization of neurointensive care units. It emphasizes the key role that neurointensive care teams play in delivering improved outcomes for patients. Neurointensive care has evolved from its original single-system focus on the central nervous system (CNS) to a multisystem speciality providing all aspects of a patient's care. Despite the widespread availability and relative simplicity of many neuromonitoring techniques, there is considerable variation in their placement and in the application of monitoring-guided therapeutic strategies. The overall goals of neurointensive care are to resuscitate and support the acutely ill patient, minimize secondary neurological injury, and prevent or treat systemic (non-neurological) complications. Protocol-guided treatment improves clinical outcome in all areas of medicine and is effective in reducing mortality and improving outcome after brain injury. Expertise in neurointensive care involves procedural skills, proficiency with standard (systemic) monitoring and management, as well as specialized neuromonitoring techniques and interventions.