Craniotomy for decompression of cranial nerves - Revision history

Chris.Rishel: Expanded on intraop management and potential neuromonitoring

2022-08-29T16:39:06Z

Expanded on intraop management and potential neuromonitoring

← Older revision		Revision as of 09:39, 29 August 2022
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	'''~~Microvascular~~ decompression''' is a surgical procedure used to relieve abnormal pressure on a cranial nerve from an artery or vein, which can alleviate symptoms of several cranial nerve disorders.		A '''craniotomy for decompression''' '''of cranial nerves''' is a surgical procedure used to relieve abnormal pressure on a cranial nerve from an artery or vein, which can alleviate symptoms of several cranial nerve disorders.

	== Overview ==		== Overview ==
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	* Noninvasive blood pressure monitoring is typically sufficient<ref>{{Cite journal\|last=Xu\|first=Risheng\|last2=Nair\|first2=Sumil K.\|last3=Materi\|first3=Josh\|last4=Raj\|first4=Divyaansh\|last5=Medikonda\|first5=Ravi\|last6=Shah\|first6=Pavan P.\|last7=Kannapadi\|first7=Nivedha V.\|last8=Wang\|first8=Andrew\|last9=Mintz\|first9=David\|last10=Gottschalk\|first10=Allan\|last11=Antonik\|first11=Laurie J.\|date=2022-05-01\|title=Case Series in the Utility of Invasive Blood Pressure Monitoring in Microvascular Decompression\|url=https://pubmed.ncbi.nlm.nih.gov/35315836/\|journal=Operative Neurosurgery (Hagerstown, Md.)\|volume=22\|issue=5\|pages=262–268\|doi=10.1227/ons.0000000000000130\|issn=2332-4260\|pmid=35315836}}</ref>		* Noninvasive blood pressure monitoring is typically sufficient<ref>{{Cite journal\|last=Xu\|first=Risheng\|last2=Nair\|first2=Sumil K.\|last3=Materi\|first3=Josh\|last4=Raj\|first4=Divyaansh\|last5=Medikonda\|first5=Ravi\|last6=Shah\|first6=Pavan P.\|last7=Kannapadi\|first7=Nivedha V.\|last8=Wang\|first8=Andrew\|last9=Mintz\|first9=David\|last10=Gottschalk\|first10=Allan\|last11=Antonik\|first11=Laurie J.\|date=2022-05-01\|title=Case Series in the Utility of Invasive Blood Pressure Monitoring in Microvascular Decompression\|url=https://pubmed.ncbi.nlm.nih.gov/35315836/\|journal=Operative Neurosurgery (Hagerstown, Md.)\|volume=22\|issue=5\|pages=262–268\|doi=10.1227/ons.0000000000000130\|issn=2332-4260\|pmid=35315836}}</ref>
			*Intraoperative neuromonitoring may be used

	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

	* Oxygen mask may exacerbate neuralgia symptoms		* Oxygen mask may exacerbate neuralgia symptoms
			*For glossopharyngeal neuralgia, if neuromonitoring, will require a neuromonitoring endotracheal tube
			**Consider video laryngoscopy to ensure correct electrode placement across vocal cords

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
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	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

			* Consider hyperventilation and/or mannitol to reduce intracranial volume to improve surgical conditions

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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	=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

			* Resume home regimen of neuropathic agents

	=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

	== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==		* Nerve injury
			* Vascular injury/hemorrhage
	~~{\| class="wikitable wikitable-horizontal-scroll"~~
	\|+
	!
	~~!Variant 1~~
	~~!Variant 2~~
	\|-
	~~\|Unique considerations~~
	\|
	\|
	\|-
	~~\|Position~~
	\|
	\|
	\|-
	~~\|Surgical time~~
	\|
	\|
	\|-
	~~\|EBL~~
	\|
	\|
	\|-
	~~\|Postoperative disposition~~
	\|
	\|
	\|-
	~~\|Pain management~~
	\|
	\|
	\|-
	~~\|Potential complications~~
	\|
	\|
	\|}

	== References ==		== References ==

Chris.Rishel: Chris.Rishel moved page Microvascular decompression to Craniotomy for decompression of cranial nerves

2022-08-29T16:32:25Z

Chris.Rishel moved page Microvascular decompression to Craniotomy for decompression of cranial nerves

← Older revision	Revision as of 09:32, 29 August 2022
(No difference)

Chris.Rishel: Added categories

2022-08-15T02:57:51Z

Added categories

← Older revision		Revision as of 19:57, 14 August 2022
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	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			<references />
			[[Category:Neurosurgery]]
			[[Category:Intracranial neurosurgery]]

Chris.Rishel: Started article

2022-08-15T02:56:43Z

Started article

New page

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = PIV
± Arterial line
| monitors = Standard
5-lead ECG
Temperature
± ABP
| considerations_preoperative = Cranial nerve exam
Oxygen mask may exacerbate symptoms
| considerations_intraoperative =
| considerations_postoperative =
}}

'''Microvascular decompression''' is a surgical procedure used to relieve abnormal pressure on a cranial nerve from an artery or vein, which can alleviate symptoms of several cranial nerve disorders.

== Overview ==

=== Indications ===

* Trigeminal neuralgia
* Hemifacial spasm
* Geniculate neuralgia
* Glossopharyngeal neuralgia

=== Surgical procedure ===
The procedure is performed through a small craniectomy behind the ear. Retractors are placed to expose the relevant nerves and vascular structures. Under microscopy, a small sponge is placed to separate the suspected blood vessel and nerve. In some circumstances, adherent veins may be cauterized or a rhizotomy may be performed. The dura is then closed and the craniectomy site is covered with a titanium plate.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Airway exam may be limited by neurologic symptoms
|-
|Neurologic
|Cranial nerve exam to identify symptoms and exacerbating factors
|}

=== Labs and studies ===

* BMP
* CBC

=== Patient preparation and premedication ===

* Consider preoperative multimodal analgesia
* Continue home regimen of neuropathic agents

== Intraoperative management ==

=== Monitoring and access ===

* Noninvasive blood pressure monitoring is typically sufficient<ref>{{Cite journal|last=Xu|first=Risheng|last2=Nair|first2=Sumil K.|last3=Materi|first3=Josh|last4=Raj|first4=Divyaansh|last5=Medikonda|first5=Ravi|last6=Shah|first6=Pavan P.|last7=Kannapadi|first7=Nivedha V.|last8=Wang|first8=Andrew|last9=Mintz|first9=David|last10=Gottschalk|first10=Allan|last11=Antonik|first11=Laurie J.|date=2022-05-01|title=Case Series in the Utility of Invasive Blood Pressure Monitoring in Microvascular Decompression|url=https://pubmed.ncbi.nlm.nih.gov/35315836/|journal=Operative Neurosurgery (Hagerstown, Md.)|volume=22|issue=5|pages=262–268|doi=10.1227/ons.0000000000000130|issn=2332-4260|pmid=35315836}}</ref>

=== Induction and airway management ===

* Oxygen mask may exacerbate neuralgia symptoms

=== Positioning ===

* Pinned frame

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

* Typically PACU

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]